Chronic atrophic rhinitis (often simply atrophic rhinitis) is a chronic

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

of the

nose A nose is a sensory organ and respiratory structure in vertebrates. It consists of a nasal cavity inside the head, and an external nose on the face. The external nose houses the nostrils, or nares, a pair of tubes providing airflow through the ...

characterised by

atrophy Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), malnutrition, poor nourishment, poor circulatory system, circulation, loss of hormone, ...

nasal mucosa The nasal mucosa lines the nasal cavity. It is part of the respiratory mucosa, the mucous membrane lining the respiratory tract. The nasal mucosa is intimately adherent to the periosteum or perichondrium of the nasal conchae. It is continuous w ...

, including the

glands A gland is a Cell (biology), cell or an Organ (biology), organ in an animal's body that produces and secretes different substances that the organism needs, either into the bloodstream or into a body cavity or outer surface. A gland may also funct ...

, turbinate bones and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena. It can be described by

empty nose syndrome Empty nose syndrome (ENS) is a Syndrome, clinical syndrome in which there is a sensation of Asphyxia, suffocation despite a clear airway. This syndrome is often referred to as a form of secondary atrophic rhinitis. ENS is a potential complicatio ...

Signs and symptoms

* It is most commonly seen in females. * It is reported among patients from lower socioeconomic groups. * The nasal cavities become roomy and are filled with foul smelling crusts which are black or dark green and dry, making expiration painful and difficult. * Microorganisms are known to multiply and produce a foul smell from the nose, though the patients may not be aware of this, because the nerve endings (responsible for the perception of smell) have become atrophied. This is called merciful anosmia. * Patients usually complain of nasal obstruction despite the roomy nasal cavity, which can be caused either by the obstruction produced by the discharge in the nose, or as a result of sensory loss due to atrophy of nerves in the nose, so the patient is unaware of the air flow. In the case of the second cause, the sensation of obstruction is subjective. * Bleeding from the nose, also called epistaxis, may occur when the dried discharge (crusts) are removed. * Septal perforation and dermatitis of

nasal vestibule The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nasal c ...

can occur. The nose may show a saddle-nose deformity. * Atrophic rhinitis is also associated with similar atrophic changes in the

pharynx The pharynx (: pharynges) is the part of the throat behind the human mouth, mouth and nasal cavity, and above the esophagus and trachea (the tubes going down to the stomach and the lungs respectively). It is found in vertebrates and invertebrates ...

larynx The larynx (), commonly called the voice box, is an organ (anatomy), organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal ...

, producing symptoms pertaining to these structures. Hearing impairment can occur due to

Eustachian tube The Eustachian tube (), also called the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately long and in diameter. It ...

blockage causing

middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles (malleus, incus, and stapes), which transfer the vibrations ...

effusion.

Etiology

Causes can be remembered by the mnemonic HERNIA: *

Hereditary Heredity, also called inheritance or biological inheritance, is the passing on of traits from parents to their offspring; either through asexual reproduction or sexual reproduction, the offspring cells or organisms acquire the genetic inform ...

factors: the disease runs in families *

Endocrine The endocrine system is a messenger system in an organism comprising feedback loops of hormones that are released by internal glands directly into the circulatory system and that target and regulate distant organs. In vertebrates, the hypotha ...

imbalance: the disease tends to start at puberty and mostly involves females *

Racial Race is a categorization of humans based on shared physical or social qualities into groups generally viewed as distinct within a given society. The term came into common usage during the 16th century, when it was used to refer to groups of va ...

factors: white people are more susceptible than natives of equatorial Africa *

Nutrition Nutrition is the biochemistry, biochemical and physiology, physiological process by which an organism uses food and water to support its life. The intake of these substances provides organisms with nutrients (divided into Macronutrient, macro- ...

al deficiency: vitamins A or D, or iron *

Infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

: ''

Klebsiella pneumoniae ''Klebsiella pneumoniae'' is a Gram-negative, non-motile, encapsulated, lactose- fermenting, facultative anaerobic, rod-shaped bacterium. It appears as a mucoid lactose fermenter on MacConkey agar. Although found in the normal flora of the mo ...

'' subsp. ''ozaenae'', diphtheroids, ''

Proteus vulgaris ''Proteus vulgaris'' is a rod-shaped, nitrate-reducing, indole-positive and catalase-positive, hydrogen sulfide-producing, Gram-negative bacterium that inhabits the intestinal tracts of humans and animals. It can be found in soil, water, and ...

'', ''E. coli'', etc. *

Autoimmune In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an " autoimmune disease" ...

factors: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa.

Secondary atrophic rhinitis

Specific infections, such as

syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms depend on the stage it presents: primary, secondary, latent syphilis, latent or tertiary. The prim ...

leprosy Leprosy, also known as Hansen's disease (HD), is a Chronic condition, long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the Peripheral nervous system, nerves, respir ...

and rhinoscleroma, may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent

sinusitis Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include production of thick nasal mucus, nasal congestion, facial congestion, facial pain, facial pressure ...

radiotherapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a treatment using ionizing radiation, generally provided as part of cancer therapy to either kill or control the growth of malignant cells. It is normally delivered by a linear particle ...

of the nose, or as a complication of surgery of the turbinates. The United Kingdom

National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...

has stated that "Most cases of atrophic rhinitis in the UK occur when the turbinates are damaged or removed during surgery". Some authors refer to as Atrophic rhinitis secondary to sinus surgery as the

Unilateral atrophic rhinitis

Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side.

Pathology

* The ciliated columnar epithelium of the nasal mucosa is replaced by stratified squamous epithelium. * Atrophy of mucosa, turbinal bones and seromucinous glands tends to occur, due to obliterative endarteritis and periarteritis causing decreased blood supply, hence the supplying area atrophies. * Arrested development of paranasal sinuses.

Diagnosis

Diagnosis is based on clinical history and examination. Examination is clinical, via anterior rhinoscopy and fibreoptic, using nasendoscopy. A

CT scan A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

can be used to confirm the diagnosis and review disease extent.

Treatment

Treatment of atrophic rhinitis can be either medical or surgical. Medical measures include: * Nasal irrigation using normal saline * Nasal irrigation and removal of crusts using alkaline nasal solutions. * 25% glucose in glycerine can be applied to the nasal mucosa to inhibit the growth of proteolytic organisms which produce foul smell. * Local antibiotics, such as Chloromycetin. *

Vitamin D Vitamin D is a group of structurally related, fat-soluble compounds responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, along with numerous other biological functions. In humans, the most important compo ...

₂ . * Estradiol spray for regeneration of seromucinous glands and vascularization of mucosa. * Systemic streptomycin (1g/day) against Klebsiella organisms. * Oral

potassium iodide Potassium iodide is a chemical compound, medication, and dietary supplement. It is a medication used for treating hyperthyroidism, in radiation emergencies, and for protecting the thyroid gland when certain types of radiopharmaceuticals are u ...

for liquefaction of secretion. * Placental extract injected in the submucosa. * Rifampicin 600 mg once daily for 12 weeks. Surgical interventions include: * Young's operation. * Modified Young's operation. * Narrowing of nasal cavities, submucosal injection of Teflon paste (William's operation), section and medial displacement of the lateral wall of the nose. * Transposition of parotid duct to maxillary sinus or nasal mucosa (Wittmack's operation) * Complete inversion of mucoperiosteum of maxillary antrum to create a neo-turbinate (Raghav Sharan's operation) * Repeated Stellate ganglion block (Sardana's operation) * Vestibuloplasty

History

This disorder was known since the time of ancient Egypt, almost 4,000 years ago, and descriptions of it are found in the historical medical papyri. In the

Edwin Smith Papyrus The Edwin Smith Papyrus is an ancient Egyptian medical manual, medical text, named after Edwin Smith (Egyptologist), Edwin Smith who bought it in 1862, and the oldest known surgical treatise on trauma (medicine), trauma. This document, which ma ...

(1700 BC) it was prescribed a treatment based on wine and breast milk to cure this disease. The ancient Greek and Indian civilizations were aware of atrophic rhinitis.

References

External links

{{Respiratory pathology Inflammations Nose disorders ja:臭鼻症