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JuraNumminen

Atrophic Rhinitis and Ozaena

Atrophic rhinitis is a chronic condition affecting the nasal cavities, caused by progressing atrophy of nasal mucosa and the underlying bones.
In atrophic rhinitis, a long-term infection by Klebsiella ozaenae often occurs simultaneously on the mucosae of the nose and paranasal sinuses.
Differences in the prevalence between populations exist. In Finland, atrophic rhinits had already started vanishing, but it still occurs in immigrants.
Specialist health care is responsible for the final diagnosis and treatment planning
Conservative treatment consists of nasal irrigation as well as moisturising drops and sprays, and an adequate humidification of the room air at night.

Atrophic rhinitis may be primary and of unknown aetiology or secondary, in which case it may be the consequence of nasal surgery, trauma, granulomatous conditions or infections, or it may be caused by rhinitis medicamentosa or radiotherapy.
Atrophic rhinitis is most common among middle aged adults. It is more common in women than in men (6:1.5).
Atrophic rhinitis is becoming rare in developed countries but is still encountered in immigrant populations.
Mild atrophy of the mucosa of the nasal cavities associated with ageing is common.

Atrophy of the nasal mucosa is associated with disturbed mucus flow. As a result, viscous secretions and dry greenish scale-like crusts form in the nasal cavities.
A foul smell from the nose (ozaena) signifies an advanced state of atrophic rhinitis. Other symptoms may include epistaxis, loss of smell, cacosmia (even normal smells are perceived as foul) and nasal obstruction.
As the disease progresses the nasal cavities may become very roomy. Even in these cases, nasal obstruction usually remains the only subjective symptom.

Rhinoscopy
Bacterial culture verifies the diagnosis of ozaena; the sample will grow Klebsiella ozaenae and often also other rods.
Laboratory investigations: basic blood count with platelets, glucose, Treponema pallidum antibodies

There is no known curative treatment.
No scientific evidence from controlled randomised studies exists on the superiority of one treatment modality over another one. Treatment should therefore be chosen individually for each patient according to treatment response.
The main aims of conservative treatment are: the moistening of the mucous membranes, lubrication and the clearing of crusts.
Irrigation of the nasal cavities with a sodium chloride solution, using a purpose made nasal irrigation bottle.
Moistening nasal sprays, and the humidification of room air at night
Nasal oil sprays and drops
Note: no nasal corticosteroid sprays or other nasal decongestants to be prescribed for atrophic rhinitis, even if the patient complains of nasal obstruction!
Targeted antimicrobial treatment based on culture results is warranted if the infective symptoms worsen.

Each new patient with atrophic rhinitis should be referred to a specialist physician for the planning of conservative treatment, possible surgery and follow-up schedule.
Investigations in specialist care
- A biopsy to establish the histopathology of the condition
- Cone beam computed tomography

Regular appointments (irrigation, removal of crusts) a few times a year in primary health care depending on the symptoms and the need for treatment.

Jiang C, Shi R, Sun Y. Study of inferior turbinate reconstruction with Medpor for the treatment of empty nose syndrome. Laryngoscope 2013;123(5):1106-11. [PubMed]