Causes and risk factors
Atrophic rhinitis is characterized by atrophic changes of all parts of nose, namely mucosa, submucosa, turbinates, blood vessels, and nerves. Atrophic rhinitis can be primary or secondary. It begins at puberty. It can occur between the ages of 15-45 years. It is common in females. The condition can be hereditary. There is thinning of nasal membrane. Primary causes include lack of nutrition, vitamin deficiency, autonomic imbalance, infection by organisms like Klebsiella. Exanthemata in childhood may cause atrophic rhinitis later. People having a broad nose can be at risk of getting atrophic rhinitis. Due to wide spacing, there is drying of mucus membrane of nose. It is also common in patients with deviated nasal septum. Secondary causes include chronic specific infections like syphilis, leprosy, lupus vulgaris, TB, initial stages of rhinoscleroma may produce atrophic changes in the nose. Extensive surgery of nose may lead to the condition. It may be secondary to chronic sinusitis.
Clinical presentation
Atrophic rhinitis is characterized by the triad of fetor, crusting and atrophy. Patients present with ozena, i.e., foul smell from the nose which is experienced by others; however, patient complains of a loss of smell [anosmia]. There is dryness of nose. Foul smelling crusts develop in the nose. Mild epistaxis may occur. Nasal obstruction occurs and the patient complains that he/she can’t experience air flowing through the nose. The bridge of the nose is depressed due to atrophy of nasal septum. Mucosa is pale and atrophic and covered with greyish green, foul smelling crusts. Turbinates are atrophied. Sometimes there is perforation of nasal septum.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. X-ray of paranasal sinuses is done. Routine hemogram is advised. Chest x-ray and sputum examination is done for diagnosis of TB. Nasal smear for leprosy and tubercle bacilli is obtained.
Treatment
Treatment depends upon the underlying cause. If there is any primary cause, it should be treated accordingly. Conservative treatment includes use of nasal drops, alkaline nasal douche which prevents crusting and foul smell from the nose. It helps to keep nasal cavity clean and moist. Antibiotics are prescribed for the treating infection. Vasodilators to improve blood supply to the nose may be given. Improving nutrition and vitamin A supplements will contribute further to the treatment. Surgical intervention of nasal cavity may be required. Blood supply to the nose may be improved by cervical sympathectomy.
Other Modes of treatment
The other modes of treatment can also be effective in treating atrophic rhinitis. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating atrophic rhinitis.
