ATROPHIC RHINITIS (OZAENA)

📌 Definition: Chronic inflammation of the nose characterized by atrophy of nasal mucosa and turbinate bones.
Key Feature: Nasal cavities are roomy but full of foul-smelling crusts.

Aetiology (Primary)

Exact cause is unknown. Remember Mnemonic: HERNIA

• H - Hereditary: Runs in families.
• E - Endocrinal: Starts at puberty; Females > Males; ceases after menopause.
• R - Racial: White & Yellow races > natives of equatorial Africa.
• N - Nutritional: Deficiency of Vit A, D, Iron. (Decreasing in West).
• I - Infective:
  • Klebsiella ozaenae (Perez bacillus).
  • Secondary invaders: Proteus, E. coli, Staph (Cause the smell).
• A - Autoimmune: Destructive process against nasal mucosa antigens.

Pathology

• Epithelium: Ciliated Columnar → Stratified Squamous (Metaplasia).
• Vessels: Obliterative endarteritis (decreased blood supply).
• Bone: Resorption of turbinates → Roomy nasal chambers.
• Glands: Atrophy of seromucinous glands (Dryness).

Clinical Features

Common in Females (Puberty).

• Foul Smell (Stench): Patient becomes a social outcast.
• Merciful Anosmia: Patient is unaware of their own smell due to nerve atrophy.
• Nasal Obstruction: Paradoxical (Nose is wide, but obstructed by large crusts).
• Epistaxis: When crusts are removed.

Examination Findings

• Cavity: Roomy (Posterior wall of nasopharynx is visible).
• Crusts: Greenish or greyish black; dry.
• Turbinates: Reduced to mere ridges.
• Deformity: Saddle nose may be present.
• Septal Perforation: May be present.

Treatment

Aim: Maintain nasal hygiene + Remove crusts/smell.

1. Medical Management

Method	Mechanism / Details
Nasal Irrigation (Alkaline Douche)	Solution: Soda bicarb (1) + Sodium biborate (1) + NaCl (2). Action: Loosens crusts and removes tenacious discharge.
25% Glucose in Glycerine	Applied after cleaning. Action: Inhibits proteolytic organisms (Stops the smell).
Kemicetine™ Solution	Contains Chloromycetin, Oestradiol, Vit D2.
Systemic Streptomycin	1g/day for 10 days. Target: Klebsiella organisms.

2. Surgical Management

• Young's Operation: Complete closure of both nostrils (using flaps) for 6 months.
  Result: Mucosa reverts to normal; crusting reduces.
• Modified Young's: Partial closure (avoids total obstruction discomfort).
• Narrowing Operations: To reduce air currents (prevents drying).
  methods: Teflon injection, Medial displacement of lateral wall.
📚 Ref: Diseases of Ear, Nose & Throat (Dhingra), 8th Ed.