bubble_chart Overview

Atrophic rhinitis is a slowly progressive atrophic inflammation of the nasal cavity, characterized by atrophy of the nasal mucosa, periosteum, and bone. When severe and accompanied by a typical foul odor, it is called ozena. It often begins during adolescence and is more common in women than in men.

bubble_chart Etiology

The cause of the disease remains unclear. There are many theories, which can be summarized into two categories:
(1) Primary: It is considered a local manifestation of a systemic disease, possibly related to deficiencies in lipids and fat-soluble vitamins, nutritional disorders, trace element deficiencies or imbalances, genetic factors, collagen diseases, etc. It may also have some association with endocrine dysfunction, as it predominantly occurs in young women and symptoms worsen during menstruation. With recent advancements in immunology, it has been discovered that most patients with this condition exhibit immune dysfunction, leading some to suggest that it may be an immune-related disease.
(2) Secondary: Caused by local factors, such as trauma or excessive surgical removal of the nasal muc membrane, or due to specific pestilence diseases like subcutaneous nodes, scleroma, leprosy, syphilis, etc. In the advanced stage of chronic hypertrophic rhinitis or due to long-term irritation from purulent discharge in chronic suppurative sinusitis, excessive proliferation of fibrous connective tissue occurs, leading to impaired blood circulation and nutritional disorders in the nasal muc membrane, resulting in atrophy. Extreme deviation of the nasal septum, excessive widening of one nasal cavity, or prolonged stimulation from increased airflow, dust, or harmful gases can also cause the disease. Some have proposed that the disease is caused by infections from specific bacteria, such as ozaenae bacillus or diphtheria-like bacillus. However, it is now believed that these bacteria are not the true pathogens but rather secondary infections in atrophic rhinitis.

bubble_chart Diagnosis

(1) Dryness of the nose and nasopharynx: This is caused by atrophy of the nasal mucous membrane glands and reduced secretions.
(2) Stuffy nose: Stuffy nose may result from purulent crusts blocking the nasal cavity, or due to dulled sensory nerves in the nasal mucous membrane. Even after removing the crusts, the passage of air may go unnoticed, leading to a mistaken perception of stuffy nose.
(3) Nasal discharge: Often presents as lumpy or tubular purulent crusts that are difficult to expel. Forceful removal of dry crusts may cause slight nasal bleeding.
(4) Olfactory dysfunction: Most commonly manifests as reduced or lost sense of smell. This is caused by atrophy of the olfactory mucous membrane or blockage by dry crusts.
(5) Foul-smelling breath: Due to bacterial growth beneath the purulent crusts, the proteins in the crusts decompose, producing a foul odor, a condition known as ozena.
(6) Headache and dizziness: Atrophy of the nasal turbinates impairs the nose's ability to regulate and retain warmth. Inhaling cold air irritates the nasal mucous membrane, and the stimulation from purulent crusts can also lead to headache and dizziness. {|105|}

bubble_chart Treatment Measures

(1) Nasal cleaning: Rinse the nasal cavity with 500–1000 ml of warm saline or normal warm salt water to remove purulent crusts, facilitating the application of topical medications. If the crusts are difficult to remove, tweezers can be gently used to extract them.
(2) Nasal medication: Commonly used lubricating nasal drops, such as compound formula Oil of Wild Mint, liquid paraffin, 50% honey, or clear cod liver oil, can promote nasal mucosal congestion and swelling, enhance blood circulation, and reduce dryness and foul odor in the nose. Alternatively, 1% streptomycin solution can be used as nasal drops to inhibit bacterial growth, alleviate inflammatory erosion, and facilitate epithelial growth. Additionally, these agents lubricate the nasal mucosa and soften crusts, making them easier to expel.

(3) Vitamin therapy: Various vitamins have been tested, with vitamin A injections (50,000–100,000 units daily) or oral vitamin B2 (10–15 mg, three times daily) commonly used to protect mucosal epithelium, promote tissue cell metabolism, and enhance resistance to infection. Vitamin AD preparations (50,000 units injected 2–3 times weekly) or cod liver oil capsules (2 capsules, three times daily) may also be administered. Oral nicotinic acid (50–100 mg, three times daily) is another option. Some suggest iron supplements as a treatment, such as ferrous sulfate tablets (0.3 g, three times daily after meals).
(4) Surgical therapy: This may be attempted for cases unresponsive to prolonged treatment. The goal is to narrow the nasal cavity, reduce air intake, minimize moisture evaporation, and decrease crust formation while stimulating nasal mucosal congestion and increased secretion to improve symptoms.