Atrophic Rhinitis (Ozaena)

1. Chronic nasal disease
2. Progressive atrophy of mucosa and underlying bone of turbinates
3. Presence of viscid secretion → foul odour crust

Aetiology

a.     Primary (unknown cause)

                                               i.     Infection

1.     Klebsiella ozaena

2.     Bacillus mucosus

3.     Coccobacillus foetidus ozaena

4.     Diphtheria bacilli

                                             ii.     Endocrine imbalance 

1.     Female

2.     Puberty

                                           iii.     Heredity

                                            iv.     Racial influence

                                             v.     Nutritional

1.     Iron deficiency

                                            vi.     Autoimmune disease

b.       Secondary

                                                               i.      Chronic sinusitis

                                                             ii.      Excessive surgical destruction

                                                            iii.      Chronic granulomatus disease

1.       Syphilis

2.       Lupus

3.       Leprosy

4.       TB

5.       Rhinoscleroma

                                                            iv.      Radiotherapy

Pathology

1.     Metaplasia – columnar ciliated to squamous epithelium

2.     ↓ in no. & size of alveolar glands .

3.     + endarteritis and periarteritis of terminal arterioles.

4.     Active absorption of bone

•       C/F :

–       Symptoms

1.       Nasal obstruction

2.       Epistaxis

3.       Anosmia (merciful anosmia)

–       Signs

1.       Fetor

2.       Crusts- green, yellow, black

-           detached –bleeding

1.       Roomy cavity

2.       Atrophic laryngopharngitis

Treatment

1.     Conservative

a.     Nasal douching x 2

                                                        i.     280ml –warm water

                                                      ii.     28.4 g sod. bicarbonate

                                                    iii.     28.4 g sod diborate

                                                     iv.     56.7 g sod chloride

b.     25% glucose in glycerin

                                                        i.     Inhibits proteolytic organism

c.     Oestradiol in arachis oil

d.     Kemicetine antiozaena solution

                                                        i.     Chlormphenicol , estradiol, vit D2

e.     Potassium iodide

f.      Autogenous vaccines

g.     Human placental extracts

h.     Rifampicin

2.Surgical

1.Young’s operation

2.     Modified Young’s operation

3.     Submucosal inj of teflon paste

4.     Insertion of fat/ cartilage bone or teflon

5.     Medial displacement of lateral wall.