Definition

Primary atrophic rhinitis accompanied by a foul smelling odour from within the nose is known as ozaena, however, atrophic rhinitis can also occur without the foul smell. A secondary form of atrophic rhinitis can occur due to trauma, surgery or occupational exposure to chemicals. The nasal cavity becomes abnormally wide due to atrophy of the mucosa and of the bony nasal skeleton within the nose. The glands and nerve fibres within the lining of the nose degenerate and the normal lining of the nose changes with loss of the muco-ciliary transport mechanism.

Incidence/Age

This condition may occur in children and adults and is much more frequently seen in Eastern Europe and India.

Causes

The cause of primary atrophic rhinitis is not known with certainty, however, secondary atrophic rhinitis is due to trauma to the nose or extensive surgery to the nose and sinuses. Occupational exposure to glass, wood or asbestos may also contribute to the secondary atrophic rhinitis.

Symptoms/Signs

This condition can often occur in women and the face may be typically flattened and slightly broad. The nasal cavity is usually filled with greenish, yellowish or brown crusts. Once the crusts are removed, the extent of size of the nasal cavity can be found. The lining of the nasal cavity is found to be atrophic with fibrosis seen in the sub-epithelial layer. The inferior turbinates are atrophic and where ozaena is present, there is a foetid secretion with crust and a foul smell.

The patients are usually anosmic and are thus unaware of the unpleasant smell. There is a sensation of nasal obstruction even despite removal of the crusting. The mucosa is dry and the changes may extend to the pharynx, larynx and trachea.
Complications of the Disorder

As above

Tests

Biopsy of the mucosa within the nasal cavity confirms the sub-epithelial fibrosis and loss of muco-ciliary mechanism. CT scanning of the nasal cavity and sinuses may be useful.
Treatment

This is largely medical and conservative in nature with repeated cleaning of the nasal cavity using douching with an alkaline nasal douche solution. The use of Vaseline applied to the nasal vestibules may be useful, as douching may be frequent in an effort to control the crusting within the nose.

Mr D Skinner FRCS
Last Editorial Review: 25/1/2010