Chronic atrophic rhinitis, or simply atrophic rhinitis, is a chronic
inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
of the
nose
A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes th ...
characterised by
atrophy
Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply t ...
of
nasal mucosa
The nasal mucosa lines the nasal cavity. It is part of the respiratory mucosa, the mucous membrane lining the respiratory tract. The nasal mucosa is intimately adherent to the periosteum or perichondrium of the nasal conchae. It is continuous wit ...
, including the glands,
turbinate bones
In anatomy, a nasal concha (), plural conchae (), also called a nasal turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose in humans and various animals. The conchae are shaped like ...
and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are
rhinitis sicca anterior and ozaena. It can also be described as the empty nose syndrome.
Signs and symptoms
* It is most commonly seen in females.
* It is reported among patients from
lower socioeconomic groups.
* The nasal cavities become roomy and are filled with foul smelling crusts which are black or dark green and dry, making expiration painful and difficult.
* Microorganisms are known to multiply and produce a foul smell from the nose, though the patients may not be aware of this, because the nerve endings (responsible for the perception of smell) have become atrophied. This is called
merciful anosmia.
* Patients usually complain of nasal obstruction despite the roomy nasal cavity, which can be caused either by the obstruction produced by the discharge in the nose, or as a result of sensory loss due to atrophy of nerves in the nose, so the patient is unaware of the air flow. In the case of the second cause, the sensation of obstruction is subjective.
*
Bleeding from the nose, also called epistaxis, may occur when the dried discharge (crusts) are removed.
*
Septal perforation and dermatitis of
nasal vestibule
The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nasal c ...
can occur. The nose may show a saddle-nose deformity.
* Atrophic rhinitis is also associated with similar atrophic changes in the
pharynx
The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struc ...
or
larynx
The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...
, producing symptoms pertaining to these structures. Hearing impairment can occur due to
Eustachian tube
In anatomy, the Eustachian tube, also known as the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately long and in d ...
blockage causing
middle ear
The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear).
The mammalian middle ear contains three ossicles, which transfer the vibrations of the eardrum into waves in the ...
effusion.
Etiology
Causes can be remembered by the mnemonic HERNIA:
*
Hereditary
Heredity, also called inheritance or biological inheritance, is the passing on of traits from parents to their offspring; either through asexual reproduction or sexual reproduction, the offspring cells or organisms acquire the genetic inform ...
factors: the disease runs in families
*
Endocrine
The endocrine system is a messenger system comprising feedback loops of the hormones released by internal glands of an organism directly into the circulatory system, regulating distant target organs. In vertebrates, the hypothalamus is the neu ...
imbalance: the disease tends to start at puberty and mostly involves females
*
Racial
A race is a categorization of humans based on shared physical or social qualities into groups generally viewed as distinct within a given society. The term came into common usage during the 1500s, when it was used to refer to groups of variou ...
factors: white people are more susceptible than natives of equatorial Africa
*
Nutrition
Nutrition is the biochemical and physiological process by which an organism uses food to support its life. It provides organisms with nutrients, which can be metabolized to create energy and chemical structures. Failure to obtain sufficient n ...
al deficiency: vitamins A or D, or iron
*
Infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
: ''
Klebsiella
''Klebsiella'' is a genus of Gram-negative, oxidase-negative, rod-shaped bacteria with a prominent polysaccharide-based capsule.
''Klebsiella'' species are found everywhere in nature. This is thought to be due to distinct sublineages developin ...
ozaenae'',
diphtheroids, ''
Proteus vulgaris
''Proteus vulgaris'' is a rod-shaped, nitrate-reducing, indole-positive and catalase-positive, hydrogen sulfide-producing, Gram-negative bacterium that inhabits the intestinal tracts of humans and animals. It can be found in soil, water, and ...
'',
''E. coli'', etc.
*
Autoimmune
In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an "autoimmune disease". P ...
factors: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa.
Secondary atrophic rhinitis
Specific infections, such as
syphilis
Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...
,
leprosy
Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...
and
rhinoscleroma
Rhinoscleroma, is a chronic granulomatous bacterial disease of the nose that can sometimes infect the upper respiratory tract.Palmer & Reeder. It most commonly affects the nasal cavity—the nose is involved in 95–100 per cent of cases—however, ...
, may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent
sinusitis
Sinusitis, also known as rhinosinusitis, is inflammation of the nasal mucosa, mucous membranes that line the paranasal sinuses, sinuses resulting in symptoms that may include thick Mucus#Respiratory system, nasal mucus, a nasal congestion, plugg ...
or
radiotherapy
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radia ...
of the nose, or as a complication of surgery of the
turbinates
In anatomy, a nasal concha (), plural conchae (), also called a nasal turbinate or turbinal, is a long, narrow, curled shelf of bone tissue, bone that protrudes into the breathing passage of the nose in humans and various animals. The conchae ar ...
.
The United Kingdom
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
has stated that "Most cases of atrophic rhinitis in the UK occur when the turbinates are damaged or removed during surgery". Some authors refer to as Atrophic rhinitis secondary to sinus surgery as the
empty nose syndrome
Empty may refer to:
Music Albums
* ''Empty'' (God Lives Underwater album) or the title song, 1995
* ''Empty'' (Nils Frahm album), 2020
* ''Empty'' (Tait album) or the title song, 2001
Songs
* "Empty" (The Click Five song), 2007
* ...
.
Unilateral atrophic rhinitis
Extreme
deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side.
Pathology
* The ciliated columnar epithelium of the nasal mucosa is replaced by stratified squamous epithelium.
* Atrophy of mucosa, turbinal bones and seromucinous glands tends to occur, due to obliterative endarteritis and periarteritis causing decreased blood supply, hence the supplying area atrophies.
* Arrested development of paranasal sinuses.
Diagnosis
Diagnosis is based on clinical history and examination. Examination is clinical, via
anterior rhinoscopy and fibreoptic, using nasendoscopy. A
CT scan can be used to confirm the diagnosis and review disease extent.
Treatment
Treatment of atrophic rhinitis can be either medical or surgical.
Medical measures include:
* Nasal irrigation using normal saline
* Nasal irrigation and removal of crusts using alkaline nasal solutions.
* 25% glucose in glycerine can be applied to the nasal mucosa to inhibit the growth of proteolytic organisms which produce foul smell.
* Local antibiotics, such as
chloromycetine.
*
Vitamin D
Vitamin D is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group are vitamin D3 (c ...
2 .
* Estradiol spray for regeneration of seromucinous glands and vascularization of mucosa.
* Systemic streptomycin (1g/day) against Klebsiella organisms.
* Oral
potassium iodide
Potassium iodide is a chemical compound, medication, and dietary supplement. It is a medication used for treating hyperthyroidism, in radiation emergencies, and for protecting the thyroid gland when certain types of radiopharmaceuticals are us ...
for liquefaction of secretion.
* Placental extract injected in the submucosa.
* Rifampicin 600 mg once daily for 12 weeks.
Surgical interventions include:
*
Young's operation.
* Modified Young's operation.
* Narrowing of nasal cavities, submucosal injection of Teflon paste (William's operation), section and medial displacement of the lateral wall of the nose.
* Transposition of parotid duct to maxillary sinus or nasal mucosa (Wittmack's operation)
* Complete inversion of mucoperiosteum of maxillary antrum to create a neoturbinate (Raghav Sharan's operation)
* Repeated Stellate ganglion block (Sardana's operation)
* Vestibuloplasty
History
This disorder was known since the time of ancient Egypt, almost 4,000 years ago, and descriptions of it are found in the historical
medical papyri
Egyptian medical papyri are ancient Egyptian texts written on papyrus which permit a glimpse at medical procedures and practices in ancient Egypt. These papyri give details on disease, diagnosis, and remedies of disease, which include herbal re ...
. In the
Edwin Smith Papyrus
The Edwin Smith Papyrus is an ancient Egyptian medical text, named after Edwin Smith who bought it in 1862, and the oldest known surgical treatise on trauma. From a cited quotation in another text, it may have been known to ancient surgeons as t ...
(1700 BC) it was prescribed a treatment based on wine and breast milk to cure this disease.
The ancient Greek and Indian civilizations were aware of atrophic rhinitis.
See also
*
Empty nose syndrome
Empty may refer to:
Music Albums
* ''Empty'' (God Lives Underwater album) or the title song, 1995
* ''Empty'' (Nils Frahm album), 2020
* ''Empty'' (Tait album) or the title song, 2001
Songs
* "Empty" (The Click Five song), 2007
* ...
References
External links
{{Respiratory pathology
Inflammations
Nose disorders
ja:臭鼻症