Atrophic Rhinitis

Woman With Nosebleed Suffering From Atrophic Rhinitis

 

Atrophic rhinitis is a chronic degenerative condition of the inside of the nose.It is more common in women than in men, but is rare overall in the United States, where it is more prevalent in tropical countries. This disease involves progressive deterioration and shrinking (atrophy) of the mucous lining of the nasal passageways and the underlying bones, which affects the nose’s function. Though atrophic rhinitis is not life-threatening, it can cause distressing symptoms.

 

Symptoms of Atrophic Rhinitis

Atrophic rhinitis is characterized by three signs and symptoms:

  • Progressive atrophy of the nasal mucosal tissue
  • A thick greenish crust inside the nose
  • A distinctive bad odor from the nose

Progressive deterioration of the tissues of the nose can lead to a decreased or complete loss of sense of smell. Other common symptoms of atrophic rhinitis can include discharge from the nose, frequent nosebleeds, sore throat, and headaches.

What Causes Atrophic Rhinitis?

There are two types of atrophic rhinitis – primary and secondary.

Primary atrophic rhinitis is identified by the presence of the disease without any known cause, though often Klebsiella ozaenae bacteria can be found in the nose of these patients. Some doctors believe primary atrophic rhinitis may be due to genetics, infections, nutritional deficiency, developmental disorders, hormonal imbalance, allergy, or immune conditions.

Secondary atrophic rhinitis is more common in the US compared to the primary form. It refers to atrophic rhinitis that has developed due to an underlying condition, such as a chronic nasal infection or other disease affecting the nose, or a medical treatment, such as radiation therapy or sinus surgery. A deviated septum can also be a risk factor for secondary atrophic rhinitis, as is older age and nasal trauma.

Atrophic rhinitis can often co-exist with other conditions, including:

Who is More Prone to Atrophic Rhinitis?

Women, particularly young and middle-aged women, are more prone to primary atrophic rhinitis. Other groups at higher risk include older adults, people with poor nutrition or hygiene, those in hot, dry climates, individuals who have had nasal surgery, and those with certain underlying conditions like autoimmune diseases.

Diagnosis and Treatment for Atrophic Rhinitis

Atrophic rhinitis is diagnosed based on the signs and symptoms, a physical exam, and medical imaging of the sinuses. Additional tests may be needed to rule out other causes that present with similar signs and symptoms, or to identify any underlying causes of secondary atrophic rhinitis.

Atrophic rhinitis can be difficult to treat. Treatment doesn’t always work and any treatment that is effective needs to be carried out long-term to keep symptoms away. Management usually starts with the least-invasive measures but can escalate all the way up to surgery.

Non-surgical treatment options include:

  • Nasal irrigation to improve hydration of the mucous lining and reduce crust formation
  • Nasal sprays or drops, such as glucose glycerin, to inhibit bacterial growth while moisturizing the nasal lining
  • Topical or oral antibiotics
  • Injections of compounds that promote dilation of blood vessels, protect against inflammation, or reduce deterioration and damage to the nasal tissues
  • Wearing a nasal obturator, a prosthetic device inserted into the nose to narrow the nasal passageways and relieve symptoms

An otolaryngologist (ear, nose, throat) specialist will be able to perform surgery for atrophic rhinitis if necessary, which typically involves surgically closing the nostrils, either partially or completely. The goal of surgery in these cases is to:

  • Decrease the size of the nasal passageway, which limits dehydration of the nasal mucosa from too much airflow
  • Encourage regeneration of the nasal mucosa
  • Increase lubrication of the mucous lining
  • Improve blood flow to the nasal cavities

While surgical treatment can often be effective at relieving symptoms, some people find that atrophic rhinitis can still recur.

An otolaryngologist is the best-placed medical specialist to manage atrophic rhinitis. If any underlying diseases are found to be contributing to secondary atrophic rhinitis, they may collaborate with other specialists to formulate the most effective treatment plan.