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'''Chronic atrophic rhinitis,''' or simply '''atrophic rhinitis''', is a chronic [[inflammation]] of [[Human nose|nose]] characterised by [[atrophy]] of [[Mucus|nasal mucosa]], including the glands, [[turbinate bones]] 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 empty nose syndrome. |
'''Chronic atrophic rhinitis,''' or simply '''atrophic rhinitis''', is a chronic [[inflammation]] of the [[Human nose|nose]] characterised by [[atrophy]] of [[Mucus|nasal mucosa]], including the glands, [[turbinate bones]] 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. |
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==Signs and symptoms== |
==Signs and symptoms== |
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* It is most commonly seen in females |
* It is most commonly seen in females. |
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* It is reported among patients from [[lower socioeconomic groups]].<ref name="pmid16354334">{{cite journal |vauthors=Dutt SN, Kameswaran M |title=The aetiology and management of atrophic rhinitis |journal=J Laryngol Otol |volume=119 |issue=11 |pages=843–52 |date=November 2005 |pmid=16354334 |doi=10.1258/002221505774783377 |
* It is reported among patients from [[lower socioeconomic groups]].<ref name="pmid16354334">{{cite journal |vauthors=Dutt SN, Kameswaran M |title=The aetiology and management of atrophic rhinitis |journal=J Laryngol Otol |volume=119 |issue=11 |pages=843–52 |date=November 2005 |pmid=16354334 |doi=10.1258/002221505774783377 |doi-access=free }}</ref><ref name="pmid10567992">{{cite journal |vauthors=Bunnag C, Jareoncharsri P, Tansuriyawong P, Bhothisuwan W, Chantarakul N |title=Characteristics of atrophic rhinitis in Thai patients at the Siriraj Hospital |journal=Rhinology |volume=37 |issue=3 |pages=125–30 |date=September 1999 |pmid=10567992 }}</ref> |
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* 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. |
* 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. |
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* 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]]. |
* 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]]. |
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* 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. |
* 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. |
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* Bleeding from the nose, also called epistaxis, may occur when the dried discharge (crusts) are removed. |
* [[Nosebleed|Bleeding from the nose]], also called epistaxis, may occur when the dried discharge (crusts) are removed. |
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* Septal perforation and dermatitis of [[nasal vestibule]] can occur. The nose may show a saddle-nose deformity. |
* [[Septal perforation]] and dermatitis of [[nasal vestibule]] can occur. The nose may show a saddle-nose deformity. |
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* Atrophic rhinitis is also associated with similar atrophic changes in the [[pharynx]] or [[larynx]], producing symptoms pertaining to these structures. Hearing impairment can occur due to [[Eustachian tube]] blockage causing [[middle ear]] effusion. |
* Atrophic rhinitis is also associated with similar atrophic changes in the [[pharynx]] or [[larynx]], producing symptoms pertaining to these structures. Hearing impairment can occur due to [[Eustachian tube]] blockage causing [[middle ear]] effusion. |
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Permanent loss of smell and impairment of taste may also be a result of this disease, even after the symptoms are cured. |
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== Etiology == |
== Etiology == |
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* [[Heredity|Hereditary]] factors: the disease runs in families |
* [[Heredity|Hereditary]] factors: the disease runs in families |
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* [[Endocrine]] imbalance: the disease tends to start at puberty and mostly involves females |
* [[Endocrine]] imbalance: the disease tends to start at puberty and mostly involves females |
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* [[Racial]] factors: white people are more susceptible than natives of equatorial Africa |
* [[Racial]] factors: white people are more susceptible than natives of equatorial Africa |
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* [[Nutrition]]al deficiency: vitamins A or D, or iron<ref name="n413">{{cite journal | last=Bist | first=Sampan S. | last2=Bisht | first2=Manisha | last3=Purohit | first3=Jagdish P. | title=Primary Atrophic Rhinitis: A Clinical Profile, Microbiological and Radiological Study | journal=ISRN Otolaryngology | publisher=Hindawi Limited | volume=2012 | date=2012-11-19 | issn=2090-5750 | doi=10.5402/2012/404075 | doi-access=free | pages=1–6}}</ref> |
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* [[Nutrition]]al deficiency: vitamins A or D, or iron{{citation needed|date=December 2012}} |
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* [[Infection]]: ''[[Klebsiella]] ozaenae'', [[Corynebacterium|diphtheroids]], ''[[Proteus vulgaris]]'', [[Escherichia coli|''E. |
* [[Infection]]: ''[[Klebsiella pneumoniae]]'' subsp. ''ozaenae'', [[Corynebacterium|diphtheroids]], ''[[Proteus vulgaris]]'', [[Escherichia coli|''E. coli'']], etc. |
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* [[Autoimmune]] factors: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa. |
* [[Autoimmune]] factors: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa. |
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===Secondary atrophic rhinitis=== |
===Secondary atrophic rhinitis=== |
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Specific infections, such as [[syphilis]], [[leprosy]] and [[rhinoscleroma]], may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent [[sinusitis]] or [[radiotherapy]] of the nose, or as a complication of surgery of the [[turbinates]].<ref name=":0">{{Cite journal| |
Specific infections, such as [[syphilis]], [[leprosy]] and [[rhinoscleroma]], may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent [[sinusitis]] or [[radiotherapy]] of the nose, or as a complication of surgery of the [[turbinates]].<ref name=":0">{{Cite journal|last1=deShazo|first1=Richard D.|last2=Stringer|first2=Scott P.|date=2011-02-01|title=Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery|journal=Current Opinion in Allergy and Clinical Immunology|volume=11|issue=1|pages=1–7|doi=10.1097/ACI.0b013e328342333e|issn=1473-6322|pmid=21157302|s2cid=27205163}}</ref> The United Kingdom [[National Health Service]] has stated that "Most cases of atrophic rhinitis in the UK occur when the turbinates are damaged or removed during surgery".<ref>{{Cite web|url=http://www.nhs.uk/Conditions/Rhinitis---non-allergic/Pages/Causes.aspx|title=Non-allergic rhinitis - Causes - NHS Choices|last=Choices|first=NHS|website=www.nhs.uk|language=en|access-date=2017-08-12}}</ref> Some authors refer to as Atrophic rhinitis secondary to sinus surgery as the [[empty nose syndrome]].<ref name=":0" /> |
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===Unilateral atrophic rhinitis=== |
===Unilateral atrophic rhinitis=== |
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Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side. |
Extreme [[nasal septum deviation|deviation of nasal septum]] may be accompanied by atrophic rhinitis on the wider side. |
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==Pathology== |
==Pathology== |
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* The ciliated columnar epithelium of the nasal mucosa is replaced by stratified squamous epithelium. |
* The ciliated columnar epithelium of the nasal mucosa is replaced by stratified squamous epithelium. |
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* 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.<ref name="Gleeson">{{Cite book|url=https://books.google. |
* 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.<ref name="Gleeson">{{Cite book|url=https://books.google.com/books?id=MuRyCQAAQBAJ&q=chronic+atrophic+rhinitis+scott+brown%27s+otorhinolaryngology&pg=PA1465|title=Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed: 3 volume set|last1=Gleeson|first1=Michael|last2=Clarke|first2=Ray|date=2008-04-25|publisher=CRC Press|isbn=9781444109832|language=en}}</ref> |
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* Arrested development of paranasal sinuses. |
* Arrested development of paranasal sinuses. |
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==Diagnosis== |
==Diagnosis== |
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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. |
Diagnosis is based on clinical history and examination. Examination is clinical, via [[Rhinoscope#Anterior Rhinoscopy|anterior rhinoscopy]] and fibreoptic, using nasendoscopy. A [[CT scan]] can be used to confirm the diagnosis and review disease extent. |
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==Treatment== |
==Treatment== |
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Medical measures include: |
Medical measures include: |
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*Nasal irrigation using normal saline<ref name=":0" /> |
* Nasal irrigation using normal saline<ref name=":0" /> |
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*Nasal irrigation and removal of crusts using alkaline nasal solutions |
* 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. |
* 25% glucose in glycerine can be applied to the nasal mucosa to inhibit the growth of proteolytic organisms which produce foul smell. |
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*Local antibiotics, such as [[Chloramphenicol| |
* Local antibiotics, such as [[Chloramphenicol|Chloromycetin]]. |
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*[[Vitamin D]]<sub>2</sub> . |
* [[Vitamin D]]<sub>2</sub> . |
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*Estradiol spray for regeneration of seromucinous glands and vascularization of mucosa. |
* Estradiol spray for regeneration of seromucinous glands and vascularization of mucosa. |
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*Systemic streptomycin (1g/day) against Klebsiella organisms. |
* Systemic streptomycin (1g/day) against Klebsiella organisms. |
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*Oral [[potassium iodide]] for liquefaction of secretion. |
* Oral [[potassium iodide]] for liquefaction of secretion. |
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*Placental extract injected in the submucosa.<ref>{{Cite book|url=https://books.google. |
* Placental extract injected in the submucosa.<ref>{{Cite book|url=https://books.google.com/books?id=MuRyCQAAQBAJ&q=placental+extract+scott+browns+otorhinolaryngology&pg=PA1466|title=Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed: 3 volume set|last1=Gleeson|first1=Michael|last2=Clarke|first2=Ray|date=2008-04-25|publisher=CRC Press|isbn=9781444109832|language=en}}</ref> |
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*Rifampicin 600 mg once daily for 12 weeks.<ref name="Gleeson"/> |
* Rifampicin 600 mg once daily for 12 weeks.<ref name="Gleeson"/> |
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Surgical interventions include: |
Surgical interventions include: |
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*[[Young's operation]]. |
* [[Young's operation]]. |
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* Modified Young's operation. |
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*Modified Young's operation.Some people could not tolerate Young's operation as it lead to mouth breathing and de-nasal voice.So a modification of the above procedure is to leave a 3 mm opening in the centre of the two flaps.This is known as modified Young's operation. |
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*Narrowing of nasal cavities, submucosal injection of Teflon paste(William's operation), section and medial displacement of the lateral wall of the nose. |
* Narrowing of nasal cavities, submucosal injection of Teflon paste (William's operation), section and medial displacement of the lateral wall of the nose. |
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*Transposition of parotid duct to maxillary sinus or nasal mucosa(Wittmack's operation) |
* Transposition of parotid duct to maxillary sinus or nasal mucosa (Wittmack's operation) |
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*Complete inversion of mucoperiosteum of maxillary antrum to create a |
* Complete inversion of mucoperiosteum of maxillary antrum to create a neo-turbinate (Raghav Sharan's operation) |
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*Repeated Stellate ganglion block(Sardana's operation) |
* Repeated Stellate ganglion block (Sardana's operation) |
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*Vestibuloplasty |
* Vestibuloplasty |
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== History == |
== History == |
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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. In the [[Edwin Smith Papyrus]] (1700 BC) it was prescribed a treatment based on wine and breast milk to cure this disease.<ref name=":0" /> The ancient Greek and Indian civilizations were aware of atrophic rhinitis.<ref name="pmid8820180">{{cite journal |author=Shehata MA |title=Atrophic rhinitis |journal=Am J Otolaryngol |volume=17 |issue=2 |pages=81–6 |year=1996 |pmid=8820180 |doi= 10.1016/s0196-0709(96)90000-9 |
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]]. In the [[Edwin Smith Papyrus]] (1700 BC) it was prescribed a treatment based on wine and breast milk to cure this disease.<ref name=":0" /> The ancient Greek and Indian civilizations were aware of atrophic rhinitis.<ref name="pmid8820180">{{cite journal |author=Shehata MA |title=Atrophic rhinitis |journal=Am J Otolaryngol |volume=17 |issue=2 |pages=81–6 |year=1996 |pmid=8820180 |doi= 10.1016/s0196-0709(96)90000-9}}</ref> |
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== |
==See also== |
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* [[Empty nose syndrome]] |
* [[Empty nose syndrome]] |
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| Line 97: | Line 95: | ||
| ICD10 = {{ICD10|J|31|0|j|30}} |
| ICD10 = {{ICD10|J|31|0|j|30}} |
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| ICD9 = {{ICD9|472.0}} |
| ICD9 = {{ICD9|472.0}} |
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| ICDO = |
| ICDO = |
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| OMIM = |
| OMIM = |
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| MedlinePlus = 001627 |
| MedlinePlus = 001627 |
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| eMedicineSubj = |
| eMedicineSubj = |
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| eMedicineTopic = |
| eMedicineTopic = |
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| MeshID = D012222 |
| MeshID = D012222 |
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| SNOMED CT = 195769008 |
| SNOMED CT = 195769008 |
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Latest revision as of 22:00, 22 June 2024
 | This article needs additional citations for verification. (June 2016) |
| Chronic atrophic rhinitis | |
|---|---|
| Specialty | Otorhinolaryngology  |
Chronic atrophic rhinitis, or simply atrophic rhinitis, is a chronic inflammation of the nose characterised by atrophy of nasal mucosa, including the glands, turbinate bones 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
[edit]- It is most commonly seen in females.
- It is reported among patients from lower socioeconomic groups.[1][2]
- 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 can occur. The nose may show a saddle-nose deformity.
- Atrophic rhinitis is also associated with similar atrophic changes in the pharynx or larynx, producing symptoms pertaining to these structures. Hearing impairment can occur due to Eustachian tube blockage causing middle ear effusion.
Etiology
[edit]Causes can be remembered by the mnemonic HERNIA:
- Hereditary factors: the disease runs in families
- Endocrine imbalance: the disease tends to start at puberty and mostly involves females
- Racial factors: white people are more susceptible than natives of equatorial Africa
- Nutritional deficiency: vitamins A or D, or iron[3]
- Infection: Klebsiella pneumoniae subsp. ozaenae, diphtheroids, Proteus vulgaris, E. coli, etc.
- Autoimmune factors: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa.
Secondary atrophic rhinitis
[edit]Specific infections, such as syphilis, leprosy and rhinoscleroma, may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis or radiotherapy of the nose, or as a complication of surgery of the turbinates.[4] The United Kingdom National Health Service has stated that "Most cases of atrophic rhinitis in the UK occur when the turbinates are damaged or removed during surgery".[5] Some authors refer to as Atrophic rhinitis secondary to sinus surgery as the empty nose syndrome.[4]
Unilateral atrophic rhinitis
[edit]Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side.
Pathology
[edit]- 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.[6]
- Arrested development of paranasal sinuses.
Diagnosis
[edit]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
[edit]Treatment of atrophic rhinitis can be either medical or surgical.
Medical measures include:
- Nasal irrigation using normal saline[4]
- 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 Chloromycetin.
- Vitamin D2 .
- Estradiol spray for regeneration of seromucinous glands and vascularization of mucosa.
- Systemic streptomycin (1g/day) against Klebsiella organisms.
- Oral potassium iodide for liquefaction of secretion.
- Placental extract injected in the submucosa.[7]
- Rifampicin 600 mg once daily for 12 weeks.[6]
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 neo-turbinate (Raghav Sharan's operation)
- Repeated Stellate ganglion block (Sardana's operation)
- Vestibuloplasty
History
[edit]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. In the Edwin Smith Papyrus (1700 BC) it was prescribed a treatment based on wine and breast milk to cure this disease.[4] The ancient Greek and Indian civilizations were aware of atrophic rhinitis.[8]
See also
[edit]References
[edit]- ^ Dutt SN, Kameswaran M (November 2005). "The aetiology and management of atrophic rhinitis". J Laryngol Otol. 119 (11): 843–52. doi:10.1258/002221505774783377. PMID 16354334.
- ^ Bunnag C, Jareoncharsri P, Tansuriyawong P, Bhothisuwan W, Chantarakul N (September 1999). "Characteristics of atrophic rhinitis in Thai patients at the Siriraj Hospital". Rhinology. 37 (3): 125–30. PMID 10567992.
- ^ Bist, Sampan S.; Bisht, Manisha; Purohit, Jagdish P. (2012-11-19). "Primary Atrophic Rhinitis: A Clinical Profile, Microbiological and Radiological Study". ISRN Otolaryngology. 2012. Hindawi Limited: 1–6. doi:10.5402/2012/404075. ISSN 2090-5750.
- ^ a b c d deShazo, Richard D.; Stringer, Scott P. (2011-02-01). "Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery". Current Opinion in Allergy and Clinical Immunology. 11 (1): 1–7. doi:10.1097/ACI.0b013e328342333e. ISSN 1473-6322. PMID 21157302. S2CID 27205163.
- ^ Choices, NHS. "Non-allergic rhinitis - Causes - NHS Choices". www.nhs.uk. Retrieved 2017-08-12.
- ^ a b Gleeson, Michael; Clarke, Ray (2008-04-25). Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed: 3 volume set. CRC Press. ISBN 9781444109832.
- ^ Gleeson, Michael; Clarke, Ray (2008-04-25). Scott-Brown's Otorhinolaryngology: Head and Neck Surgery 7Ed: 3 volume set. CRC Press. ISBN 9781444109832.
- ^ Shehata MA (1996). "Atrophic rhinitis". Am J Otolaryngol. 17 (2): 81–6. doi:10.1016/s0196-0709(96)90000-9. PMID 8820180.