Atrophic Rhinitis

Definition:

It is a chronic inflammation of nose characterized by atrophy of the nasal mucosa.

Typically seen in females nearing puberty.

Aetiology:

1. Hereditary
2. Racial (more in whites)
3. Endocrinal disturbances (oestrogen)
4. Nutritional deficiency.
5. Infections
6. Auto-immune

Pathology:

Squamous metaplasia in the mucosa, atrophy of seromucinous glands, venous blood sinusoids and neve elements, obliterative endarteritis. Turbinates undergo resorption. Paranasal sinuses are small due to arrested development.

Clinical features:

1. Anosmia
2. Degenerative changes
3. Nasal obstruction
4. Epistaxis
5. Greenish/greyish black dry crusts
6. Typically, the posterior wall of the nasopharynx can be visualised.
7. Nose may show saddle deformity

Treatment:

No definitive treatment is available for this condition. The following measures are tried to provide releif to the patient.

Medical

1. Nasal irrigation and removal of crusts (alkaline solution)
2. 25% glucose in glycerine
3. Local antibiotics
4. Oestradiol spray
5. Placental extract
6. Potassium iodide (oral)

Surgical

1. Young's / Modified Young's operation - it involves the complete or partial closure of both the nostrils, to be opened after 6 months. This allows the turbinates and the mucosa to grow.
2. Narrowing the nasal cavities - this is done by injection of teflon paste or insertion of fat/cartilage/bone/teflon strips under the mucoperiostium.