Atrophic Rhinitis

Atrophic rhinitis usually occurs in late middle-aged to elderly patients. The cause of atrophic rhinitis is unknown, with the leading theory being age-related mucosal atrophy, sometimes complicated by secondary bacterial infection. Primary atrophic rhinitis resembles the rhinitis associated with Sjogren's syndrome or previous nasal surgery, including extensive turbinectomy. Examination generally reveals a patent nasal airway with atrophic, erythematous turbinates, despite the symptoms of congestion.

Some subjects with atrophic rhinitis report nasal congestion, crusting of the nasal airway, and a bad smell (ozena). Ozena is associated with bacterial overgrowth of the mucosa, particularly Klebseilla ozaenae and Pseudomonas aeruginosa. The appearance of ozena may resemble chronic granulomatous disease, such as Wegener's granulomatosis or sarcoidosis, or the effects of previous local irradiation. The prevalence of ozena is variable, with a greater occurrence in select geographic areas, such as southeastern Europe, China, Egypt, or India rather than northern Europe or the United States.

Symptomatic treatment of atrophic rhinitis with low-dose decongestants and nasal saline lavage is minimally effective. Individuals with confirmed sicca complex, or Sjogren's syndrome (Table 7), may benefit from oral cevimeline 30 mg three times a day, keeping in mind that bronchospasm and arrhythmias are potential side effects. Oral antibiotic therapy is necessary for ozena. Topical antibiotic therapy, such as gentamycin or tobramycin 15 mg/mL or ciprofloxacin 0.15 mg/mL in saline, may offer some benefit for subjects with atrophic rhinitis and recurrent mucosal infections or sinusitis, although there are no studies to validate this treatment. An over-the-counter topical treatment

  1. 5. Concha bullosa: coronal computed tomography scan image of the paranasal sinuses. The arrows point to the concha bullosa in each middle turbinate. In this case, septae divide the concha bullosa into more than one air space. The usual result of the cocha bullosa is enlargement of the turbinate, usually resulting in chronic nasal congestion. Infection may occur in the concha bullosa. Frequently the septum is deviated away from a unilateral concha bullosa. Therefore, this entity should be considered in a patient complaining of chronic congestion.
  2. 5. Concha bullosa: coronal computed tomography scan image of the paranasal sinuses. The arrows point to the concha bullosa in each middle turbinate. In this case, septae divide the concha bullosa into more than one air space. The usual result of the cocha bullosa is enlargement of the turbinate, usually resulting in chronic nasal congestion. Infection may occur in the concha bullosa. Frequently the septum is deviated away from a unilateral concha bullosa. Therefore, this entity should be considered in a patient complaining of chronic congestion.

reported to reduce bacterial colonization, Sino Fresh®, is another consideration. No clinical trials support this agent in atrophic rhinitis; thus, a treatment trial is in reality a trial and benefits may be the result of the lavage, at a much greater cost than saline. The addition of proplylene glycol, 3-15%, or glycerin to nasal saline may prolong the benefits of topical moisturization by reducing the water's surface tension or reducing the irritation from irrigation. Application of petrolatum or petrolatum with eucalyptus/menthol (Vicks® ointment) to the nasal mucosa at night may help reduce nasal bleeding. Topical shea butter (Butterbar), an over-the-counter herbal therapy, also may be of some benefit but is unproven.

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