1. Atrophic Rhinitis(Ozaena)

2. Defintion
A chronic Inflammatory disease of nose with
Atrophy of nasal mucosa and turbinate bones
The nasal cavity is roomy with foul smelling discharge.
Can be primary or secondary

3. Causes Mnemonics:HERNIA Hereditary:common in members of same family
Endocrine disturbance:common in females starting at puberty; crust and fetor decrease after menopause.
Racial:common in white races.
Nutritional deficiency:Vitamin A, D, Iron; decresing in western countries due to better nutrition
Infection:Klebsiella ozaenae, diptheroids, proteus vulgaris, E. Coli, staphylococci
Autoimmune:Reaction to antigens released from nasal mucosa.

4. Pathology Chronic inflammatory condition.
Ciliated columnar epthelium changes to stratified squamous type
Bones undergo resorption leading to widening of chambers
Atrophy of seromucinous gland, periosteum and nerve
Arteries of mucosa, periosteum, bone show obliterative endarteritis.
Arrest of development of sinuses leading to small sinuses

5. Clinical Features Affects pubertal females
Merciful Anosmia:foul smell from nose
Obstruction:due to large crusts
Epistaxis:on crust removal
On Examination:
Greenish/grey black crust in nasal cavity;pale mucosa
Bleeds on removal
Roomy:turbinates reduced to ridges, posterior pharyngeal wall visualised
Septal perforation, vestibulitis of nose
Saddle deformity of nose

6. Other presentation Atrophic pharyngitis:dry and glazed with crusts
Atrophic laryngitis:Cough and hoarseness
Hearing Impairement:OME dut to ET obstruction
PNS:Small and underdeveloped with thick walls, Appear opaque on X-ray

7. Prognosis
Persists for years but resolve in middle age.

8. Treatment
Medical
No complete cure, treatment aims removal of crusts, maintaining nasal hygeine
Nasal irrigation and rwmoval of crusts:Normal saline/Solution of 1 part sodium biborate, 1 part sodium bicarbonate,2 part sodium chloride in 280 ml water
25% glucose in glycerine:After crust removal,prevent proteolytic organism growth and foul smelling.
Local antibiotics:To prevent secondary infection;Kemicetine solution(chlormycetin,oestradiol,vitamin D2) used
Oestradiol spray:Increase vascularity and regenerate seromucinous gland
Placental extract:Submucosal injection

9. Systemic streptomycin:1g/day for 10 days against klebsiella; reduce odor and crust
potassium iodide:liquifies nasal secretion

10. Surgical Youngs Operation:
Raising vestibular mucosal flaps and closing for about 6 month>mucosa reverts back to normal
Modified Youngs Operation:
Same but partial closure of flaps only; Eliminates the discomfort of bilateral nasal obstruction
Narrowing the nasal cavities:
submucosal teflon paste; bone, cartilage, teflon strips under mucoperiosteum;medialisation of lateral nasal wall

11. Secondary Atrophic Rhinitis
Diseases:leprosy,lupus,Rhinoscleroma
Surgically excessively removed turbinates
Irradiation
Long standing purulent sinusitis

12. Unilateral Atrophic Rhinitis
Deviated Nasal Septum:Atrophic Rhinitis in the wider side

13. Thank you