Chronic atrophic rhinitis is a chronic inflammation

Inflammation

Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

 of nose

Human nose

The visible part of the human nose is the protruding part of the face that bears the nostrils. The shape of the nose is determined by the ethmoid bone and the nasal septum, which consists mostly of cartilage and which separates the nostrils...

 characterised by atrophy

Atrophy

Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations , poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, disuse or lack of exercise or disease intrinsic to the tissue itself...

 of nasal mucosa

Mucus

In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...

, 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.

Etiology

• Heredity
  Heredity
  Heredity is the passing of traits to offspring . This is the process by which an offspring cell or organism acquires or becomes predisposed to the characteristics of its parent cell or organism. Through heredity, variations exhibited by individuals can accumulate and cause some species to evolve...
  
   factors: the disease runs in families
• Endocrine imbalance: the disease tends to start at puberty and mostly involves females
• Racial factors: whites are more susceptible than natives of equatorial Africa
• Nutrition
  Nutrition
  Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....
  
  al deficiency: vitamins A or D, or iron
• Infection
  Infection
  An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
  
  : Klebsiella
  Klebsiella
  Klebsiella is a genus of non-motile, Gram-negative, oxidase-negative, rod-shaped bacteria with a prominent polysaccharide-based capsule. It is named after the German microbiologist Edwin Klebs...
  
   ozaenae, diphtheroids
  Corynebacterium
  Corynebacterium is a genus of Gram-positive rod-shaped bacteria. They are widely distributed in nature and are mostly innocuous. Some are useful in industrial settings such as C. glutamicum. Others can cause human disease. C...
  
  , Proteus vulgaris
  Proteus vulgaris
  Proteus vulgaris is a rod-shaped, Gram negative bacterium that inhabits the intestinal tracts of humans and animals. It can be found in soil, water and fecal matter. It is grouped with the enterobacteriaceae and is an opportunistic pathogen of humans...
  
  , E. coli
  Escherichia coli
  Escherichia coli is a Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms . Most E. coli strains are harmless, but some serotypes can cause serious food poisoning in humans, and are occasionally responsible for product recalls...
  
  , etc.
• Autoimmune: viral infection or some other unidentified insult may trigger antigenicity of the nasal mucosa.

Pathology

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 causing decreased blood supply, hence the supplying area atrophies.

Clinical manifestations

The disease is most commonly seen in females, and tends to appear during puberty. It can occur, however, as early as 12 months of age. 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 their elements (responsible for the perception of smell) have become atrophied. 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

Nasal vestibule

Nasal Vestibule is the most anterior part of the nasal cavity. It is enclosed by the cartilages of nose and lined by the same epithelium of the skin . The other part of the nasal cavity, which is lined by the respiratory epithelium, is called nasal cavity proper...

 can occur. The nose may show a saddle-nose deformity. Atrophic rhinitis is also associated with similar atrophic changes in the pharynx

Pharynx

The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...

 or larynx

Larynx

The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...

, producing symptoms pertaining to these structures. Hearing impairment can occur due to Eustachian tube

Eustachian tube

The Eustachian tube is a tube that links the nasopharynx to the middle ear. It is a part of the middle ear. In adult humans the Eustachian tube is approximately 35 mm long. It is named after the sixteenth-century anatomist Bartolomeo Eustachi...

 blockage causing middle ear

Middle ear

The middle ear is the portion of the ear internal to the eardrum, and external to the oval window of the cochlea. The mammalian middle ear contains three ossicles, which couple vibration of the eardrum into waves in the fluid and membranes of the inner ear. The hollow space of the middle ear has...

 effusion.

Permanent loss of smell and impairment of taste may also be a result of this disease, even after the symptoms are cured.

Secondary atrophic rhinitis

Specific infections, such as syphilis

Syphilis

Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...

, lupus, leprosy

Leprosy

Leprosy or Hansen's disease is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Named after physician Gerhard Armauer Hansen, leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions...

 and rhinoscleroma

Rhinoscleroma

Rhinoscleroma, or simply Scleroma, is a chronic granulomatous bacterial disease of the nose that can sometimes infect the upper respiratory tract. It most commonly affects the nasal cavity—the nose is involved in 95-100 per cent of cases—however, it can also affect the nasopharynx, larynx, trachea,...

, may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis

Sinusitis

Sinusitis is inflammation of the paranasal sinuses, which may be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days...

, radiotherapy of the nose or excessive surgical removal of turbinates.

Unilateral atrophic rhinitis

Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side.

Effects on athletic performance

Despite what Weston Butler says, chronic atrophic rhinitis does not have any effect on athletic performance.

Medical measures include:

• Nasal irrigation using normal saline
• Nasal irrigation and removal of crusts using alkaline solutions
• 25% glucose in glycerine can be applied to the nasal mucosa to inhibit the growth of foul-smelling proteolytic organisms
• Local antibiotics, such as chloramphenicol (Kemicetine)
• Estradiol
  Estradiol
  Estradiol is a sex hormone. Estradiol is abbreviated E2 as it has 2 hydroxyl groups in its molecular structure. Estrone has 1 and estriol has 3 . Estradiol is about 10 times as potent as estrone and about 80 times as potent as estriol in its estrogenic effect...
  
   and vitamin D
  Vitamin D
  Vitamin D is a group of fat-soluble secosteroids. In humans, vitamin D is unique both because it functions as a prohormone and because the body can synthesize it when sun exposure is adequate ....
  
  ₂
• Estradiol spray
• Systemic streptomycin
• Oral potassium iodide
• Placental extract injected in the submucosa

Surgical interventions include:

• Young's operation
  Young's operation
  Young's operation is a surgery designed for the treatment of atrophic rhinitis, first described by Austen Young in 1967.-Procedure:The surgical procedure involves closure of the nasal cavity affected with atrophic rhinitis by creating mucocutaneous flaps....
  
  
• Modified Young's operation
• Narrowing of nasal cavities, submucosal injection of Teflon paste, section and medial displacement of the lateral wall of the nose
• Transposition of parotid duct to maxillary sinus or nasal mucosa