Nose Treatment

Atrophic Rhinitis

Atrophic Rhinitis is a chronic inflammatory nasal disease characterized by progressive atrophy of the mucosa, and underlying bone of the turbinates. There is a viscid secretion in the nose which rapidly dries and forms crusts which emits a characteristic foul odour called ozaena and the patient himself suffers from anosmia.


Atrophic rhinitis is of two types:
2) Secondary

Aetiology of primary atrophic rhinitis includes:
  • 1. Hereditary factors: The disease runs in family.
  • 2. Endocrinal disturbance: The disease usually starts at puberty. It involves females more than males. It tends to cease after menopause. These factors have raised the possibility of disease being an endocrinal disorder.
  • 3. Racial factors: White and yellow races are more susceptible than natives of equatorial Africa.
  • 4. Nutritional deficiency: Due to deficiency of vitamin A, D or iron or some other dietary factors.
  • 5. Infective: Organisms involved include Klebsiella ozaenae, diphtheroids, Proteus vulgaris, Escherichia coli, staphylococci, and streptococci.
  • 6. Autoimmune process
Organisms isolated are:
  • Klebsiella ozaenae
  • Diphtheroids
  • Proteus vulgaris
  • Escherichia coli
  • Staphylococci
  • Streptococci
  • Nose emits foul smell.
  • Anosmia - There is foul smell from nose which the patient himself is unaware of due to marked anosmia (merciful anosmia) which accompanies degenerative changes.
  • Dryness.
  • Epistaxis.
  • Blocking of nose.
  • There is atrophy of the nerve as well, hence the patient loses the sensation of smell.

  • External Nose: Bridge of the nose appears depressed due to atrophy of the nasal septum.
  • Anterior rhinoscopy reveals roomy nostrils with crusts, occasionally with septal perforation.
  • Posterior rhinoscopy shows crusts.


Conservative treatment:

    • Glucose in glycerin nasal drops: 25% glucose in glycerin, inhibits the growth of proteolytic organisms.
    • Kemicetine antiozoenal solution containing chloramphenicol 90 mg, vitamin D2, and oestradiol Di-propionate.
    • Alkaline nasal douche: In 280 ml warm water the following are added:
      • Sodium bicarbonate 28.4 gm for loosening the crusts.
      • Sodium diborate 28.4 gm.
      • Sodium Chloride for isotonicity 56.7 gm.


Numerous surgical attempts have been made to narrow the nasal passage. Various surgical procedures indicated are:

  • Inspection of Teflon strips, polythene, cartilage in the mucoperichondrial flap.
  • Stellate ganglion blocks.
  • Young’s surgery: Young in 1967 invented a procedure to close the nostril which is later re-opened after varying periods.
  • Modified Young’s closure: This is similar to Young's closure but the anterior nares are partially closed, permitting minimal breathing for the patient.
  • Raghav Sharan’s operation: This includes implantation of maxillary sinus mucosa in the nostril.
  • Wittmack’s surgery: Implantation of the Stenson’s duct (parotid duct) into the maxillary antrum.
  • Lautenslager’s Surgery: The lateral wall of the nose is medialised to narrow the nasal cavity.

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