Types:

Atrophic rhinitis is of two types:
1)Primary
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

Symptoms:

• 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.

Signs:

• 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.

Treatment:

Conservative treatment:

Local:

• • 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.

Surgical:

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.