It is a chronic inflammation of nose characterized by atrophy of nasal mucosa and turbinate bones. The nasal cavities are roomy and full of foul-smelling crusts. Atrophic rhinitis is of two types: primary and secondary.
Atrophic rhinitis (AR) is a condition that affects the interior of your nose. The condition occurs when the tissue that lines the nose, known as the mucosa, and the bone underneath shrink down. This shrinking down is known as atrophy. It can lead to changes in function of the nasal passages.
Typically, AR is a condition that affects both of your nostrils at the same time. AR can be very bothersome, but it’s not life-threatening. You may require several types of treatment to resolve symptoms.[3]
The exact cause is not known. Various theories advanced regarding its causation are:
Hereditary factors. Disease is known to involve more than one member in the same family.
Endocrinal disturbance. Disease usually starts at puberty, involves females more than males, the crusting and foetor associated with disease tends to cease after menopause; these factors have raised the possibility of disease being an endocrinal disorder.
Nutritional deficiency. Disease may be due to deficiency of vitamin A, D or iron or some other dietary factors. The fact that incidence of disease is decreasing in western countries and is rarely seen in well-to-do families raises the possibility of some nutritional deficiency.
Autoimmune process. The body reacts by a destructive process to the antigens released from the nasal mucosa. Viral infection or some other unspecified agents may trigger antigenicity of nasal mucosa. Pathology Ciliated columnar epithelium is lost and is replaced by stratified squamous type. There is atrophy of seromucinous glands, venous blood sinusoids and nerve elements. Arteries in the mucosa, periosteum and bone show obliterative endarteritis. The bone of turbinates undergoes resorption causing widening of nasal chambers. Paranasal sinuses are small due to their arrested development.
Specific infections like syphilis, lupus, leprosy and rhinoscleroma may cause destruction of the nasal structures leading to atrophic changes.
While it’s not clear what exactly causes it, several underlying factors may put you more at risk for developing primary AR, including:
Primary AR is unusual in the United States. It’s more prevalent in tropical countries.
The conditions that may make you more likely to develop secondary AR include:
Ciliated columnar epithelium is lost and is replaced by stratified squamous type. There is atrophy of seromucous glands, venous blood sinusoids and nerve elements. Arteries in the mucosa, periosteum and bone show obliterative endarteritis. The bone of turbinates undergoes resorption causing widening of nasal chambers. Paranasal sinuses are small due to their arrested development.
[A] PRIMARY ATROPHIC RHINITIS
[B] SECONDARY ATROPHIC RHINITIS
Disease commonly seen in females and starts around puberty. There is foul smell from the nose making the patient a social outcast though patient himself is unaware of the smell due to marked anosmia (merciful anosmia) which accompanies these degenerative changes. Patient may complain of nasal obstruction in spite of unduly wide nasal chambers. This is due to large crusts filling the nose. Epistaxis may occur when the crusts are removed.
Examination shows nasal cavity to be full of greenish or greyish black dry crusts covering the turbinates and septum. Attempts to remove them may cause bleeding.
When the crusts have removed, nasal cavities appear roomy with atrophy of turbinates so much so that the posterior wall of nasopharynx can easily seen. Nasal turbinates may reduce to mere ridges. Nasal mucosa appears pale. Septal perforation and dermatitis of nasal vestibule may be present. Nose may show a saddle deformity. Atrophic changes may also seen in the pharyngeal mucosa which may appear dry and glazed with crusts). Similar changes may occur in the larynx with cough and hoarseness of voice (atrophic laryngitis). Hearing impairment may notice because of obstruction to eustachian tube and middle ear effusion. Paranasal sinuses are usually small and under develop with thick walls. They appear opaque on X-ray. Antral wash is difficult to perform due to thick walls of the sinuses.
Prognosis The disease persists for years but there is a tendency to recover spontaneously in middle age.
Specific infections like syphilis, lupus, leprosy and rhinoscleoma may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis, radiotherapy to 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.
The examination of patients with rhinitis should include an examination of the nose, and assessment for possible comorbidities and complications. The physical examination of a patient with rhinitis may reveal the following:
Increased temperature may be seen especially when there is an infectious etiology (infectious rhinitis/rhinosinusitis)
Ocular findings i.e.: Commonly seen in patients with allergic rhinitis. Some of the ocular findings include:
Nasal findings i.e.: Examination of the nasal cavity with a speculum or otoscope may reveal the following:
Ear findings i.e.: Otoscopic examination of the ears may reveal signs suggestive of associated co-morbidities such as:
Face i.e.
Mouth and Throat i.e.
Neck i.e.
Diagnosis is based on clinical history and examination. Examination is clinical, via anterior rhinoscopy and fiberoptic, using nasal endoscopy. A CT scan can be used to confirm the diagnosis and review disease extent.
It may be medical or surgical.
(a) Firstly, Nasal irrigation and removal of crusts. Warm normal saline or an alkaline solution making by dissolving a teaspoonful of powder containing soda bicarbonate 1 part, sodium biforate 1 part, sodium chloride 2 parts in 280 mL of water is using to irrigate the nasal cavities. The solution is run through one nostril and comes out from the other. It loosens the crusts and removes thick tenacious discharge. Care should take to avoid pushing the fluid into the sinuses and eustachian tube. Initially, irrigations are doing two or three times a day but later once in every 2 or 3 days is sufficient. Hard crusts may difficult to remove by irrigation. They are first loosning and then mechanically remove with forceps or suction.
(b) Secondly, 25% glucose in glycerin. After crusts are removed, nose is painted with 25% glucose in glycerin. This inhibits the growth of proteolytic organisms which are responsible for foul smell.
(c) Thirdly, Local antibiotics. Spraying or painting the nose with appropriate antibiotics help to eliminate secondary infection. Kemicetine™ antiozaena solution contains chloromycetin, oestradiol and vitamin D2 and may found useful.
(e) Placental extract injected submucosally in the nose may provide some relief.
(f) Systemic use of streptomycin. 1 g/day for 10 days has given good results in reducing crusting and odour. It is effective against Klebsiella organisms.
(g) Potassium iodide given by the mouth promotes and liquefies nasal secretion.
It includes: (a) Young’s operation. Both the nostrils are close completely just within the nasal vestibule by raising flaps. They are opening after 6 months or later. In these cases, mucosa may revert to normal and crusting reduced. Modified Young’s operation. To avoid the discomfort of bilateral nasal obstruction, modified Young’s operation aims to partially close the nostrils. It is also claiming to give the same benefit as Young’s.
(b) Narrowing the nasal cavities. Nasal chambers are very wide in atrophic rhinitis and air currents dry up secretions leading to crusting. Narrowing the size of the nasal airway helps to relieve the symptoms.
(i) Firstly, Submucosal injection of teflon paste.
(ii) Secondly, Insertion of fat, cartilage, bone or teflon strips under the mucoperiosteal of the floor and lateral wall of nose and the muco-perichondrium of the septum.
(iii) Thirdly, Section and medial displacement of lateral wall of nose.
Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.
A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.
A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?
The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.
The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.
The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.
So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).
Lupus, cancer, polypi of nose, sanious discharge, especially when ulceration is present.
Soreness and scabs nose discharge of thick, yellow mucous or of dry, hard, yellow-green plugs; the parts, especially septum narium, swollen, red and sore to touch,
(<) evenings; point of nose cracked; WEAK OR ENTIRE LOSS OF SMELL.
Indicated especially in Rhinitis. Cancer, ulcer on right alae nasi, burning, stinging, painful, forming a thick, hard crust, which comes off and leaves a bleeding, mattery surface soon followed by another crust; nostrils; corners of mouth also anus red and excoriated; CANNOT BREATHE THROUGH NOSTRILS WHEN ASLEEP; nose swollen, burns,
coppery-red, with desire for liquors; ichorous, sanious and foetid discharges, with marked prostration and great general debility (Ars. iod.).[2]
Offensive, greenish discharge from nose, with caries of bones and a feeling as if nose would burst; numbness of bones of face; pimple on tip of nose; small tubercles on cheeks; TEARING PAINS FROM WITHIN OUTWARD in bones of nose, (<) at night. Mercurio- syphilis and scrofula
Scrofulous and syphilitic affections of bones of nose and face; caries of bones of nose and palate; PUTRID SMELL WHEN BLOWING NOSE, RECOGNIZE BY PATIENT, though olfaction impair; excessively foetid discharge; burning, itching, smarting soreness in nose which is sensitive to touch; unbearable frontal headache; caries extends into cheek-bones, with same tearing, boring pain; bony destruction of ear with Obstinate Otorrhea: Yellow, Thick discharge from nose, or dry firm pieces are blowing out, always of an offensive odor: nose sunken in, perforation of septum.
Specifically indicated medicine for Rhinitis Ozaena scrofulous with unbearable odor: Nasal cavity ulcerated deep in, with dry yellowish scruff and senses of obstruction; nostrils stuffed up with hard crusts; lupus of alae nasi, ulceration of soft parts with perforation of Septum
Swelling of nose and upper lip in children, with acrid discharge; purulent, thick, or yellow-red discharge, making lip sore; specifically red itching pustules on upper lip and cheeks; nose swollen inside and outside; impaired smell.; Additionally, EPISTAXIS FREQUENT AND PROFUSE, ALMOST TO FAINTING; loud breathing through nose.
Copious, offensive, thick, greenish-yellow discharge with OSSEOUS GROWTHS IN NOSE; Moreover, blowing of much mucus from nose with ineffectual desire to sneeze.[2]
Scrofulous ozaena; swelling of nose, with pimples inside and outside, forming crusts which last a long time; vesicle at right nostril with malignant ulcerations; LITTLE BOILS INSIDE OF NOSE, WITH TENSE ALSO BURNING SENSATION, (<) during menses; saddle across nose with copper-colored eruption. Lastly, Carcinoma nasi.
Ozaena with burning in nostrils and stitching pain in septum; discharge of pus and blood from nose; additionally, boring in nostrils; smell of animals in back part of nose; fibrous polypi, hard and elastic, pricking also itching after touching or handling; EXCESSIVELY ACUTE SMELL, WITH PURULENT DISCHARGE.
Offensive discharge from nose also throat, smelling like putrid herring pickle; posterior wall of throat covered with a dry greenish-yellow scab, Furthermore, extending up to nose; pains from root of nose to ears when swallowing; sense of smell; gone; NOSE BLEEDS WHEN VIOLENTLY BLOWN.
Indicated especially in Rhinitis. Dry scabs in nose, with sore, cracked and ulcerated nostrils; frequently discharge of thick, yellowish, fetid mucus from nose, which may form either hard masses or crusts; loss of smell dryness of noise; Besides this, discharge from nose MUCH MORE FOETID DURING MENSES, catches cold easily; oozing behind ears.[2]
NOSE FEELS UNNATURALLY DRY, Moreover, being obstruct by large clinkers of dark-greenish, fetid, hard masses, hawk up from post- nasal space, (<) morning till noon; rapid exfoliation also ulceration; loss of smell; PERFORATING ULCERS ON SEPTUM AND ELSEWHERE; desires also fulness from inflammation of frontal sinuses; ropy, tough mucous discharge from posterior nares, offensive or not; polypus nasi.
Ozaena, discharge from nose like glue, drying up in posterior nares; perspiration of septum; NOSE STOPPED UP AND RUNS AT THE SAME TIME; rawness and smarting in nostrils.
Septum sore with sharp pain; much mucus descends into throat, causing hawking; constant inclination to swallow; thick yellow coating on back of tongue.
Mercurio-syphilis; foetid, yellow, corroding nasal discharge; generally, ozaena with ulcers; STITCHES IN NOSE AS FROM SPLINTERS; dirty, bloody mucus from posterior nares; large, soft protuberances on alae, covered with crusts; green casts from nose every morning.[2]
Ozaena with ulceration; discharge also thick.
Ozaena scrofulosa, catches cold easily from deficiency of vital heat; loss of smell or foetid smell before nose; blowing of large lumps of yellow-green mucus or crusts with blood from nose; painful eruption on tip of nose; goneness in epigastrium; sweat in axillae, palms of hands and soles of feet.
Gnawing and ulcers high up the nose, with great sensitiveness of place of contact nose inwardly dry, excoriated, covered with crusts; obstructed mornings, fluent during day; intolerable itching of tip of nose; cold nose
Chronic catarrh, discharge offensive-smelling, thick, yellow or yellowish-green; caries of nasal bones; dull, thick, heavy sensation in forehead or throbbing extending to occiput; trickling into pharynx; itching behind ears, she would like to scratch them off.
SMELL IN NOSE AS OF FISH BRINE; painful scabs in nostrils; blows out much thick green mucus mixed with blood and pus; later brown scabs from; nose sore; red eruption on alae, often moist; skin of face greasy; watery, purulent otorrhea, smelling like putrid meat (Tell. like fish brine); persistent insomnia; sycosis [2]
It is a chronic inflammation of nose characterized by atrophy of nasal mucosa and turbinate bones.
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