Atrophic Rhinitis or Add Ozaena
rhinitis atrophy It is a disease in which the lining of the nose changes from the lining of the airways to the lining that covers the skin. causing the lining of the nose to become atrophy and the bone structure may be much smaller. This will cause residual mucus in the nose. and dry in flakes clinging to the mucous membrane of the nose when accumulated more may obstruct the nasal cavity and can cause a foul smell rhinitis atrophy.
This can be divided into 2 types:
1. Types that occur naturally without any known cause. This may be related to hormonal changes , infections , stress, poor nutrition due to lack of certain nutrients , genetic , disorders of the immune system
2. Type a cause. or occurs after certain diseases such as Tuberculosis , leprosy , syphilis , chronic sinusitis , after nose and sinus surgery , after radiation therapy for cancer of the nose and sinus, or accidents.
The incidence of this disease is common in women. It usually begins at the age of 13 – 15 years. This disease is often found in developing countries such as Egypt , India , China. In Thailand, it can be found. From the study of this disease in Thailand. It was found that the ratio found in women to men = 5.6 : 1. The lowest age of onset was 5 years, with patients having symptoms ranging from 6 months to more than 20 years.
patients are often told by close people. smelly nose There may also be a stuffy nose. which is caused by the accumulation of flakes within the nasal cavity until it becomes clogged Nose symptoms may not be able to smell. In addition, the patient may come with bleeding from the nose.
On examination of the nose, dry, yellowish-brown or greenish scales appear on the septum of the nose. when pulling out the scab will see some swamps coated on the lining after cleaning It can be seen that the nasal mucosa has a general atrophy. The nasal cavity is quite wide.
Diagnosis can be diagnosed by history taking and physical examination with the signs and symptoms mentioned above Further investigations that should be done include examination of the mucous membranes of the nose , bacterial culture from mucus or scabs , susceptibility to various antimicrobial agents , radiographs of the nose and sinuses. To see if there is a sinus infection or not. May draw blood to see if there is pallor from iron deficiency or not. monitor nutrition; VDRL test if syphilis infection is suspected. in cases of suspected tuberculosis or leprosy A nasal biopsy may be performed.
Treatment begins with a description of the disease. and disease progression let the patient know in the case of cause should be treated according to symptoms and treat the cause In the case of a spontaneous type with no known cause Treatment will be symptomatic treatment only.
Symptomatic treatment is
1. Clean the inside of the nose by removing the scabs. and suck the pus and mucus out until clean Then rinse the nose with saline 2-3 times a day .
2. After cleaning. Nasal drops may be used. Nose drops to soften scabs and less bad smell (used in Siriraj Hospital, there are 2 types: (1) 5% alcohol + 3% glycerine + isotonic saline and (2) 50% glucose + 50% glycerine)
3. Antimicrobials may be given from time to time. especially the patients who have the result of culturing. From the experience of treating patients with this disease in Thailand found that Antimicrobial therapy improves the patient’s condition.
4. Correct malnutrition, for example, the patient eats more protein food and given vitamins , minerals , iron. In addition, patients will be scheduled for periodic nasal cleanings to monitor their response to treatment. and keep an eye out for complications
In cases where symptomatic treatment was not improved The patient’s symptoms are still a lot. may consider surgery due to the wide nasal cavity This causes the volume of air to pass through the nose quite large in each inhalation. The nose has to work harder to provide moisture. and heat to the inhaled air The mucous membranes of the nose dry easily.
Therefore, surgery was performed to narrow the nasal cavity. by putting materials such as synthetics or insert the patient’s own tissue It was found to be less reactive than synthetics, but in the long term it may be soluble. and can be absorbed There was also surgery to close the nostrils so that no more air can pass through or less. It was found that the mucous membrane of the nose returned to normal after 2-3 years of surgery. in cases with sinusitis Sinusitis surgery and post-operative antimicrobial therapy can improve symptoms in patients with atrophic rhinitis.
1. Chronic sinusitis is common due to the loss of function of the nasal hairs.
2. Throat and laryngitis. In some cases, abnormalities of the nasal mucosa may spread to the neck wall and larynx and bacteria that grow in the nasal cavity may be swallowed cause inflammation of the throat And the larynx more easily.
3. The septum through the nasal cavity found that some patients There may be a wound on the front septum septum. And spread through it until
4. nose collapse if patients rhinitis atrophy of the nasal septum perforation or nose bridge collapse may be the cause of a type that is caused. Or can occur after some diseases such as tuberculosis , leprosy , syphilis.