What Is Atrophic Rhinitis?
Atrophic rhinitis, also known in the literature as ozaena, dry rhinitis, or empty nose syndrome (open nose syndrome), is a rare but severely quality-of-life-impairing chronic nasal disease characterized by progressive thinning (atrophy) of the nasal mucosa and underlying bone tissue.
In this condition, the nasal cavities are significantly wider than normal. Despite this, patients often describe a sensation of nasal obstruction. This is defined as paradoxical nasal obstruction, which develops due to disruption of the physiological structure of intranasal airflow and altered sensory perception.
Key features of atrophic rhinitis:
- Severe nasal dryness
- Thick and hard crusting
- Foul-smelling nasal discharge (fetor)
- Burning sensation and tenderness inside the nose
- Gradual decrease in sense of smell over time
Epidemiology and Causes
The exact cause of atrophic rhinitis is still not clearly known today.
Primary Atrophic Rhinitis
In the past, the disease was thought to be associated with the Klebsiella ozaenae bacterium, and an infectious origin was considered primary. Today, this condition is classified as primary atrophic rhinitis.
It is more commonly seen in:
- Hot climates
- Developing countries
- Younger age groups
Factors thought to potentially play a role in the development of the disease:
- Developmental anomalies
- Endocrine disorders
- Circulatory problems
- Nutritional deficiencies
- Autoimmune diseases
- Genetic predisposition
None of these factors have been definitively proven with strong scientific evidence alone.
Secondary Atrophic Rhinitis
This is the more commonly encountered form in current clinical practice. The most important causes include:
- Excessive and aggressive turbinate surgery
- Nasal trauma
- Granulomatous diseases (e.g., Wegener’s granulomatosis)
- Cocaine use
- Mucosal damage following radiotherapy
In this group, the disease generally follows a more severe course, and a detailed surgical history is of great importance for diagnosis.
Symptoms
The most common complaints in atrophic rhinitis:
- Foul-smelling nasal discharge
- Heavy crusting
- Intranasal dryness
- Easy bleeding
- Feeling of blockage despite an open nose
- Disturbing odor problem in social life
In advanced stages:
- Septal perforation may develop
- Collapse of the nasal bridge (saddle nose deformity) may occur
How Is It Diagnosed?
Diagnosis is largely made through clinical evaluation.
Primary diagnostic methods:
- Detailed patient history
- Anterior and posterior rhinoscopy
- Endoscopic nasal examination
In the presence of foul-smelling discharge:
- Nasal culture is taken to identify the causative microorganism and antibiotic sensitivity.
When necessary:
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
are used to evaluate the paranasal sinuses.
Treatment Approach
Treatment of atrophic rhinitis is a long-term, patience-requiring, and gradual process.
Conservative (Medical and Care) Treatment
The foundation of treatment always consists of non-surgical methods:
- Regular nasal irrigation
- Gentle removal of crusts
- Moisturizing nasal gels and ointments
- Mucosa-protective topical agents
In advanced stages:
- Drops containing 50% glucose + glycerin may help reduce crusting and foul odor.
Topical Antibiotic Treatment
Topical antibiotics are not routinely used in every patient.
However, in the presence of:
- Foul-smelling discharge
- Clinical signs of infection
- Sometimes pathogen growth in culture
topical antibiotic drops or irrigations selected according to antibiogram (e.g., preparations containing gentamicin) may be used for short-term and controlled periods.
Topical antibiotic therapy is suitable for selected cases with infection exacerbation; it is not a treatment for dryness and crusting alone.
In some patients with accompanying intense inflammation:
- Topical steroid + antibiotic combinations may be preferred for short-term use.
Surgical Treatment
Today, surgical treatment for atrophic rhinitis is considered very rarely and only in selected severe cases.
The most well-known surgical method:
Young’s Procedure
- Nasal openings are temporarily closed with flaps prepared from vestibular skin
- Time is allowed for the nasal mucosa to recover
- The nose can be reopened months later
Purpose:
- To reduce intranasal airflow
- To support mucosal healing
- To reduce dryness and foul odor
Today, it is applied with limited indications due to its effects on patient tolerance and quality of life.
Disease Course (Prognosis)
The course of atrophic rhinitis varies from person to person.
- In some patients, symptoms may spontaneously improve by middle age
- In some cases, lifelong follow-up and care may be required
Early diagnosis, regular nasal care, and proper treatment selection are the most important factors in controlling the disease.
