Atrophic rhinitis: treatment, what is it, the main symptoms
The content of the article:
- The reasons for the development of pathology
- Symptoms of atrophic rhinitis
- Diagnostics
- Treatment of atrophic rhinitis
- Video
One of the most rare but severe chronic diseases of the nose is atrophic rhinitis. What it is? What does the diagnosis include and what are the main treatments for atrophic rhinitis?
Atrophic rhinitis (AR) is a progressive dystrophic process, which is accompanied by atrophy of the mucous membrane, submucosa, and with a progressive course - the periosteum and bone tissue of the nasal cavity.
Ozena, one of the forms of atrophic rhinitis, is characterized by a sharp unpleasant odor
The disease is less common than other forms of chronic rhinitis. The prevalence of chronic atrophic rhinitis in adults is higher than in children.
AR has two forms:
- plain;
- ozena, or fetid coryza.
Depending on the extent of the process, simple AR can be limited and diffuse.
A limited form of pathology, or anterior dry rhinitis, mainly affects the anterior part of the nasal septum and the anterior ends of the inferior turbinates. In the diffuse form, the disease spreads to the entire nasal cavity.
Ozena can be mild, moderate or severe in severity.
ICD-10 code (International classification of diseases 10th revision): J31.0 - chronic rhinitis: atrophic rhinitis, ozena.
The reasons for the development of pathology
The development of AR is based on impaired blood supply and innervation of the nasal mucosa. The causes of the disease are manifold:
- genetic constitutional dystrophy of the upper respiratory tract;
- diseases of the immune system;
- diseases of the gastrointestinal tract, in particular, pathology of the liver and biliary tract;
- hormonal disorders;
- severe infectious diseases;
- injuries to the nose and paranasal sinuses;
- surgical interventions (conchotomy, adenotomy, removal of foreign bodies, polypotomy, prolonged or repeated nasal tamponade, as well as conditions after septoplasty);
- radiation therapy in the nasal area;
- long-term use of vasoconstrictor nasal drops;
- unfavorable social conditions;
- nutrition with a violation of the vitamin balance;
- psychogenic stress during puberty.
One of the risk factors for the development of the disease is the prolonged use of vasoconstrictor nasal drops
Atrophic rhinitis occurs more often in persons living in dry, hot climates.
The etiology and pathogenesis of ozena have not been finally established. There are several theories:
- genetic;
- constitutional;
- endocrine-vegetative;
- trophic;
- bacterial;
- psychogenic.
Among the many alleged causes of the occurrence of ozena, an infectious theory is distinguished, following which the disease develops as a result of infection of a weakened organism with a specific osenous pathogen - Klebsiella Abel-Levenberg. In addition to this microorganism, a specific fungus, the Zhilkova mushroom, is often secreted in the blood serum or urine.
There is a suggestion that the development of Ozena is associated with Klebsiella pneumoniae ozaenae
Of great importance in the pathogenesis of the disease is infected hyposiderosis (excessive formation and accumulation of hemosiderin - a pigment consisting of iron oxide), in which the level of serum iron in the blood decreases.
Entering the upper respiratory tract, Klebsiella pneumoniae ozaenae causes inflammation of the nasal mucosa with increased production of mucous secretions. A large number of leukocytes migrate to the inflammation focus. Subsequently, the products of tissue decay and destroyed capsules of bacteria are released in the form of purulent discharge. The secret becomes thick and viscous, its discharge is disturbed, and crusts form on the walls of the nasal cavity.
Klebsiella pneumoniae ozaenae causes dysbiosis in the nasal cavity. At the same time, blood supply and tissue innervation deteriorate, dystrophic changes occur in bone tissue and mucous membrane.
Symptoms of atrophic rhinitis
Simple AR is characterized by the following features:
- decrease in mucus discharge;
- tendency to crust, but odorless;
- Difficulty nasal breathing;
- feeling of dryness in the nose;
- decreased sense of smell;
- minor nosebleeds;
- irritability, general weakness.
The disease may present with minor nosebleeds
Ozena is characterized by a sharp atrophy of the mucous membrane and bony walls of the nasal cavity. Coarse crusts with a very unpleasant odor quickly form on the walls. After removing them, the fetid odor disappears for a while, until new crusts form. At the same time, the patient himself does not feel this smell due to atrophy of the receptor zone of the olfactory analyzer.
When the atrophic process spreads to the pharynx, larynx and trachea, hoarseness develops, an obsessive cough appears and breathing becomes difficult.
As a result of bone atrophy, the outer nose can be deformed, the nasal bridge sinks and a duck nose is formed.
Diagnostics
The diagnosis is made on the basis of complaints, anamnesis data, the results of laboratory and instrumental research methods. Patients with AR report excruciating dryness in the nose, viscous crusts, and shortness of breath.
Computed tomography or radiography may be done to confirm the diagnosis.
On examination, there is a pallor of the skin and visible mucous membranes, mouth breathing. With AR during rhinoscopy, pale, atrophic mucous membranes are determined.
When carrying out anterior rhinoscopy, the following signs are revealed during the ozena:
- expansion of the nasal cavity, which is associated with a decrease in the lower turbinates;
- the mucous membrane is pale pink, thin, shiny;
- dilated nasal passages are filled with thick pus-like secretions;
- discharge, drying, forms crusts on the walls of the nasal cavity.
Atrophy of the mucous membrane and shells leads to the fact that with anterior rhinoscopy, the posterior wall of the nasopharynx is freely visualized. The violation can spread not only to the nasal cavity, but also to the pharynx, larynx and trachea.
Bacteriological sowing at the lake reveals the osenous Klebsiella.
Cytological or histological examination of the nasal mucosa with osen reveals:
- sharp thinning of the mucous membrane;
- thinning of the bone tissue of the shells and walls of the nose;
- metaplasia of columnar epithelium into stratified squamous epithelium;
- decrease in the number of mucous glands;
- weak development or disappearance of cavernous tissue;
- changes in blood vessels of the type of obliterating endarteritis;
- replacement of bone tissue of shells with connective tissue.
Additionally, a clinical blood test is performed, the level of iron is determined, and an X-ray or computed tomography of the paranasal sinuses is prescribed.
Treatment of atrophic rhinitis
AR treatment includes frequent rinsing of the nasal cavity with physiological or hypertonic solution, as well as preparations based on sea salt (Dolphin, Aqualor). For better cleansing of mucus, secretions and crusts, a nasal aspirator can be used during washes. Also, to facilitate the discharge of the crusts, tampons soaked in olive, sea buckthorn or peach oil are introduced into the nasal cavity.
For rinsing the nasal cavity, preparations based on sea salt can be used, in particular Dolphin
In order to enhance the functions of the mucous glands, the walls of the nasal cavity can be lubricated with Lugol's solution.
To reduce the atrophic process, oil drops and emollient ointments (vaseline, lanolin, naphthalene) are used, which are injected into the nasal cavity.
When a pathogenic pathogen is identified, taking into account sensitivity, systemic and local antibacterial therapy is selected (tetracycline series, chloramphenicol group).
Other therapies:
- treatment of concomitant diseases, iron deficiency anemia;
- exposure to a helium-neon laser (to stimulate the trophism of the nasal mucosa);
- general stimulating treatment: vitamin therapy, autohemotherapy, protein therapy, injections of aloe extract, pyrogenal;
- vaccine therapy: a vaccine from bacteria growing in the nasal cavity of ozena patients.
In some cases, palliative surgery is indicated
How to treat ozena with insufficient effectiveness of conservative treatment? In this case, palliative operations are performed for artificial mechanical narrowing of the nasal cavity. In the area of the lower nasal passage and the nasal septum, poorly differentiated tissues are implanted that do not have pronounced antigenic properties: autocartilage, umbilical cord, amniotic membranes. Spongy bone plates, fat, teflon, nylon, acrylic plastic, alloplastic antimicrobial polymer can also be used. Due to the stimulation of the nasal mucosa after the operation, the hydration of the nasal mucosa improves, the number of crusts and the offensive odor decreases.
Traditional methods of ozena treatment (vegetable oils, aloe juice, mint, sage, seaweed, honey) can be used only after consultation with a specialist against the background of the prescribed main treatment.
Video
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Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
