Question:
I live in Denver, CO which is very dry, and I have had chronic colds since last November. I was recently diagnosed with atrophic rhinitis. My allergist recommended a daily Atrophic Rhinitis treatment of a sinus wash daily (NeilMed or a neti pot). He also wants me to swab my sinuses with olive oil twice a day. My doctor didn’t seem alarmed by what I have, but I researched this disease on the Internet and it seems more serious than he made it out to be. My doctor told me that if I follow these directives, I shouldn’t have as many colds next winter. He never recommended an antibiotic or antibiotic ointment. What do you think?
Answer:
Atrophic rhinitis can be quite a problem and can vary greatly in its severity- from a little dryness, to foul smelling crusting and infection. It can be caused by chronic infection or chronic irritation, aggressive surgery or at times we don’t know the cause. The nose works as a filter. The mucous in the nose traps particles- including bacteria, viruses, allergens and others and pushes them down into the stomach where stomach acid can destroy them. The nose also is a humidifier and temperature regulator. By the time inhaled air reaches the back of the throat, it is both 100 per cent humidified and brought to body temperature. With atrophic rhinitis, one or all of these functions are reduced or eliminated.
First, one should try to find the cause of the problem. Unusual infections such as rhinoscleroma, or inflammations such as sarcoidosis can be treated. Symptomatic treatment for atrophic rhinitis aims at replacing or reinforcing the lost functions. Hypertonic saline (extra-salty) nasal rinses are aimed at helping the nose clean itself of the particles discussed above. Topical application of ointment once or twice a day to the anterior part of the nose will help trap particles and moisturize the nasal cavity. Theoretically, these should be water soluble- such as rhinaris nasal gel- but others such as petroleum based triple antibiotic ointments like bacitracin have been used. A room humidifier, kept clean, will help in the heating months.
When there is an infection, we use appropriate antibiotics as an Atrophic Rhinitis treatment, preferably based on culture. For brief periods one may need oral antibiotics, but generally we rely on antibiotic ointments- such as bactroban, or appropriate antibiotic washes- I don’t recommend continuing on antibiotics topically or using oral antibiotics persistently without another indication. It may lead to getting infections that are resistant to antibiotics.
Robert L. Pincus MD
NY Sinus Center
Frequently Asked Questions
Atrophic rhinitis is a condition characterized by dryness, crusting, and sometimes foul-smelling infections in the nose. It can result from chronic infections, chronic irritation, aggressive nasal surgeries, or sometimes its cause is unknown. It affects the nose’s ability to filter, humidify, and regulate temperature of inhaled air.
Atrophic rhinitis reduces or eliminates the nose's natural functions including filtering particles such as bacteria and viruses, humidifying inhaled air, and regulating air temperature. This impairment can lead to increased susceptibility to infections and nasal discomfort.
Daily treatment typically includes a sinus wash using hypertonic saline solutions such as NeilMed or a neti pot to help cleanse the nose. Additionally, applying a water-soluble ointment or olive oil to the nasal cavity twice daily helps to moisturize and trap particles, and using a clean room humidifier can maintain moisture in dry environments.
Antibiotics are used only when there is evidence of bacterial infection, ideally guided by culture results. Oral antibiotics may be needed briefly, but generally, topical antibiotic ointments or washes are preferred. Persistent or unnecessary use of antibiotics can lead to resistant infections and is discouraged.
Daily use of antibiotic ointments is not generally recommended unless there is an active infection. Instead, water-soluble ointments or oils are preferred for moisturizing. Overuse of antibiotics may cause resistant infections and should be avoided unless prescribed by a doctor.
Yes, because atrophic rhinitis impairs the nose’s filtering and humidifying functions, individuals may experience more frequent colds or sinus infections. Proper treatment can help reduce these occurrences by restoring nasal moisture and function.
Using a clean room humidifier to add moisture to dry indoor air, especially in dry climates like Denver, can help. Avoiding nasal irritants and following nasal hygiene routines such as saline rinses and topical moisturizers also aid in managing symptoms.
