Question: Thank you very much for allowing us to ask questions. I have atrophic rhinitis. Can this be caused by allergies? I have many airborne allergies. Also, how would you culture the bacteria? Mucous? Or swab (this does not seem to work)? I took one month of Levaquin and for that month and the month after I felt great. Then it came back. Is there a better protocol? I saw medical articles that said three months of Cipro, or rifampin or streptomycin injections where curative.
Any guidance would be truly appreciated.
Answer:
Thanks for your question. Atrophic rhinitis implies that the tissues of the nasal and sinus cavities are damaged and have lost much of their ability to function well. The job of the nose and sinuses is to humidify and warm air (to 98.6 degrees and 100% humidity) by the time the air gets to the back of the nose. The mucous is both a lubricant and catches particles (viruses, bacteria, dust, etc.) and brings them down the back of the nose to the throat where they are swallowed and destroyed by stomach acid.
Atrophic rhinitis is usually NOT caused by allergies- but more commonly by damage to the tissues- either from removing too much during a surgical procedure- or from scarring from infection, caustic nasal medication (cocaine, Afrin abuse) or sometimes an unknown cause. Allergic rhinitis is called Atopic rhinitis- so you just want to be sure of the correct terminology.
Atrophic rhinitis can be best treated often with topical medications in the nose- ointments such as Bactroban placed on a fingertip just on the inside of the nose- and with nasal rinses (Saltaire, NeilMed)- at times with medications such as antibiotics and steroids in the rinse. Alternatively, the use of sinus nebulizers (deliver fine mists) with hypertonic (extra salty) salt water with or without the same medications can be helpful.
Sinus cultures need to be taken off the mucous directly where it comes out of the sinuses to be accurate. This needs to be done with a telescope in the nose (a blind nasal swab is not helpful), and I would expect this to be done by any sinus specialist. While we know the most common organisms causing sinus infections statistically, each individual may have an unusual organism, and it is always best to treat with the most appropriate antibiotics when needed.
I hope this helps clear things up.
Robert Pincus MD
Co-Director NY Sinus Center
Associate Professor Otolaryngology, NY Medical College
Frequently Asked Questions
Atrophic rhinitis is generally not caused by allergies. It usually results from damage to the nasal and sinus tissues due to factors like excessive surgical removal, scarring from infections, or abuse of nasal medications such as Afrin or cocaine. Allergic rhinitis, also known as atopic rhinitis, is a different condition and should not be confused with atrophic rhinitis.
The nose and sinuses warm and humidify incoming air to body temperature and 100% humidity before it reaches the back of the throat. Mucous produced in these cavities acts as a lubricant and traps particles like viruses and bacteria, which are then moved to the throat to be swallowed and destroyed by stomach acid, helping protect the respiratory system.
Bacteria in sinus infections should be cultured from mucus directly exiting the sinuses. This requires using a nasal telescope to collect the mucus rather than a blind nasal swab, which is usually not effective. Accurate cultures help identify the specific organisms to guide appropriate antibiotic treatment.
Atrophic rhinitis is often treated with topical nasal medications such as ointments like Bactroban applied inside the nostrils, nasal rinses like Saltaire or NeilMed often combined with antibiotics or steroids, and sinus nebulizers delivering hypertonic saline with or without medications. These approaches help restore nasal function and reduce symptoms.
Some medical articles have suggested that extended antibiotic treatments, such as three months of Cipro or use of rifampin or streptomycin injections, might be curative in some cases. However, any antibiotic treatment should be guided by accurate sinus cultures to identify the appropriate organism and antibiotic, rather than empirical long-term use.
A blind nasal swab often fails to provide accurate cultures because it does not sample mucus directly from the sinuses. Proper sinus cultures require using a nasal telescope to reach the mucus where it exits the sinuses, ensuring precise identification of bacteria to guide treatment effectively.
