Q & A

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Is there any reason for septicemia in the condition of atrophic rhinitis?

Question: Is there any reason for septicemia in the condition of atrophic rhinitis?

Answer: Thank you for your question. Atrophic rhinitis, also known as ozena, is a condition in which the nasal cavity loses its ability to serve as a filter due to chronic inflammation of the nose. While atrophic rhinitis is a chronic nasal condition that has an unknown cause, it causes the formation of thick dry crusts in a normally roomy nasal cavity. This is a result of a decrease in size (atrophy) of the nasal mucous lining and the underlying bone. However, while this condition is characterized by the atrophy of the nasal mucosa, it also includes the turbinate bones, the glands, as well as the nerve elements that supply the nose. Normally, the air we breathe in should reach 98.6 degrees F and 100 percent humidity by the time it reaches the back of the nose.

The common symptoms associated with atrophic rhinitis include a runny nose, a stuffy nose, nosebleeds, nasal crusting, nasal deformity, a sore throat, a decreased or loss of smell, as well as frequent upper respiratory infections.

Aggressive surgery, or chronic infection, can cause scarring and the loss of the function of the nose. It can result in crusting, stuffiness, a bad odor and increased risk of infection. Septicemia (a blood-borne infection), while possible, would be quite rare.

Treatment for atrophic rhinitis includes humidification, treatment with ointments and irrigations with a Netti pot or nasal flush. Using nasal irrigation is usually the first line of defense, as this treatment option can help improve tissue hydration and can help reduce crusting in the nose. However, it is important that you irrigate your nose several times a day, and the irrigation solution that you use could be a saline solution, a mixture of other salts, or even an antibiotic solution.

I hope this helps clear things up.

Robert Pincus MD

Co-Director NY Sinus Center

Q & A

Why is there crusting in atrophic rhinitis?

Question: Why is there crusting in atrophic rhinitis?

Answer:

Atrophic rhinitis is a chronic nasal condition in which the nose is unable to function as it should. The nose and the nasal linings takes the air that we breathe and warms it to 98.6 degrees F and 100 percent humidity, by the time the air reaches the back of the nose. However, sometimes the lining of the nose can become damaged and lose this function. As a result, the air then tends to be dry and irritating. With atrophic rhinitis, changes in the function of the nasal passages are caused by the mucosa (the tissue that lines the nose) and the underlying bone shrinking down, causing atrophy of the nasal passages. Typically this condition affects both of the nostrils and can be highly bothersome, even though this is not a life-threatening condition.

Atrophic rhinitis can cause crusting, sinus infections, and nosebleeds. Other common symptoms of atrophic rhinitis include:

Crusting (often green)
Nosebleeds
Nasal discharge
Nasal obstruction
Nasal deformity
Sore throat
Headaches
Bad breath
Strong odor from the nose
Watery eyes
Decreased/loss of smell
Frequent respiratory infections

Atrophic rhinitis can be caused by over-aggressive nasal surgery- especially when the inferior turbinates are removed, medication abuse (too much afrin/neosynephrine, cocaine use and certain infections). While the treatment is difficult, there are a variety of methods available to help treat atrophic rhinitis. Overall, the main goal of treatment consists of rehydrating and re-moisturizing the nasal lining to help alleviate the build-up of crust. The treatment for atrophic rhinitis is extensive and unfortunately, not always successful. In some cases, a variety of treatments are necessary, and they need to be ongoing. When treatment stops, the symptoms typically return.

I would speak to your sinus specialist about your care or visit us here at the NY Sinus Center.

Robert Pincus MD

Co-Director NY Sinus Center

Q & A

Atrophic Rhinitis

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

Atrophic Rhinitis Archives - The New York Otolaryngology Group

Is there any reason for septicemia in the condition of atrophic rhinitis?

Why is there crusting in atrophic rhinitis?

Atrophic Rhinitis