Atrophic Rhinitis

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Chronic infection of the nasal mucosa in which various components become thinner (atrophy) due to fibrosis of the terminal blood vessels

Cause

• Unknown but associated with: HIV/AIDS, poor socio-economic status, syphilis, rhinoscleroma (early stages)

Clinical features

• Tends to affect both nasal cavities
• Affects females more than males
• Foul stench not noticed by patient who cannot smell
• Crusts and bleeding points in the nose
• Epistaxis when crusts separate
• Sensation of obstruction in the nose
• Nasal airway very wide

Investigations

• C&S of smear of nasal material
• X-ray: To exclude sinusitis
• Differential diagnosis
• Atrophy from other causes

Management

Treatment

Clean nasal cavities twice daily to remove crusts (most important) Syringe nose or douche it with warm normal saline Or sodium bicarbonate solution 5% (dissolve 1 teaspoon of powder in 100 ml cup of warm water) Then apply tetracycline eye ointment 1% inside the nose twice daily Give amoxicillin 500 mg every 8 hours for 14 days For rhinoscleroma: Give 1 g every 8 hours for 6 weeks If atrophic rhinitis not better or is worse after 2 weeks Refer to ENT specialist

HC3     HC4

Prevention

• Treat/eliminate known causes, such as syphilis