Atrophic Rhinitis

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Atrophic Rhinitis Definition Symptoms Cause Diet Regimen Homeopathic Medicine Homeopath Treatment in Rajkot India

The Atrophic Rhinitis:

Atrophic Rhinitis

Definition

It is a chronic inflammation of nose characterized by atrophy of nasal mucosa and turbinate bones. The nasal cavities are roomy and full of foul-smelling crusts. Atrophic rhinitis is of two types: primary and secondary.

Atrophic rhinitis (AR) is a condition that affects the interior of your nose. The condition occurs when the tissue that lines the nose, known as the mucosa, and the bone underneath shrink down. This shrinking down is known as atrophy. It can lead to changes in function of the nasal passages.

Typically, AR is a condition that affects both of your nostrils at the same time. AR can be very bothersome, but it’s not life-threatening. You may require several types of treatment to resolve symptoms.[3]

[A] PRIMARY ATROPHIC RHINITIS

The exact cause is not known. Various theories advanced regarding its causation are:

Hereditary factors. Disease is known to involve more than one member in the same family.

Endocrinal disturbance. Disease usually starts at puberty, involves females more than males, the crusting and foetor associated with disease tends to cease after menopause; these factors have raised the possibility of disease being an endocrinal disorder.

Racial factors.
  • White and yellow races are more susceptible than natives of equatorial Africa.

Nutritional deficiency. Disease may be due to deficiency of vitamin A, D or iron or some other dietary factors. The fact that incidence of disease is decreasing in western countries and is rarely seen in well-to-do families raises the possibility of some nutritional deficiency.

Infective.
  • Various organisms have been cultured from cases of atrophic rhinitis such as Klebsiella ozaenae, (Perez bacillus), diphtheroids, Proteus vulgaris, Escherichia coli, staphylococci and streptococci but they are all considered to be secondary invaders responsible for foul smell rather than the primary causative organisms of the disease.

Autoimmune process. The body reacts by a destructive process to the antigens released from the nasal mucosa. Viral infection or some other unspecified agents may trigger antigenicity of nasal mucosa. Pathology Ciliated columnar epithelium is lost and is replaced by stratified squamous type. There is atrophy of seromucinous glands, venous blood sinusoids and nerve elements. Arteries in the mucosa, periosteum and bone show obliterative endarteritis. The bone of turbinates undergoes resorption causing widening of nasal chambers. Paranasal sinuses are small due to their arrested development.

[B] SECONDARY ATROPHIC RHINITIS

Specific infections like syphilis, lupus, leprosy and rhinoscleroma may cause destruction of the nasal structures leading to atrophic changes.

While it’s not clear what exactly causes it, several underlying factors may put you more at risk for developing primary AR, including:

  • genetics
  • poor nutrition
  • chronic infections
  • anemia due to low iron levels
  • endocrine conditions
  • autoimmune conditions
  • environmental factors

Primary AR is unusual in the United States. It’s more prevalent in tropical countries.

The conditions that may make you more likely to develop secondary AR include:

  • syphilis
  • tuberculosis
  • lupus[3]

Ciliated columnar epithelium is lost and is replaced by stratified squamous type. There is atrophy of seromucous glands, venous blood sinusoids and nerve elements. Arteries in the mucosa, periosteum and bone show obliterative endarteritis. The bone of turbinates undergoes resorption causing widening of nasal chambers. Paranasal sinuses are small due to their arrested development.

[A] PRIMARY ATROPHIC RHINITIS

[B] SECONDARY ATROPHIC RHINITIS

[A] PRIMARY ATROPHIC RHINITIS

Disease commonly seen in females and starts around puberty. There is foul smell from the nose making the patient a social outcast though patient himself is unaware of the smell due to marked anosmia (merciful anosmia) which accompanies these degenerative changes. Patient may complain of nasal obstruction in spite of unduly wide nasal chambers. This is due to large crusts filling the nose. Epistaxis may occur when the crusts are removed.

Examination

Examination shows nasal cavity to be full of greenish or greyish black dry crusts covering the turbinates and septum. Attempts to remove them may cause bleeding.

When the crusts have removed, nasal cavities appear roomy with atrophy of turbinates so much so that the posterior wall of nasopharynx can easily seen. Nasal turbinates may reduce to mere ridges. Nasal mucosa appears pale. Septal perforation and dermatitis of nasal vestibule may be present. Nose may show a saddle deformity. Atrophic changes may also seen in the pharyngeal mucosa which may appear dry and glazed with crusts). Similar changes may occur in the larynx with cough and hoarseness of voice (atrophic laryngitis). Hearing impairment may notice because of obstruction to eustachian tube and middle ear effusion. Paranasal sinuses are usually small and under develop with thick walls. They appear opaque on X-ray. Antral wash is difficult to perform due to thick walls of the sinuses.

Prognosis The disease persists for years but there is a tendency to recover spontaneously in middle age.

[B] SECONDARY ATROPHIC RHINITIS

Specific infections like syphilis, lupus, leprosy and rhinoscleoma may cause destruction of the nasal structures leading to atrophic changes. Atrophic rhinitis can also result from long-standing purulent sinusitis, radiotherapy to nose or excessive surgical removal of turbinates. Unilateral atrophic rhinitis. Extreme deviation of nasal septum may be accompanied by atrophic rhinitis on the wider side.

Physical Examination

The examination of patients with rhinitis should include an examination of the nose, and assessment for possible comorbidities and complications. The physical examination of a patient with rhinitis may reveal the following:[6][7]

General Appearance

  • Rhinorrhea may be seen
  • Mouth breathing from nasal congestion
  • Sniffing
  • Allergic shiners i.e.: Dark eye shadows beneath the lower eye lid due to blood/fluid accumulation in the infraorbital groove as a result of congestion of the nose/sinuses. It is commonly seen in childhood allergic rhinitis, and the degree of darkness is associated with the chronicity and severity of disease. It can also be seen in nonallergic rhinitis.
  • Dennie–Morgan lines i.e.: These are wrinkles/ extra skin fold underneath the lower eyelids. It is seen in children with allergic diseases such as allergic rhinitis.
  • Allergic salute- A habitual gesture of rubbing the nose upward because of nasal discomfort and pruritus. It sometimes produces a persistent horizontal crease across the nose.

Vital signs

Increased temperature may be seen especially when there is an infectious etiology (infectious rhinitis/rhinosinusitis)

HEENT

Ocular findings i.e.: Commonly seen in patients with allergic rhinitis. Some of the ocular findings include:[8]

  • Bilateral conjunctival injection, papillae and cobblestones.
  • Corneal involvement in severe cases (atopic and vernal keratoconjunctivitis).
  • Frequent rubbing of the eyes, irritability, lacrimation, mucus discharge.
  • Blepharospasm
  • Periorbital edema

Nasal findings i.e.: Examination of the nasal cavity with a speculum or otoscope may reveal the following:

  • Swollen/edematous turbinates
  • Pale, bluish or erythematous mucosa. The mucosa is often pale/bluish in allergic rhinitis. Beefy red mucosa can be seen in rhinitis medicamentosa.

Ear findings i.e.: Otoscopic examination of the ears may reveal signs suggestive of associated co-morbidities such as:

  • Otitis media with effusion- common in patients with allergic rhinitis.
  • Acute otitis media

Face i.e.

  • Facial tenderness/discomfort on palpation of the sinuses. This often occurs when the inflammation extends into the sinuses (rhinosinusitis), and it can be as a result of infection or allergy
  • Abnormal facial development such as elongated facies may be seen, especially in chronic mouth breathers

Mouth and Throat i.e.

  • Coexisting conditions like hypertrophied adenoids may be seen.
  • Dental malocclusion frequently occurs in children who are chronic mouth breathers.
  • High arch in the palate
  • Cobblestoning of the oropharynx
  • Posterior drainage of nasal secretions

Neck i.e.

  • Swollen lymph nodes may be seen in infectious rhinitis secondary to upper respiratory tract infections.

Skin

  • Eczema may be seen in patients with allergic rhinitis if there is coexisting atopic dermatitis.

Chest

  • A thorough chest examination is essential, as it may reveal abnormalities suggestive of other pathological conditions or co-morbidities such as respiratory tract infections, asthma.[4]
  • Allergy tests to confirm or rule out allergies.
  • CT scan to get detailed images of your nasal cavities.
  • Nasal endoscopy using a flexible tube with a camera (endoscope) to view the inside of your nostrils and check for nasal polyps or other problems.
  • Nasal inspiratory flow test to measure airflow when you breathe.[5]

Diagnosis is based on clinical history and examination. Examination is clinical, via anterior rhinoscopy and fiberoptic, using nasal endoscopy. A CT scan can be used to confirm the diagnosis and review disease extent.

It may be medical or surgical.

  1. Medical:

  • Complete cure of the disease is not yet possible. Treatment aims at maintaining nasal hygiene by removal of crusts and the associated putrefying smell, and to further check crust formation.

(a) Firstly, Nasal irrigation and removal of crusts. Warm normal saline or an alkaline solution making by dissolving a teaspoonful of powder containing soda bicarbonate 1 part, sodium biforate 1 part, sodium chloride 2 parts in 280 mL of water is using to irrigate the nasal cavities. The solution is run through one nostril and comes out from the other. It loosens the crusts and removes thick tenacious discharge. Care should take to avoid pushing the fluid into the sinuses and eustachian tube. Initially, irrigations are doing two or three times a day but later once in every 2 or 3 days is sufficient. Hard crusts may difficult to remove by irrigation. They are first loosning and then mechanically remove with forceps or suction.

(b) Secondly,  25% glucose in glycerin. After crusts are removed, nose is painted with 25% glucose in glycerin. This inhibits the growth of proteolytic organisms which are responsible for foul smell.

(c) Thirdly, Local antibiotics. Spraying or painting the nose with appropriate antibiotics help to eliminate secondary infection. Kemicetine™ antiozaena solution contains chloromycetin, oestradiol and vitamin D2 and may found useful.

(d) Estradiol spray.
  • Helps to increase vascularity of nasal mucosa and regeneration of seromucous glands.

(e) Placental extract injected submucosally in the nose may provide some relief.

(f) Systemic use of streptomycin. 1 g/day for 10 days has given good results in reducing crusting and odour. It is effective against Klebsiella organisms.

(g) Potassium iodide given by the mouth promotes and liquefies nasal secretion.

  1. Surgical.

It includes: (a) Young’s operation. Both the nostrils are close completely just within the nasal vestibule by raising flaps. They are opening after 6 months or later. In these cases, mucosa may revert to normal and crusting reduced. Modified Young’s operation. To avoid the discomfort of bilateral nasal obstruction, modified Young’s operation aims to partially close the nostrils. It is also claiming to give the same benefit as Young’s.

(b) Narrowing the nasal cavities. Nasal chambers are very wide in atrophic rhinitis and air currents dry up secretions leading to crusting. Narrowing the size of the nasal airway helps to relieve the symptoms.

Among the techniques followed, i.e.:

(i) Firstly, Submucosal injection of teflon paste.

(ii) Secondly, Insertion of fat, cartilage, bone or teflon strips under the mucoperiosteal of the floor and lateral wall of nose and the muco-perichondrium of the septum.

(iii) Thirdly, Section and medial displacement of lateral wall of nose.

Homeopathic Treatment of Atrophic Rhinitis

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

  • The medical history of the patient,
  • Physical and mental constitution,
  • Family history,
  • Presenting symptoms,
  • Underlying pathology,
  • Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Atrophic Rhinitis:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Alumen

Lupus, cancer, polypi of nose, sanious discharge, especially when ulceration is present.

Alumina

Soreness and scabs nose discharge of thick, yellow mucous or of dry, hard, yellow-green plugs; the parts, especially septum narium, swollen, red and sore to touch,
(<) evenings; point of nose cracked; WEAK OR ENTIRE LOSS OF SMELL.

Arsenicum Album

Indicated especially in Rhinitis. Cancer, ulcer on right alae nasi, burning, stinging, painful, forming a thick, hard crust, which comes off and leaves a bleeding, mattery surface soon followed by another crust; nostrils; corners of mouth also anus red and excoriated; CANNOT BREATHE THROUGH NOSTRILS WHEN ASLEEP; nose swollen, burns,
coppery-red, with desire for liquors; ichorous, sanious and foetid discharges, with marked prostration and great general debility (Ars. iod.).[2]

Asafoetida

Offensive, greenish discharge from nose, with caries of bones and a feeling as if nose would burst; numbness of bones of face; pimple on tip of nose; small tubercles on cheeks; TEARING PAINS FROM WITHIN OUTWARD in bones of nose, (<) at night. Mercurio- syphilis and scrofula

Aurum Met

Scrofulous and syphilitic affections of bones of nose and face; caries of bones of nose and palate; PUTRID SMELL WHEN BLOWING NOSE, RECOGNIZE BY PATIENT, though olfaction impair; excessively foetid discharge; burning, itching, smarting soreness in nose which is sensitive to touch; unbearable frontal headache; caries extends into cheek-bones, with same tearing, boring pain; bony destruction of ear with Obstinate Otorrhea: Yellow, Thick discharge from nose, or dry firm pieces are blowing out, always of an offensive odor: nose sunken in, perforation of septum.

Aurum Mur

Specifically indicated medicine for Rhinitis Ozaena scrofulous with unbearable odor: Nasal cavity ulcerated deep in, with dry yellowish scruff and senses of obstruction; nostrils stuffed up with hard crusts; lupus of alae nasi, ulceration of soft parts with perforation of Septum

Calcarea Carb

Swelling of nose and upper lip in children, with acrid discharge; purulent, thick, or yellow-red discharge, making lip sore; specifically red itching pustules on upper lip and cheeks; nose swollen inside and outside; impaired smell.; Additionally, EPISTAXIS FREQUENT AND PROFUSE, ALMOST TO FAINTING; loud breathing through nose.

Calcarea Flour

Copious, offensive, thick, greenish-yellow discharge with OSSEOUS GROWTHS IN NOSE; Moreover, blowing of much mucus from nose with ineffectual desire to sneeze.[2]

Carbo animalis

Scrofulous ozaena; swelling of nose, with pimples inside and outside, forming crusts which last a long time; vesicle at right nostril with malignant ulcerations; LITTLE BOILS INSIDE OF NOSE, WITH TENSE ALSO BURNING SENSATION, (<) during menses; saddle across nose with copper-colored eruption. Lastly, Carcinoma nasi.

Conium maculatum

Ozaena with burning in nostrils and stitching pain in septum; discharge of pus and blood from nose; additionally, boring in nostrils; smell of animals in back part of nose; fibrous polypi, hard and elastic, pricking also itching after touching or handling; EXCESSIVELY ACUTE SMELL, WITH PURULENT DISCHARGE.

Elaps cor

Offensive discharge from nose also throat, smelling like putrid herring pickle; posterior wall of throat covered with a dry greenish-yellow scab, Furthermore, extending up to nose; pains from root of nose to ears when swallowing; sense of smell; gone; NOSE BLEEDS WHEN VIOLENTLY BLOWN.

Graphitis

Indicated especially in Rhinitis. Dry scabs in nose, with sore, cracked and ulcerated nostrils; frequently discharge of thick, yellowish, fetid mucus from nose, which may form either hard masses or crusts; loss of smell dryness of noise; Besides this, discharge from nose MUCH MORE FOETID DURING MENSES, catches cold easily; oozing behind ears.[2]

Kali Brom

NOSE FEELS UNNATURALLY DRY, Moreover, being obstruct by large clinkers of dark-greenish, fetid, hard masses, hawk up from post- nasal space, (<) morning till noon; rapid exfoliation also ulceration; loss of smell; PERFORATING ULCERS ON SEPTUM AND ELSEWHERE; desires also fulness from inflammation of frontal sinuses; ropy, tough mucous discharge from posterior nares, offensive or not; polypus nasi.

Mercurious Cor

Ozaena, discharge from nose like glue, drying up in posterior nares; perspiration of septum; NOSE STOPPED UP AND RUNS AT THE SAME TIME; rawness and smarting in nostrils.

Mercurious Iod flavus

Septum sore with sharp pain; much mucus descends into throat, causing hawking; constant inclination to swallow; thick yellow coating on back of tongue.

Nitric Acid

Mercurio-syphilis; foetid, yellow, corroding nasal discharge; generally, ozaena with ulcers; STITCHES IN NOSE AS FROM SPLINTERS; dirty, bloody mucus from posterior nares; large, soft protuberances on alae, covered with crusts; green casts from nose every morning.[2]

Peru Balsam

Ozaena with ulceration; discharge also thick.

Sepia

Ozaena scrofulosa, catches cold easily from deficiency of vital heat; loss of smell or foetid smell before nose; blowing of large lumps of yellow-green mucus or crusts with blood from nose; painful eruption on tip of nose; goneness in epigastrium; sweat in axillae, palms of hands and soles of feet.

Silicea

Gnawing and ulcers high up the nose, with great sensitiveness of place of contact nose inwardly dry, excoriated, covered with crusts; obstructed mornings, fluent during day; intolerable itching of tip of nose; cold nose

Therideone

Chronic catarrh, discharge offensive-smelling, thick, yellow or yellowish-green; caries of nasal bones; dull, thick, heavy sensation in forehead or throbbing extending to occiput; trickling into pharynx; itching behind ears, she would like to scratch them off.

Thuja

SMELL IN NOSE AS OF FISH BRINE; painful scabs in nostrils; blows out much thick green mucus mixed with blood and pus; later brown scabs from; nose sore; red eruption on alae, often moist; skin of face greasy; watery, purulent otorrhea, smelling like putrid meat (Tell. like fish brine); persistent insomnia; sycosis [2]

  1. Firstly, Steam Inhalation
  2. Secondly, Avoid Smocking
  3. Lastly, Avoid Alcohol

What is Atrophic Rhinitis?

It is a chronic inflammation of nose characterized by atrophy of nasal mucosa and turbinate bones.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Atrophic Rhinitis?

  • Alumina
  • Arsenicum Album
  • Calcarea Carb
  • Graphitis
  • Kali Brom
  • Mercurious Cor
  • Nitric Acid
  • Silicea
  • Thuja

What are the causes of Atrophic Rhinitis?

  • Hereditary factors
  • Endocrinal disturbance
  • Deficiency of vitamin A, D or iron
  • Infective (e.g. Klebsiella, Diphtheroids, Proteus vulgaris)
  • Autoimmune process
  • Specific infections (e.g. syphilis, lupus, leprosy)

What are the symptoms of Atrophic Rhinitis?

  • Foul smell from the nose
  • Anosmia
  • Nasal obstruction
  • Epistaxis
  • Nasal mucosa pale
  • Septal perforation
  • Dermatitis of nasal vestibule
  • Cough also hoarseness
  • Hearing impairment

[1] Diseases_of_Ear_Nose_and_Throat_6Edition

[2] Homoeopathic Therapeutics by Lilienthal

[3]https://www.healthline.com/health/atrophic-rhinitis

[4]https://www.wikidoc.org/index.php/Rhinitis_physical_examination

[5]https://my.clevelandclinic.org/health/diseases/22886-atrophic-rhinitis#management-and-treatment

Definition

It is a chronic inflammation of nose characterized by atrophy of nasal mucosa and turbinate bones. The nasal cavities are roomy and full of foul-smelling crusts. Atrophic rhinitis is of two types: primary and secondary.

Frequently Asked Questions (FAQ)

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