Atrophic Rhinitis

Overview

What is atrophic rhinitis?

Atrophic rhinitis is nasal dryness that occurs when tissue inside of your nose thins or atrophies. Eventually, the tissue hardens. As a result, the nasal cavities where air flows through your nostrils widen. Your nasal passages become too dry, causing a foul-smelling nasal crust to form.

What do the terms “atrophic” and “rhinitis” mean?

You might better understand this condition when you break it down:

  • Atrophic or atrophy is the medical term for the shrinking, thinning or loss of tissue. With atrophic rhinitis, a thin layer of expandable tissue called mucosa inside of your nose becomes thinner and then hardens. This tissue covers bones called the turbinates that warm, humidify and filter the air you breathe. The turbinate bones may also shrink or become thinner.
  • Rhinitis is swelling (edema) and inflammation of your nasal passages. This inflammation affects your respiratory system, causing breathing problems.

How common is atrophic rhinitis?

Atrophic rhinitis is a type of nonallergic rhinitis. The common cold is another type. At any given time, as many as 30 million Americans have some type of nonallergic rhinitis.

What’s the difference between nonallergic rhinitis and allergic rhinitis?

Allergic rhinitis (hay fever) is trigged by allergens that trigger an immune response. These triggers include (but aren’t limited to) pollen, mold, pet dander or other allergens. Symptoms include chronic nasal congestion, runny nose, sneezing, sore throat and postnasal drip.

With nonallergic rhinitis, triggers like odors, smoke, medications and hormonal imbalances generally cause you to sneeze or have a runny nose. You may also have a chronic cough from postnasal drip.

What are the types of atrophic rhinitis?

There are two types of atrophic rhinitis:

  • Primary atrophic rhinitis is rare in North America. It affects about 1% of adults who live in hot, dry climates like India, Africa and Saudi Arabia. This type can also affect livestock like pigs and cows.
  • Secondary atrophic rhinitis mostly affects people who get sinus surgeries. It can occur after a turbinate reduction. This surgical procedure for nasal congestion removes part or all of the turbinates and reduces (shrinks) your mucosa tissue.
  • Rhinitis medicamentosa: This condition may lead to rhinitis in people who are taking nasal decongestants (such as oxymetazoline and phenylephrine) for long periods. Using these nasal sprays for more than three consecutive days isn’t generally recommended. The condition may lead to atrophic rhinitis.

Symptoms and Causes

What causes primary atrophic rhinitis?

Potential causes of primary atrophic rhinitis include:

  • Allergies.
  • Bacterial infections.
  • Estrogen hormone imbalance.
  • Family history of atrophic rhinitis.
  • Lack of iron or vitamins A or D.
  • Structural changes to nasal passages present at birth (congenital).

What causes secondary atrophic rhinitis?

In addition to nasal surgeries, other potential risk factors for secondary atrophic rhinitis include:

What are the symptoms of atrophic rhinitis?

Atrophic rhinitis can cause a foul-smelling crust to form inside your nostrils. Your nose may bleed if you try to dislodge it. You may also have bad breath (halitosis). You might not notice these odors, but others will.

Other symptoms of atrophic rhinitis include:

Diagnosis and Tests

How is atrophic rhinitis diagnosed?

You receive care from an otolaryngologist, a medical doctor who specializes in ear, nose and throat (ENT) conditions. Your healthcare provider will perform a physical exam and may initially diagnose the condition based on your symptoms.

You may also receive:

  • 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.

Management and Treatment

How do you treat atrophic rhinitis?

There isn’t a cure for atrophic rhinitis, but treatments can reduce the foul-smelling crust and minimize symptoms. They include:

  • Antibiotic ointments that you apply inside of your nose.
  • Moisturizing nasal ointments.
  • Estrogen in a pill or nasal spray.
  • Vitamins.
  • Humidifier.

What are surgical treatments for atrophic rhinitis?

Although rare, some people get surgery to treat the condition. There are different surgical procedures. Your healthcare provider can discuss the best option for you.

Surgery can:

  • Close off one nostril and nasal cavity, sometimes with a prosthetic (artificial) device.
  • Make your nasal passages smaller.
  • Intranasal injections.

What are home remedies for atrophic rhinitis?

You can take these steps to ease symptoms of atrophic rhinitis:

  • Lubricate nasal passages with nasal sprays or drops as recommended by your healthcare provider.
  • Moisturize the air with a humidifier.
  • Rinse out your nasal passages with a saltwater solution (nasal irrigation).

What are the complications of atrophic rhinitis?

In rare instances, atrophic rhinitis can cause you to lose your sense of smell (anosmia). You may also develop empty nose syndrome. This condition can make you feel like there’s something blocking your nasal passages, yet they’re wide open. As a result, you may constantly feel short of breath even though your lungs are taking in sufficient oxygen.

Prevention

Can you prevent atrophic rhinitis?

Unfortunately, there isn’t any way to prevent atrophic rhinitis.

Outlook / Prognosis

What is the outlook for someone with atrophic rhinitis?

Atrophic rhinitis is a chronic (long-term) condition. You can take steps to keep your nasal passages moist and minimize symptoms.

Living With

When should I call the doctor?

Call your healthcare provider if you experience:

  • Difficulty breathing.
  • Diminished sense of smell.
  • Chronic cough.
  • Nasal dryness and crusting.
  • Nasal obstruction (feeling like there’s something blocking your open nasal passages).
  • Recurrent nosebleeds.

What should I ask my provider?

You may want to ask your healthcare provider:

  • What caused atrophic rhinitis?
  • What medications can help?
  • What steps can I take at home to ease symptoms?
  • Do I need surgery?
  • Should I look for signs of complications?

A note from Cleveland Clinic

Living with persistent nasal dryness and crusting can be challenging. You’re more at risk for developing atrophic rhinitis after getting a sinus surgery like a turbinectomy. But a facial injury, bacterial infection and other conditions can also lead to this rare type of nonallergic rhinitis. Your healthcare provider can discuss treatment options with you. You may benefit from prescription medications and at-home treatments. Some people need surgery.

Last reviewed by a Cleveland Clinic medical professional on 04/25/2022.

References

  • Burks AW. Allergic and Nonallergic Rhinitis. (https://www.sciencedirect.com/topics/medicine-and-dentistry/atrophic-rhinitis) In Corren J, Baroody FM, Togias A, eds. Middleton's Allergy: Principles and Practice. 9th ed. Elsevier Inc.; 2020:Ch. 40, 636-658. Accessed 4/25/2022.
  • Dutt SN, Kameswaran M. The aetiology and management of atrophic rhinitis. (https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0022215105002161) The Journal of Laryngology & Otology. 2005 Nov;119:843-852. Accessed 4/25/2022.
  • Merck Manual (Consumer Version). Rhinitis. (https://www.merckmanuals.com/home/ear,-nose,-and-throat-disorders/nose-and-sinus-disorders/rhinitis) Accessed 4/25/2022.
  • National Health Service (NHS in the UK). Overview: Non-allergic Rhinitis. (https://www.nhs.uk/conditions/non-allergic-rhinitis/) Accessed 4/25/2022.
  • Sur DKC, Plesa ML. Chronic Nonallergic Rhinitis. (https://www.aafp.org/afp/2018/0801/p171.html) Am Fam Physician. 2018 Aug 1;98(3):171-176. Accessed 4/25/2022.

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