Atrophic Rhinitis

Atrophic rhinitis is nasal dryness that occurs when tissue inside your nose thins or breaks down (atrophies). Eventually, this tissue hardens. As a result, the nasal cavities where air flows through your nostrils widen. Your nasal passages come into more contact with air and become too dry. A foul-smelling crust can form inside your nose.

There isn’t a cure for atrophic rhinitis. But an otolaryngologist (ENT) can help you find treatments to manage it.

Types of atrophic rhinitis

There are two main types:

• Primary atrophic rhinitis: This type is rare in North America. Experts don’t know what causes it. But it’s linked to several possible causes, including bacterial infections.
• Secondary atrophic rhinitis: This type is most often a rare complication of sinus surgery. Sometimes, it happens in people who overuse nasal decongestant sprays. This is called rhinitis medicamentosa.

Symptoms of atrophic rhinitis

This condition 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. Others usually notice the odors before you do.

Symptoms include:

• Dryness and crusting inside your nose
• Feeling like your nose is blocked
• Frequent nosebleeds
• Drainage that may contain pus

Atrophic rhinitis causes

Causes depend on whether your condition is primary or secondary.

Primary atrophic rhinitis

Medical experts don’t know what causes primary atrophic rhinitis. It’s more common in places that are dry and warm for long periods, like India, Africa and Saudi Arabia. Females are affected most. Most people who have it have bacterial infections inside their noses. The most common kind linked to this condition is Klebsiella ozaenae (K. ozaenae).

Other potential causes include:

• Atypical nasal passages present at birth
• Estrogen hormone imbalance
• Biological family history of atrophic rhinitis
• Lack of iron or vitamins A or D

Secondary atrophic rhinitis

Surgery on your nose is the most common cause. Usually, it’s surgery to make the tiny bones and related tissue inside your nose smaller (turbinate reduction surgery). Symptoms can start from months to years after surgery. Other causes include:

• Conditions that weaken your immune system or cause vasculitis, like granulomatosis with polyangiitis, leprosy, sarcoidosis, syphilis and tuberculosis, as well as others
• Overuse of nasal decongestant sprays
• Radiation therapy to your head and neck area
• Trauma or injury to your nose

Complications of this condition

In rare instances, atrophic rhinitis can cause you to lose your sense of smell. You may also develop empty nose syndrome (ENS). This condition can make you feel like there’s something blocking your nasal passages. But there isn’t. Even though your lungs take in enough oxygen, you may feel short of breath.

How doctors diagnose this condition

Your healthcare provider will do a physical exam. They can diagnose the condition based on your symptoms.

You may need:

• Allergy tests to rule out rhinitis caused by allergies
• CT scan to get detailed images of your nasal cavities
• Culture test to check for bacteria like K. ozaenae
• Nasal endoscopy using a flexible tube with a camera (endoscope) to view the inside of your nose
• Nasal inspiratory flow test to measure airflow when you breathe

How do you treat atrophic rhinitis?

There isn’t a cure, but treatments can reduce symptoms. They include:

• Antibiotics: Antibiotics can kill any bacteria linked to the condition. This medicine comes in pill form, as an IV or as an ointment you rub inside your nose.
• Estrogen: Taking estrogen can widen damaged blood vessels, aiding blood flow. This helps your nose secrete mucus that moisturizes your nose. Estrogen may come as a pill or a nasal spray.
• Humidifier: Using a humidifier adds moisture to the air you breathe. This can help relieve the dryness inside your nose.
• Nasal drops: Drops that contain glucose (sugar) and glycerin (sugar alcohol) can help fight bacteria. They can add moisture to the tissue inside your nose.
• Nasal injections: Injections of safe filler material can reduce symptoms linked to empty nose syndrome. Platelet-rich plasma injections may help repair the damaged nasal tissue. But more research is needed to know for sure.
• Nasal irrigation: Flushing your nasal cavity with a saline solution can clear out crusts. The water can combat dryness. You may need to irrigate several times a day.
• Nutrition supplements: You may need to take iron pills or vitamin supplements if a deficiency is causing issues.

Surgery for atrophic rhinitis

If medicines, drops or injections aren’t helping enough, you may need surgery. The goal is to make your nasal cavities smaller. Adding bulk to your nasal cavity adds resistance to the air flowing through your nose. This can make sensations in your nose feel more normal. It may promote tissue healing.

Your surgeon may insert an implant into your nose. It may be a tissue graft from elsewhere on your body. Or it may be a safe, synthetic material. Another technique closes off one nostril and nasal cavity. Your surgeon may close off either all or part of the nostril.

When should I see my healthcare provider?

Call your healthcare provider if you experience symptoms of atrophic rhinitis. The sooner you reach out, the sooner you can find the right treatments to manage it.

What is the outlook for someone with this condition?

Atrophic rhinitis is a chronic (long-term) condition. But there are steps you can take to manage symptoms. Your healthcare provider will work with you to find treatments that help.

Most people experience relief without needing surgery.

What is the difference between rhinitis and atrophic rhinitis?

Atrophic rhinitis is a specific type of rhinitis.

Rhinitis is swelling and inflammation of your nasal passages. With atrophic rhinitis, swelling happens because the tissue inside your nose breaks down. Atrophy is the medical term for the shrinking, thinning or loss of tissue.

What is another name for atrophic rhinitis?

Other names include:

• Acute necrotizing rhinitis
• Coryza foetida
• Rhinitis atrophicans

Another name for primary atrophic rhinitis is ozaena.