Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Atrophic rhinosinusitis

INTRODUCTION

Atrophic rhinitis is an uncommon and distinct clinical syndrome of progressive atrophy of the nasal mucosa with paradoxical nasal congestion, complicated by bacterial colonization and infection and thick, troublesome nasal secretions. Enlargement of the nasal cavities may occur in some forms. Most patients also have concomitant sinusitis and thus the disorder is more accurately called atrophic rhinosinusitis. There are primary and secondary forms of this disorder, which affect different populations and have distinct presentations.

This topic will discuss the classification, clinical manifestations, diagnosis, and management of atrophic rhinosinusitis. Other forms of chronic rhinosinusitis are reviewed separately. (See "Chronic rhinosinusitis: Clinical manifestations, pathophysiology, and diagnosis" and "Management of chronic rhinosinusitis".)

CLASSIFICATION

Atrophic rhinosinusitis may be categorized into two forms: primary (or idiopathic) and secondary.

  • The primary form is seen primarily in young people in the developing world. It is associated with mucosal colonization predominantly with Klebsiella ozaenae as well as other organisms. The primary presenting symptom is foul smelling nasal discharge.
  • Secondary atrophic rhinosinusitis is seen with some regularity in the developed world and occurs in patients who underwent prior sinonasal trauma, surgery, radiation therapy, or have certain inflammatory conditions (granulomatous diseases).

PRIMARY ATROPHIC RHINOSINUSITIS

Primary (idiopathic) atrophic rhinosinusitis is principally reported among patients from lower socioeconomic groups living in geographic areas with warm climates [1-3]. Areas of high prevalence include southern Saudi Arabia, China, Africa, India, the Mediterranean, and the Philippines. It is uncommon in the United States and Europe, although it should be considered in immigrants from these areas [4]. The low incidence in developed countries has been suggested to be at least in part due to widespread availability of antibiotics [5]. By definition, there is no history of nasal trauma or surgery, granulomatous disease, or sinonasal radiation prior to the onset of symptoms.

                           

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2014. | This topic last updated: Nov 27, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Dutt SN, Kameswaran M. The aetiology and management of atrophic rhinitis. J Laryngol Otol 2005; 119:843.
  2. Zohar Y, Talmi YP, Strauss M, et al. Ozena revisited. J Otolaryngol 1990; 19:345.
  3. Bunnag C, Jareoncharsri P, Tansuriyawong P, et al. Characteristics of atrophic rhinitis in Thai patients at the Siriraj Hospital. Rhinology 1999; 37:125.
  4. Lee YJ, Moore LS, Almeyda J. A report on a rare case of Klebsiella ozaenae causing atrophic rhinitis in the UK. BMJ Case Rep 2011; 2011.
  5. Moore EJ, Kern EB. Atrophic rhinitis: a review of 242 cases. Am J Rhinol 2001; 15:355.
  6. Han-Sen C. The ozena problem. Clinical analysis of atrophic rhinitis in 100 cases. Acta Otolaryngol 1982; 93:461.
  7. Chand MS, MacArthur CJ. Primary atrophic rhinitis: a summary of four cases and review of the literature. Otolaryngol Head Neck Surg 1997; 116:554.
  8. El-Barbary A, Yassin A, Fouad H, Shennany M. Histopathological and histochemical study on atrophic rhinitis. J Laryngol Otolaryngol 1970; 84:1103.
  9. Kameswaran M. Fibre-optic endoscopy in atrophic rhinitis. J Laryngol Otol 1991; 105:1014.
  10. Sibert JR, Barton RP. Dominant inheritance in a family with primary atrophic rhinitis. J Med Genet 1980; 17:39.
  11. Abdel-Latif SM, Baheeg SS, Aglan YI, et al. Chronic atrophic rhinitis with fetor (ozena): a histopathologic tretise. Rhinology 1987; 25:117.
  12. Ferguson JL, McCaffrey TV, Kern EB, Martin WJ 2nd. Effect of Klebsiella ozaenae on ciliary activity in vitro: implications in the pathogenesis of atrophic rhinitis. Otolaryngol Head Neck Surg 1990; 102:207.
  13. Pace-Balzan A, Shankar L, Hawke M. Computed tomographic findings in atrophic rhinitis. J Otolaryngol 1991; 20:428.
  14. Castillo L, Verschuur HP, Poissonnet G, et al. Complications of endoscopically guided sinus surgery. Rhinology 1996; 34:215.
  15. Hildenbrand T, Weber RK, Brehmer D. Rhinitis sicca, dry nose and atrophic rhinitis: a review of the literature. Eur Arch Otorhinolaryngol 2011; 268:17.
  16. Ly TH, deShazo RD, Olivier J, et al. Diagnostic criteria for atrophic rhinosinusitis. Am J Med 2009; 122:747.
  17. deShazo RD, Stringer SP. Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery. Curr Opin Allergy Clin Immunol 2011; 11:1.
  18. Mishra A, Kawatra R, Gola M. Interventions for atrophic rhinitis. Cochrane Database Syst Rev 2012; 2:CD008280.
  19. Tomooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope 2000; 110:1189.
  20. Leonard DW, Bolger WE. Topical antibiotic therapy for recalcitrant sinusitis. Laryngoscope 1999; 109:668.
  21. Sinha SN, Sardana DS, Rajvanshi VS. A nine years' review of 273 cases of atrophic rhinitis and its management. J Laryngol Otol 1977; 91:591.
  22. Jaswal A, Jana AK, Sikder B, et al. Novel treatment of atrophic rhinitis: early results. Eur Arch Otorhinolaryngol 2008; 265:1211.