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 "Clinical manifestations, pathophysiology, and diagnosis of chronic rhinosinusitis" 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.