Atrophic RhinitisAtrophic Rhinitis  ’Ozena’’Ozena’
Bastaninejad, Shahin, MD, ORL & HNS, TUMSBastaninejad, Shahin, MD, ORL & HNS, TUMS
Amiralam HospitalAmiralam Hospital
and degenerativeand degenerative
& paranasal& paranasal
crusts and roomy nasal cavities  thisthis
triad is diagnostic of the conditiontriad is diagnostic of the condition
Prevalence of Primary ARPrima
prevalence countries
Pa"istan! #hina! Philippines! $alaysia!
 
&ilateral! Prevalent in young an mile age aults
,ften! no unerlying etiology is iscovere,ften! no unerlying etiology is iscovere!
although inherita&le or infectious causes (./%
. oena+ are propose mechanisms
there is ho2ever little evience to suggest
&acterial organisms cause the isease! they may
&e seconary invaers
 
1. 6' in #R > 6' in Polypoi #R
7. In $ayo clinic assay : Partial $8 an9or I8
resection 2as the most common cause
#omplication of raiation (7.%+
6ollo2ing nasal trauma (1%+
other infections : 8;! arcoiosis! <eprosy!
Rhinoscleroma! yphilis
#olumnar+   metaplastic changes  
 Atrophy of cilia  an the mucosal an
su&mucosal glan
oour 
tur&inates
o&literans+
seconary infections (main characteristic)"(main characteristic)"
 Anosmia! cacosmia
8hic" purulent ischarge 2ith a foul smell (ue to the
anaero&ic &acteria+
#omplain of ryness in the nose an throat
(pharyngitis sicca+
mucosa is seen 2hen crusts are separate
Patient is usually gloomy
6oetor (etecte from istance+
hrin"age of inferior an mile tur&inates
Insensitivity of nasal mucosa (pro&e test+
eptal perforation! myiasis! sale nose B
may &e seen
uppurating aenoial isease
=eglecte 6; 9 rhinoliths
Stenkvist
hat ishat is ENSENS!!
ENS is an iatrogeniciatrogenic  disorder most often recognized by the  presence of
paradoxical nasal obstructionparadoxical nasal obstruction despite an objectively wide nasal fossa
 
8he resorption of the tur&inate an aCacent
mucosal tissue that results from atrophic rhinitis
is reflective of the unerlying pathophysiology of
the isease! 2hereas '= is an iatrogenic
isorer 
econary AR may also &e the result of a
multitue of other factors! incluing trauma!
infection! or immunologic isorers.
 Atrophic rhinitis has clear pathogenic lin"s to
organisms isolate from nasal cultures! &ut as of
yet! there is no pathogen associate 2ith '=
 
'R
6;
morphological inices
of the treatment
 
3. oium chlorie 0g
,ne teaspoonful of this miEture in 70cc
lu"e2arm 2ater! ts or i! for *2"! 2ith a 10 to
70cc syringe
proceure an "eep saying B
 
7. ?lycerine *0cc
ou can also use ?entamicin or
#hloramphenicol rops after nasal
Rifampicin *00mg aily for 172" (generic cap.
is 300mg J ta"e 7 every morning+
Recently: #ipro 00-/0mg &i for 1-3mo#ipro 00-/0mg &i for 1-3mo
>itamin A ! 17!00 I9ay up to t2o
2ee"s.
 
3+ $oification of moifie oung
K+ Implantation
+ ,ther approaches
#ircumferential flap elevation 1 cm cephalic to the
alar rim
ifficult to elevate circumferential flap
 
odified +oungodified +oung
Staged second side with first side takedownStaged second side with first side takedown
in 6 moin 6 mo
No vestibular stenosis on takedownNo vestibular stenosis on takedown
 
 
1 in in Plastipore series! &ut in another
prosthetic series it 2as occure as high as
0%
 
Silastic SheetSilastic Sheet  Case: Primary AR -. Case: Primary AR -.momo !osto! result!osto! result
((/tolaryngology01ead and 'ec2 Surgery (/tolaryngology01ead and 'ec2 Surgery (.3-3.3-3))))
RightRight
sinus antrum
lateral nasal 2all more meially
ilastic o&turator
P rim a ry
A tro p h
77 n
itis
' n o s c
% in u s %
u rg e ry