What is the treatment for atrophic rhinitis?

Treatment of Atrophic Rhinitis

The mainstay of treatment for atrophic rhinitis is continuous nasal hygiene with saline or sodium bicarbonate irrigations, periodic crust debridement, and antibiotics for purulent secretions or acute infections. 1

Types of Atrophic Rhinitis

• Primary (idiopathic) atrophic rhinitis is more prevalent in developing countries with warm climates and is characterized by progressive atrophy of the nasal mucosa, nasal crusting, dryness, and foul odor (fetor) 1
• Secondary atrophic rhinitis develops as a result of other conditions such as chronic granulomatous disorders, chronic sinusitis, excessive nasal turbinate surgery, trauma, and radiation 1
• Both types present with similar symptoms but may differ in severity and progression, with secondary atrophic rhinitis potentially being less severe 1

Clinical Presentation

• Progressive atrophy of nasal mucosa with thick dry crusts in a roomy nasal cavity 2
• Foul odor (ozaena) that patients and others can detect 3
• Nasal dryness due to atrophy of glandular cells 1
• Paradoxical nasal congestion despite enlarged nasal cavities 1, 4
• Possible anosmia/cacosmia and epistaxis 2
• CT findings show characteristic resorption of underlying bone and absence of identifiable turbinates ("empty nose syndrome") 1

Treatment Algorithm

First-line Treatment (Conservative Management)

1. Continuous nasal hygiene:

   • Regular nasal lavage with saline or sodium bicarbonate solution 1
   • Periodic debridement of crusts when necessary 1

2. Antimicrobial therapy:

   • For purulent secretions: Add antibiotics such as mupirocin to the lavage solution 1
   • For acute infections: Systemic antibiotics 1
   • Consider targeted antibiotics against common pathogens (Klebsiella ozaenae, S. aureus, Proteus mirabilis, E. coli) 1, 3

Specific Antibiotic Approaches

• Aminoglycosides (tobramycin, gentamicin) have shown effectiveness against K. ozaenae 3
  • Topical aminoglycosides may provide effective and less expensive treatment compared to intravenous administration 3

Preventive Measures

• Maintain good nasal hygiene 5
• Ensure a well-balanced diet 5
• Smoking cessation 5
• Early detection and treatment of nasal pathology 5

Important Considerations and Pitfalls

• No controlled trials exist evaluating therapies for atrophic rhinitis, and even observational data are limited 1, 2
• Avoid excessive turbinate surgery as it can lead to secondary atrophic rhinitis 4
• Long-term management is required as atrophic rhinitis is a chronic condition that may not completely resolve 2, 6
• Regular follow-up is necessary to assess treatment response and adjust therapy as needed 5
• Patient education about the chronic nature of the disease and importance of consistent nasal hygiene is crucial 6

Special Populations

• Primary atrophic rhinitis is more common in women and in tropical countries 5
• Secondary atrophic rhinitis is more common in adults with systemic disease, history of extensive nasal surgery, or nasal trauma 5