Data on prevalence of atrophic rhinitis in the whole population are absent. In recent years in Russia classical forms of an ozena meet seldom, however prevalence of the secondary (iatrogenic) atrophic rhinitises caused by performance of excessively radical surgical interventions on nasal sinks increases.
Etiology and pathogeny
Atrophic rhinitis (ozena) is characterized by degenerative and sclerous changes of a mucous membrane and a metaplasia of a cylindrical epithelium in flat, caused by influence of external factors (for example, development of atrophic rhinitis in the addicts who are systematically accepting cocaine is very typical) or a surgical injury.
Atrophic process in a nasal cavity is connected with the specific activator — Klebsiella ozenae. It is not proved yet whether this microorganism is primary activator of this form of rhinitis or she colonizes a nasal cavity when there certain conditions are created, for example, at an iron deficiency anemia. Atrophic process takes not only a mucous membrane, but also intranasal bone structures, causing their gradual resorption. It leads to considerable expansion of a gleam of a nasal cavity that even more strengthens the drying-up action of a stream of the inhaled air and formation of crusts. In a separate form of atrophic rhinitis allocate the so-called "syndrome of an empty nose" developing after surgical removal of nasal sinks and broad opening of bosoms of a sievebone.
Clinical signs and symptoms
The main symptoms of atrophic rhinitis — formation of the crusts complicating nasal breath, and less often — an unpleasant smell from a nose. The rinoskopichesky picture — sharply expanded nasal cavity with the reduced nasal sinks and a large number dried up purulent the gray-green color separated, forming large crusts which obturirut its gleam is characteristic.
The diagnosis and the recommended clinical trials
Are necessary: • microbiological research of a nasal secret; • determination of level of iron in blood serum; • a X-ray analysis or a computer tomography of okolonosovy bosoms (for an exception of the accompanying sinusitis).
Statement of the diagnosis of atrophic rhinitis does not cause difficulties.
General principles of treatment
Symptomatic treatment. The regular irrigation of a nasal cavity for the purpose of removal of crusts and moistening of a mucous membrane remains by the main method in treatment of atrophic rhinitis. Patients can independently wash out a nasal cavity warm (35 — 40 °C) isotonic or buffered hypertonic salt solution or the otorhinolaryngologist makes a nasal cavity toilet, deleting a pathological secret with a suction. In the presence of plentiful purulent separated and an exacerbation of the accompanying sinusitis wash out a nasal cavity solutions of antimicrobic medicines or appoint a course of system antibacterial therapy. Drugs select taking into account sensitivity of the specific activator: Amikacin on 1 g to dissolve in 1 l of the distilled water, washing of a nasal cavity (a nasal shower) 2 r / days during 4 weeks or Rifampicin on 0,6 g 2 r / days during 4 weeks or Ciprofloxacin inside on 250 — 500 mg 2 r/sut14 days Locally apply the solutions, oils and ointments containing vitamins (And, B2) and Mucolyticums: Acetylcysteinum, nasal aerosol, intranazalno on 2 doses (with an interval of 5 min.) in each nostril 3 — 4 r / days
The combined drugs (Mucolyticums + vasoconstrictive): Acetylcysteinum / tuaminogeptana sulfate, a nasal aerosol, on 2 doses in each nostril 3 — 4 r / days Therapy of an iron deficiency anemia is carried out. Surgical treatment at atrophic rhinitis consists in implantation under a mucous membrane in the field of a bottom of a nasal cavity and a partition of a spongy bone, an autokhryashch, amniotic covers, mesh lavsan, teflon, capron and other alloplastichesky materials. These interventions which are carried out for the purpose of narrowing of the nasal courses not always give desirable effect.
Assessment of efficiency of treatment of atrophic rhinitis
The effect of the carried-out treatment is estimated on the basis of change of clinical manifestations (reduction of an unpleasant smell from a nose) and a rinoskopichesky picture (reduction of quantity of crusts, improvement of a condition of a mucous membrane).
Complications and side effects of treatment
Aminoglikozidny antibiotics possess ototoksichesky and nephrotoxic action. Surgical narrowing of a gleam of a nasal cavity due to replanting under a mucous membrane of a cartilage, a bone and the more so synthetic materials is followed by high risk of their rejection, suppuration and progressing of a disease.
Mistakes and unreasonable appointments
Treatment often happens inefficient at addicts cocaine addicts who, continuing to take drug, usually hide it from the doctor. Carrying out further therapy in similar conditions is inexpedient.
The forecast is adverse. All existing methods of treatment give short-term effect. Soon after the termination of medical actions symptoms of a disease recur.