Rhinitis Sicca (Atrophic Rhinitis / Ozena)

Definition and Synonyms

1. Atrophic rhinitis (ozena) - a progressive, degenerative disease of the nasal mucosa. These three terms (rhinitis sicca, atrophic rhinitis, ozena) are used interchangeably in otolaryngology.
2. Dryness of nasal mucous membranes - a symptom in conditions like Sjogren syndrome, low-humidity environments, or winter desiccation, causing nasal crusting and epistaxis.

Atrophic Rhinitis (Primary Form)

Pathology

• Nasal mucosa degenerates and loses mucociliary function
• Histology shows:
  • Squamous metaplasia of respiratory epithelium
  • Glandular atrophy
  • Diffuse endarteritis obliterans
• Mucosal colonization with Klebsiella ozaenae and other organisms (Staphylococcus aureus, Proteus mirabilis, Escherichia coli)

Clinical Features

• Foul-smelling nasal discharge (ozena = Greek for "stench")
• Yellow or green nasal crusting
• Anosmia (paradoxically, patients often cannot smell their own odor)
• Atrophy and fibrosis of nasal mucosa
• The nasal cavity appears wide and empty

Types

Management

• Nasal saline irrigation (cornerstone of treatment)
• Antibiotics (targeting K. ozaenae and colonizing organisms)
• Surgery to reduce nasal cavity size (e.g., submucosal implants to narrow a wide nasal cavity)

Note: Atrophic rhinitis is considered a separate entity from "empty nose syndrome," which is a syndrome of nasal obstruction purported to result from excessive removal of turbinate tissue. - K.J. Lee's Essential Otolaryngology, p. 579

Rhinitis Sicca as a Symptom (Environmental/Systemic)

In Low-Humidity / Environmental Settings

• Common in northern latitudes during winter when indoor heating systems desiccate ambient air
• Low humidity causes nasal mucosal desiccation
• Leading cause of epistaxis in children (ages 2-10), along with digital trauma (nose picking)
• Bleeding typically arises from Kiesselbach's plexus on the anterior nasal septum

• Pinch nostrils for 5-10 min, leaning slightly forward
• Topical vasoconstrictors (oxymetazoline, phenylephrine)
• Silver nitrate cautery if bleeding site is visible
• Topical antibiotic ointment nightly to lubricate mucosa
• Tintinalli's Emergency Medicine, p. (epistaxis section)

In Sjogren Syndrome (Sicca Syndrome)

• Dryness of nasal mucous membranes leads to nasal crusting
• Decreased olfactory acuity (hyposmia)
• Occurs alongside xerostomia, keratoconjunctivitis sicca, vaginal dryness, and fatigue
• The pathological basis is lymphocytic infiltration of exocrine glands with secondary mucosal dryness
• Andrews' Diseases of the Skin, p. (Sjogren section)

Differential Considerations