Contents
What is an ozena?
Ozena or atrophic rhinitis is a disease of the olfactory organs, which is characterized by the appearance of greenish or brownish crusts with an unpleasant odor. When the secret dries, growths form that interfere with normal breathing and may be accompanied by a gradual loss of smell.
The disease of the mucous membranes of the nose was called “ozena”, or “fetid runny nose”. As a result of atrophy of the walls of the bones and mucous membranes of the nasal cavity, a specific secret is accumulated, its gradual formation into crusts with an unpleasant odor that tightly clogs the nasal passages.
An important difference between ozena and the usual atrophic rhinitis is the fact that during ozena, atrophy affects not only the mucous membranes, but also the bone membranes, especially the shells, and the intensely secreted secret has a sharp unpleasant odor. It dries up very quickly, forming growths that make breathing difficult.
Metaplasia, i.e., the transformation of one type of tissue into another, during ozone leads to the transformation of the ciliated cylindrical epithelium into a flat one. However, with the usual atrophic rhinitis, it occurs extremely rarely and only in small areas.
Causes of ozena
To date, the causes of ozena, as well as its symptoms, have not been studied enough. A number of experts argue that the congenital pathology of the nasal cavity is to blame: an excessively enlarged width of the nose, underdeveloped paranasal sinuses and a wide facial part of the skull. Opponents of this theory believe that ozena owes its origin to the degeneration of the nasal mucosa, which, as a result of this process, gradually disintegrates, giving rise to an unpleasant odor.
In Russia, ozena is a rare disease and most known cases are diagnosed in women.
Ozena symptoms
Symptoms of ozena are severe dryness in the nose, the accumulation of numerous crusts, the appearance of a characteristic unpleasant odor, difficulty breathing through the nose, loss of smell or its sharp deterioration.
Ozena is an insidious disease that begins in early childhood (7-8 years) and reaches the final stage closer to 40 years and older.
In medical practice, there are 3 stages of atrophic rhinitis:
First or initial;
Progressive;
Last.
Each of them is characterized by its own characteristics.
The first stage
The initial stage has no special symptoms. Childhood illness begins as chronic rhinitis. Only an experienced doctor is able to trace the development of ozen in a child, which is visualized by an increase in the nasal sinuses and changes in the color of the mucosa.
Since the development of the disease, ozena is gaining strength and the smell from the nose becomes more pronounced and pronounced. This is followed by damage to the receptors, the child practically does not feel anything. It is important to note that ozena is much more common in girls. Especially in adolescence.
middle stage
This stage is characterized by the almost complete absence of smell. The nose starts to flow. Patients complain of difficulties associated with breathing, increased dryness in the nose, which follows the formation of rough crusts. A person suffering from atrophic rhinitis develops weakness, dizziness and frequent nosebleeds. Patients become more irritable. Against this background, depressive disorders may occur.
Final stage
The last stage appears at the age of about 40 years and older. Dryness in the nose begins to bother less, the crusts disappear, the smell disappears. There seems to be a recovery, but the effects of rhinitis remain and require treatment.
Diagnostics
Atrophic rhinitis is diagnosed by the following manifestations:
Clinical symptoms;
medical history;
Rhinoscopy and additional research.
The disease is characterized by difficulties in diagnosis, especially at the peak of development. Doctors often treat ozena like a common cold. And only with the appearance of crusts and a specific smell is the diagnosis made with a 100% probability. Diagnosis of ozena can be carried out in the following cases: chronic rhinitis, purulent sinusitis, osteomyelitis, tumors, syphilis.
Ozena treatment
Traditional treatments for ozena include elimination of dryness and accumulation of crusts in the nose and deodorization. In this case, the nose is washed with a three percent solution of hydrogen peroxide, potassium permanganate (pink), and a simple saline solution. For convenience, use an Esmarch mug or a watering can for the nose. The washing procedure is quite simple: the patient needs to tilt his head forward, slightly opening his mouth so that the therapeutic fluid freely pours out through one of the halves of the nose and is not swallowed. In the process of washing, it is necessary to act carefully, to ensure that the medicine does not get into the auditory tube.
The doctor may also perform a Gotstein tamponade. A tampon soaked in a one to two percent solution of iodine in glycerin is placed in the nasal cavity and left for two to three hours. Then the swab is removed, and with it the crusts with an unpleasant odor are removed. In some cases, it is recommended to lubricate the nose daily with a two to five percent solution of iodoglycerin.
A number of studies have shown an improvement in the condition of patients with ozena after the use of such physiotherapeutic procedures as iontophoresis and diathermy. Positive results were also obtained after inhalation of ionized air by patients, as a result of which patients were prescribed to use an air ionizer at home.
The essence of the surgical treatment of ozena is the artificial narrowing of the nasal cavity. The most sparing surgical technique is the introduction of fat, bone, cartilage into the submucosal tissue. After implantation, a strong reaction of the mucous membrane and perichondrium occurs, which is expressed in increased formation of connective tissue and blood vessels, an increase in the size and number of mucous glands. Such serious changes that occurred as a result of surgical intervention lead to an improvement in the condition of patients.
Recently, new trends have emerged in the treatment of ozena. The bone was replaced by polystyrene (ivalon) with the further introduction of deoxycorticosteroid acetate under the patient’s skin as a hormone that stimulates the development of connective tissues and blood vessels.
The most radical method today is the Lautenschläger surgical operation. It lies in the fact that the inner wall of the maxillary sinus of the patient is pressed to the nasal septum. At the same time, the wall of the sinus is separated and with the help of a tampon it is fixed in the desired position. Subsequently, the separated wall is held in a new position as a result of the fusion of the surfaces of the nasal concha and the nasal septum.
Complications
Ozena can lead to various complications. First of all, the larynx, ears and eyes suffer. In other cases, there are problems with the gastrointestinal tract, neuritis, bronchitis, memory loss, depressive disorders. Patients may suffer from psychological disorders, up to suicide attempts or complete rejection of society.
Prevention
Preventive measures during the development of ozena are aimed at reducing the deterioration of the patient’s condition, preventing relapse, and reducing the likelihood of infecting others. Doctors recommend to undergo therapy in a timely manner, regularly treat cutlery with bactericidal agents, and take measures aimed at strengthening immunity. Rejection of bad habits, proper nutrition and regular care of the sinuses will contribute to a speedy recovery.