OVERVIEW

What is atrophic rhinitis?

Atrophic rhinitis, as the name suggests, is a nasal inflammation characterized primarily by the "atrophy" of the nasal mucosa^[1].

In milder cases, the lesions occur superficially, affecting only the nasal mucosa. In more severe cases, the lesions extend deeper, leading to atrophy of the nasal mucosa, underlying turbinates, and even nasal bones.

Common symptoms of atrophic rhinitis include nasal congestion and dryness. In advanced cases, the nasal cavity may enlarge, accompanied by nasal bleeding, reduced or complete loss of smell, and foul-smelling breath.

With improved living standards and nutritional conditions, atrophic rhinitis has become increasingly rare.

What are the types of atrophic rhinitis?

Based on its causes, atrophic rhinitis can be classified into two main types^[1]:

• Primary: The exact cause remains unclear, and it progresses slowly but has a prolonged course.
• Secondary: The cause is identifiable, often related to nasal diseases, chronic irritation, or nasal surgeries.

SYMPTOMS

What are the symptoms of atrophic rhinitis?

Main symptoms include nasal dryness, nasal congestion, dry nasal discharge that easily forms crusts, recurrent nosebleeds, reduced sense of smell, foul odor in the nasal cavity, etc. Nasal discomfort may also cause headaches and ear fullness^[1].

• Nasal congestion: During an episode of atrophic rhinitis, excessive purulent crusts block the nasal cavity, causing congestion. Alternatively, due to atrophy of sensory nerves in the nasal mucosa, the brain may misinterpret the sensation as "nasal congestion" even when the airway is clear.
• Dryness in the nose and throat: Atrophy of nasal mucosal glands reduces secretions, or chronic mouth breathing leads to persistent dryness in the nasopharynx.
• Nosebleeds: Caused by thinning of the nasal mucosa, forceful nose blowing, or nose picking, which ruptures capillaries. Bleeding is usually minor.
• Reduced or loss of smell: Atrophy of the nasal mucosa affects connected olfactory nerves, leading to diminished or absent sense of smell.
• Foul odor: Atrophic rhinitis is also called "ozena" due to the accumulation of purulent crusts and specific bacteria in the nasal cavity, which produce malodorous gases as they decompose. However, most patients cannot detect the smell due to their reduced olfactory function.
• Headache: Pain typically occurs in the forehead, temples, or occipital region. Atrophy of the nasal mucosa impairs its warming and moisturizing functions, and irritation from dry, cold air or pressure from crusts can trigger headaches.

What complications can atrophic rhinitis cause?

Nasal congestion from atrophic rhinitis may lead to headaches, dizziness, and disrupted sleep quality.

Symptoms like nasal dryness, foul odor, and reduced sense of smell can severely disrupt daily life, causing low mood or even depression.

Chronic atrophic rhinitis may spread inflammation to nearby organs, leading to otitis media, dacryocystitis, or pharyngitis.

CAUSES

What Causes Atrophic Rhinitis?

The exact cause of primary atrophic rhinitis is not yet fully understood, but it is currently believed to be related to the following factors^[1,2]:

• Endocrine disorders: For example, hypothyroidism can cause nasal mucosal edema. Atrophic rhinitis is more common in women, possibly due to hormonal changes or endocrine imbalances during pregnancy or menopause.
• Vitamin or trace element deficiencies: Recent studies suggest a link between this condition and deficiencies in vitamins (A, B, D, E) and trace elements, particularly in regions with poor living conditions and inadequate nutrition, where the risk is higher.
• Immune dysfunction: Immunological research has found that most patients with this condition exhibit reduced levels of lactate dehydrogenase in the nasal mucosa, suggesting a possible connection to immune system disorders.

The causes of secondary atrophic rhinitis are well-defined and primarily result from nasal diseases, chronic irritation, or nasal surgeries^[1]:

• Chronic rhinitis or sinusitis: Patients with chronic rhinitis or sinusitis often have excessive mucus and purulent secretions in the nasal cavity, which chronically irritate the nasal mucosa, leading to atrophic rhinitis.
• Physical irritation: Prolonged exposure to high temperatures or dusty environments can irritate the nasal passages, increasing the risk of atrophic rhinitis.
• Chronic hypertrophic rhinitis: This condition can impair blood supply to the nasal mucosa, causing atrophy and resulting in atrophic rhinitis.
• Repeated improper surgical procedures: Excessive removal of mucosa and turbinates, which are responsible for warming and humidifying air, may lead to atrophic rhinitis.
• Specific infectious diseases: Infections such as tuberculosis, syphilis, and leprosy can damage the nasal mucosa, contributing to atrophic rhinitis.

Is Atrophic Rhinitis Hereditary?

Since the root cause of atrophic rhinitis is not yet fully understood, it remains unclear whether the condition is hereditary. Research on this topic is ongoing.

While multiple family members may develop atrophic rhinitis, this does not necessarily indicate genetic inheritance. Shared environmental factors, such as excessively dry living conditions, could explain why several members of the same household develop the condition.

Is Atrophic Rhinitis Contagious?

No. Atrophic rhinitis is not an infectious disease and is not contagious.

DIAGNOSIS

What tests are needed for atrophic rhinitis?

• Nasal endoscopy: Includes anterior rhinoscopy and nasal endoscopy to examine the nasal cavity, nasal mucosa, and nasal secretions. Patients with atrophic rhinitis may exhibit thinning and redness of the nasal mucosa, accompanied by nosebleeds, crusting, and purulent discharge, with possible enlargement of the nasal cavity.
• Imaging tests: Such as CT scans, primarily to assess structural abnormalities in the nasal cavity, rule out other diseases, and aid in diagnosis. Patients with atrophic rhinitis may show thinning of the nasal mucosa, shrinkage of the turbinates, excessive nasal cavity enlargement, or sinus hypoplasia.
• Blood tests: Mainly to check for abnormalities in blood cell counts, assess the possibility of infection, and support diagnosis.

Which diseases have symptoms similar to atrophic rhinitis?

Certain specific nasal infections, such as nasal tuberculosis, leprosy, scleroma, and syphilis, may resemble atrophic rhinitis, as they can also cause nasal congestion, nosebleeds, and thick nasal discharge.

However, these infections often present with unique symptoms. For example, nasal tuberculosis may involve ulcers, while nasal syphilis can cause erosions on the external nasal skin—features absent in atrophic rhinitis. Differentiation can be made through nasal endoscopy and pathogen testing.

TREATMENT

Which department should I visit for atrophic rhinitis?

Otolaryngology (ENT).

Can atrophic rhinitis be cured? How long does treatment take?

Atrophic rhinitis cannot be cured. Current treatments only alleviate symptoms and require long-term, even lifelong management.

How is atrophic rhinitis treated?

There is no specific cure for atrophic rhinitis. The following methods are commonly used^[1,3]:

• Nasal irrigation: Crusts may be purulent or foul-smelling. Rinsing with warm saline solution 1–2 times daily can clean the nasal cavity and remove crusts and odor.
• Nasal medications: Drops like compound menthol oil or cod liver oil moisturize the nasal cavity, soften crusts, and promote shedding. 50% glucose drops may stimulate mucosal secretion.
• Nutritional supplements: Vitamins A, B, C, D, and E protect mucosal epithelium and improve circulation. Iron or zinc supplements may also help.

Surgery is not recommended, and nasal decongestants should be avoided.

What are the common side effects of atrophic rhinitis medications?

Medications for atrophic rhinitis are generally mild with few side effects. Some patients allergic to menthol oil may experience nasal burning—discontinue use if this occurs.

Does atrophic rhinitis require follow-up?

Yes. Follow-up timing depends on recovery progress as advised by your doctor. Seek immediate care if new symptoms arise.

DIET & LIFESTYLE

What should be noted in daily life for atrophic rhinitis?

• Avoid extremely dry or high-temperature environments to reduce irritation to the nasal mucosa. A humidifier can be used indoors.
• Wear a mask when the air quality is poor or when going out in winter.
• Use medications under the guidance of a doctor and avoid purchasing or using nasal sprays without professional advice. Some patients frequently use nasal decongestants (e.g., oxymetazoline hydrochloride, xylometazoline hydrochloride) due to nasal congestion, which is highly inadvisable as it may worsen symptoms rather than alleviate them.
• Avoid blowing the nose forcefully to prevent further irritation of the nasal mucosa.

What dietary precautions should be taken for atrophic rhinitis?

Patients with atrophic rhinitis, due to malnutrition of the nasal mucosa, should focus on consuming foods rich in vitamins, such as fresh fruits, vegetables, and whole grains.

Quit smoking and drinking, and reduce intake of spicy and irritating foods like chili peppers, Sichuan peppercorns, and ginger to minimize nasal mucosa irritation^[2].

Does atrophic rhinitis affect daily activities such as exercise, high-altitude travel, or flying?

• Due to impaired nasal mucosa function, patients should avoid traveling to high-altitude, dry, or oxygen-deficient areas to prevent worsening symptoms.
• When flying, chewing gum or performing chewing motions can help relieve ear discomfort. Seek medical attention if ear pain occurs.
• Light exercises like walking, jogging, or tai chi are generally fine. However, overly intense activities should be avoided as increased breathing effort may exacerbate the sensation of hyperventilation, which is already common in atrophic rhinitis patients.

PREVENTION

How to prevent atrophic rhinitis?

Since the root cause of atrophic rhinitis remains unclear, there are no highly targeted preventive measures. Following these steps may help reduce the risk of developing atrophic rhinitis.

• If you suffer from chronic rhinitis, sinusitis, or chronic hypertrophic rhinitis, seek proper treatment to minimize chronic irritation to the nasal cavity and damage to the blood supply of the nasal mucosa.
• Avoid high-temperature or dusty work or living environments. If unavoidable due to work, take occupational protective measures.
• Undergo nasal surgery at a reputable ENT department to prevent excessive nasal procedures.
• Use an air purifier indoors during severe air pollution and wear a mask outdoors. If indoor air is too dry, use a humidifier to increase humidity.