R. NICKBRYANMDPATRICIA A.HUDGINSMD
Primary atrophic rhinitis, or ozena, is a chronic nasal disease that is characterized by progressive mucosal atrophy with resorption of the underlying bone and formation of thick, foul-smelling crusts. In 1876, Fraenkel described these clinical findings as a separate entity of the nose.1 The disease is uncommon in the United States but appears to be endemic in subtropical and temperate countries. In affected areas, such as Egypt, the annual incidence among ear, nose, and throat outpatients is 1%.2 The exact etiology of atrophic rhinitis remains elusive, although several pathogenetic factors have been suggested. Bacterial organisms, including Klebsiella ozaenae, nontoxic Corynebacterium diphtheriae, and Coccobacillus, have been reported to cause atrophic rhinitis; however, some of them may secondarily invade damaged mucosa.3 Iron and vitamin A deficiency are also purported causes.4 Han-Sen5 found 84% symptomatic improvement in patients treated with high doses of vitamin A. The disease is more common in women than in men, supporting a hormonal theory, mainly estrogen deficiency.6 Autonomic imbalance, poor pneumatization of the maxillary sinus, collagen disorder, and heredity have also been investigated as causative factors.7 Mickiewicz et al8 found atrophic rhinitis in workers exposed to phosphorite and apatite dusts.
Radiology Quiz Case 4: Diagnosis. Arch Otolaryngol Head Neck Surg. 2005;131(8):744–745. doi:10.1001/archotol.131.8.744