Treatment of Atrophic Rhinitis

Introduction to Atrophic Rhinitis

The American Academy of Allergy, Asthma, and Immunology recommends continuous nasal hygiene with saline or sodium bicarbonate irrigations, periodic crust debridement, and antibiotics for purulent secretions or acute infections as the mainstay of treatment for atrophic rhinitis 1, 2

Primary (idiopathic) atrophic rhinitis is more prevalent in developing countries with warm climates and is characterized by progressive atrophy of the nasal mucosa, nasal crusting, dryness, and foul odor (fetor) 1, 3
Secondary atrophic rhinitis develops as a result of other conditions such as chronic granulomatous disorders, chronic sinusitis, excessive nasal turbinate surgery, trauma, and radiation 1, 2

Nasal dryness due to atrophy of glandular cells 1
Paradoxical nasal congestion despite enlarged nasal cavities 1, 2
CT findings show characteristic resorption of underlying bone and absence of identifiable turbinates ("empty nose syndrome") 1, 3

Regular nasal lavage with saline or sodium bicarbonate solution is recommended as part of continuous nasal hygiene 1, 2
Periodic debridement of crusts when necessary is recommended as part of continuous nasal hygiene 1, 2
For purulent secretions, adding antibiotics such as mupirocin to the lavage solution is recommended 1
For acute infections, systemic antibiotics are recommended 1, 2
Consider targeted antibiotics against common pathogens (Klebsiella ozaenae, S. aureus, Proteus mirabilis, E. coli) 1, 2

No controlled trials exist evaluating therapies for atrophic rhinitis, and even observational data are limited 1