Interventions for atrophic rhinitis

Atrophic rhinitis is a chronic nasal condition with unknown cause. It is characterised by the formation of thick dry crusts in a roomy nasal cavity, which has resulted from progressive wasting away or decrease in size (atrophy) of the mucous nasal lining (mucosa) and underlying bone. The various symptoms include foetor (strong offensive smell), crusting/nasal obstruction, nosebleeds, anosmia (loss of smell) or cacosmia (hallucination of disagreeable odour), secondary infection, maggot infestation, nasal deformity, pharyngitis, otitis media and even, rarely, extension into the brain and its membranes. Atrophic rhinitis can be classed as primary or, where it is a consequence of another condition or event, secondary. Its prevalence varies in different regions of the world but it is common in tropical countries. A wide variety of treatments have been described in the literature, however treatment is usually conservative (for example, nasal irrigation and douches; nose drops (e.g. glucose-glycerine, liquid paraffin); antibiotics and antimicrobials; vasodilators (drugs that cause dilation of blood vessels) and prostheses). Surgical treatment aims to decrease the size of the nasal cavities, promote regeneration of normal mucosa, increase lubrication of dry nasal mucosa and improve the vascularity (blood flow) of the nasal cavities.

We searched systematically for randomised controlled trials (RCTs) studying any treatment or combination of treatments for atrophic rhinitis in patients with atrophic rhinitis. Despite a comprehensive search we found no RCTs which met our inclusion criteria, although a RCT comparing surgery (Young’s operation) with nasal lubrication for primary atropic rhinitis is underway. Further high-quality research into this chronic disease, with a longer follow-up period, is therefore required to conclusively establish the long-term benefits or risks of different treatment modalities for atrophic rhinitis

Authors' conclusions: 

There is no evidence from randomised controlled trials concerning the long-term benefits or risks of different treatment modalities for atrophic rhinitis. Further high-quality research into this chronic disease, with a longer follow-up period, is therefore required to establish this conclusively. 

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Background: 

Atrophic rhinitis is a chronic nasal pathology characterised by the formation of thick dry crusts in a roomy nasal cavity, which has resulted from progressive atrophy of the nasal mucosa and underlying bone. The common symptoms may include foetor, ozaena, crusting/nasal obstruction, epistaxis, anosmia/cacosmia and secondary infection with maggot infestation. Its prevalence varies in different regions of the world and it is common in tropical countries. The condition is predominantly seen in young and middle-aged adults, especially females, with a racial preference amongst Asians, Hispanics and African-Americans. A wide variety of treatment modalities have been described in the literature, however the mainstay of treatment is conservative (for example, nasal irrigation and douches; nose drops (e.g. glucose-glycerine, liquid paraffin); antibiotics and antimicrobials; vasodilators and prostheses). Surgical treatment aims to decrease the size of the nasal cavities, promote regeneration of normal mucosa, increase lubrication of dry nasal mucosa and improve the vascularity of the nasal cavities.

Objectives: 

To assess the effectiveness of interventions for atrophic rhinitis.

Search strategy: 

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 28 March 2011.

Selection criteria: 

Randomised controlled trials (RCTs) studying any treatment or combination of treatments in patients with atrophic rhinitis. We excluded studies with follow-up of less than five months following treatment/intervention.

Data collection and analysis: 

Three review authors abstracted and assessed studies. We tabulated and then compared the responses of the review authors separately for the individual studies.

Main results: 

No studies met the inclusion criteria for the review. We identified one RCT comparing oral rifampicin plus nasal wash versus nasal submucosal placentrex injection plus nasal wash versus a control group (nasal wash) but had to exclude this study due to inadequate length of follow-up. A further RCT comparing Young’s operation with nasal lubrication for primary atropic rhinitis is underway.

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