Is your nose always dry? Does it have a bad smell and crusts? It could be (Atrophic Rhinitis)!

Do you also feel like your nose is always dry? Do you sometimes feel like your nose smells bad, or do you feel like crusty things are forming inside your nose? Then this is something that may be important to you. We call this condition `(Atrophic Rhinitis)`. Let's talk about it simply and in a way that is easy to understand.

What is `(Atrophic Rhinitis)`?

Simply put, `(Atrophic Rhinitis)` is a condition in which the tissue inside your nose dries out and shrinks. Think of it like a plant drying out without water. Over time, this tissue becomes thinner and can sometimes become hard . As a result, the airways through your nostrils become wider. But the problem is, because there is no moisture inside your nose, a crust forms inside your nose that has a very bad smell . This is a really annoying condition.

What do the words "Atrophic" and "Rhinitis" mean?

To understand this situation better, let's analyze these two words a little.

• Atrophic or atrophy is a medical term for the shrinking, thinning, or loss of tissue. In atrophic rhinitis, the thin, thin lining (similar to skin) inside your nose called the mucosa becomes thin and then becomes hard . This mucosa covers the tiny bones inside your nose called the turbinates, which warm, moisten, and filter the air we breathe. Sometimes these turbinates can also shrink or thin.
• Rhinitis is the swelling (also called edema) and inflammation of the nasal passages. This inflammation can affect your respiratory system and cause difficulty breathing.

So, it's clear to you now that `(Atrophic Rhinitis)` is a condition in which the tissues inside the nose become shrunken, swollen, and inflamed.

How common is `(Atrophic Rhinitis)`?

Atrophic Rhinitis is a type of rhinitis that is not caused by an allergy . The common cold is another example of this. At any given time, it is estimated that about 30 million people in the United States suffer from some form of non-allergic rhinitis. Sri Lanka is no exception to this condition.

The difference between nonallergic rhinitis and allergic rhinitis

There is a slight difference between these two.

• Allergic rhinitis ( also known as hay fever) is caused by certain things (allergens) that trigger our body's immune system (immune response). Examples include pollen, mold, and animal dander. Symptoms can include a stuffy nose, runny nose , sneezing, sore throat, and postnasal drip.
• In non-allergic rhinitis , sneezing and runny nose are usually caused by things like odors, smoke, certain medications, and hormonal imbalances. Postnasal drip can also cause a persistent cough. Atrophic rhinitis falls into this category.

What are the types of `(Atrophic Rhinitis)`?

There are two main types of `(Atrophic Rhinitis)`:

1. Primary Atrophic Rhinitis : This is very rare in countries like North America. However, in countries with hot, dry climates like India, Africa, and Saudi Arabia, about 1% of adults can develop this. Surprisingly, this type can also develop in animals like cows and pigs.

2. Secondary Atrophic Rhinitis : This mostly affects people who have had sinus surgeries. This can especially happen after a turbinate reduction surgery. This surgery involves removing some or all of the turbinates. This causes the mucosa to shrink.

Also keep in mind the condition called `(Rhinitis Medicamentosa)`: Some people use `(nasal decongestants)` (for example `(sprays)` like `(oxymetazoline)` and `(phenylephrine)`) for a long time. It is generally not recommended to use `(sprays)` like this for more than three days in a row. If you continue to use it, you may develop a condition called `(Rhinitis Medicamentosa)`, which can even lead to `(Atrophic Rhinitis)`. Therefore, it is best to use nasal `(sprays)` only as directed by your doctor.

What are the causes of primary `(Atrophic Rhinitis)`?

There are several possible causes of primary atrophic rhinitis:

• Allergies.
• Bacterial infections.
• Imbalance of the hormone estrogen.
• If someone in the family has `(Atrophic Rhinitis)` (something that is hereditary).
• Deficiency of nutrients such as iron, vitamin A, or vitamin D.
• If there are congenital (`(congenital)`) structural changes in the nasal passages.

What are the causes of secondary `(Atrophic Rhinitis)`?

In addition to nasal surgery, there are several other risk factors for developing secondary ``Atrophic Rhinitis``:

• Autoimmune diseases (diseases in which our body's own defense system attacks our own body).
• Diseases such as `(Granulomatosis with polyangiitis (GPA))` (formerly known as `(Wegener's)`).
• Other infections, including sinus infections.
• Radiation therapy for cancer.
• A disease called ``Sarcoidosis``.
• Sexually transmitted diseases like syphilis.
• Accidents or injuries to the nose.
• As mentioned earlier, prolonged use of nasal decongestant sprays.

What are the symptoms of `(Atrophic Rhinitis)`?

The main symptom, and one that is easily noticeable to others, is the formation of a crust inside the nostrils that has a very bad smell . If you try to remove the crust with your hands or something else, you may experience nosebleeds (`(epistaxis)`). You may also experience a bad smell from the mouth (`(halitosis)`).

The strange thing is, you may not notice this bad smell! But the people around you will definitely notice it. This can make you feel uncomfortable in public.

Other symptoms that may be seen include:

• Frequent nosebleeds (epistaxis).
• A pus-like fluid coming out of the nose.
• Dry and crusty nose (this is what you feel first).
• Sinus infections (sinusitis).

Imagine, there is a person named Nilanthi, who has been developing these kinds of crusts on her nose for some time, and it also smells bad. She has been ignoring it. Later, her friends said, "Nilanthi, sometimes when I'm around you, I smell a little strange." That's when Nilanthi decided to look into this. So, sometimes we can be uncomfortable for others without even realizing it.

How to diagnose `(Atrophic Rhinitis)`?

If you have these symptoms, you should see an ear, nose, and throat specialist (an otolaryngologist, or ENT doctor). He or she will examine you and first diagnose the condition based on your symptoms.

In addition, you can also do tests like these:

• Allergy tests to confirm whether you have allergies or not.
• Take detailed pictures of the nasal cavities (CT scan).
• A test called a nasal endoscopy involves inserting a flexible tube (endoscope) with a camera inside the nose to look for polyps (growths) or other problems inside the nose.
• A ``Nasal inspiratory flow test'' measures how much air goes in through the nose when you breathe.

How is `(Atrophic Rhinitis)` treated?

To be honest, there is currently no cure for `(Atrophic Rhinitis)`. However, there are treatments to reduce that bad-smelling crust and control the symptoms. Don't worry, you can get relief with these treatments.

General treatment

• Apply antibiotic ointments inside the nose (if there is an infection).
• Moisturizing nasal ointments are given to keep the nose moist.
• Estrogen-containing pills or nasal spray.
• Vitamins.
• Use a humidifier to increase the humidity in the air at home.

Surgical treatment

This is very rare, but some people need surgery to treat this condition. There are different surgical options. Your doctor will explain to you which option is best for you.

Surgery can do things like:

• The closure of one nostril and nasal cavity (sometimes using a prosthetic device).
• Narrowing the nasal passages.
• Intranasal injections.

What remedies can be done at home?

You can do these things at home to reduce the symptoms of `(Atrophic Rhinitis)`:

• Keep your nasal passages moist : Use nasal sprays or drops as recommended by your doctor. Rinsing your nose with saline water is a good idea.
• Add moisture to the air : Use a humidifier to maintain moisture in the air at home, especially in the bedroom.
• Nasal irrigation : Rinsing the nasal passages with a salt water solution (made by adding a little salt to boiled water) helps to remove crusts and clear the nose. You can use something like a neti pot for this.

What are the possible complications of `(Atrophic Rhinitis)`?

It's very rare, but atrophic rhinitis can cause you to lose your sense of smell completely (anosmia) . You can also have a condition called empty nose syndrome . This is a strange condition. This is when your nasal passages are open and wide, but you still feel like something is stuck in your nose. So, even though your lungs are getting enough oxygen, you may still feel short of breath.

Can `(Atrophic Rhinitis)` be prevented?

Unfortunately, there is currently no way to prevent the occurrence of `(Atrophic Rhinitis)`.

What is the outlook for someone with `(Atrophic Rhinitis)`?

Atrophic Rhinitis is a long-term (chronic) condition . This means that it doesn't go away completely in a short time. But don't worry. You can do things like keep your nasal passages moist, minimize your symptoms, and live a normal life. The most important thing is to follow your doctor's instructions.

When should you see a doctor?

If you have symptoms like these, it's best to see a doctor for advice:

• If you have difficulty breathing.
• If your sense of smell seems to have decreased.
• If you have a persistent cough.
• If the nose continues to be dry and crusty.
• If you have a feeling of something being blocked (`(nasal obstruction)`) even though your nasal passages are open.
• If you have frequent nosebleeds.

Although these things can happen with a common cold, if they persist, you should definitely see a doctor.

Things to ask your doctor

When you go to see a doctor, don't forget to ask these questions:

• Why do I have `(Atrophic Rhinitis)`?
• What medications can help me?
• What can I do at home to reduce symptoms?
• Will I need surgery?
• Should I be aware of complications?

Things we need to remember from this story

Having a dry, crusty nose can be really annoying. You're especially at risk of developing atrophic rhinitis after a sinus surgery like a turbinectomy. However, this rare form of non-allergic rhinitis can also occur due to other causes, such as a facial injury or bacterial infection.

The most important thing is that if you have these symptoms, don't be afraid to see a doctor and get advice. Then you can talk about the right treatment options for you. You may find relief with medications and home remedies. It is very rare that you will have to resort to surgery. So, it is very important to be aware of this.

` Atrophic rhinitis, dry nose, nasal crusts, bad breath, nosebleeds, ENT, respiratory diseases