49 years
A bad smell is felt in my nose sometimes . i took suprax and nasonex and it did not work. what to do?
Aug 14, 2014
The exact cause of primary atrophic rhinitis is not known, but the following factors have been suggested to play a role:
(a) Hereditary factors: more than one member in the same family is affected
(b) Endocrinal disturbance: it usually starts in puberty, affects females more than males, the crusting and bad smell associated with disease tends to fade away after menopause; which makes it likely that this condition has an endocrine origin
(c) Racial factors. White and yellow races are more susceptible.
(d) Nutritional deficiency: this condition has been attributed to Vit A, D or iron deficiency, especially that this illness is rarely encountered in well-to- do families, which raises the possibility of some sort of nutritional deficiency.
(e) Infective. Klebsiella ozaenae , (Perez bacillus), diphtheroids, P vulgaris, E. coli, Staphylococci and Streptococci but these bacteria are all thought to be secondary invaders that cause the foul smell rather than the primary causative agents.
(f) Autoimmune process. The immune system in the body reacts by a self-destructive process to the antigens released from the nasal mucosa. This can be triggered by certain viral infections or some other unspecified agents
This disease is commonly seen in females and starts around puberty. You may be having nasal obstruction although your nasal canals are wider than usual; this is because of large crusts filling the nose. Epistaxis (nose bleeds) may occur upon removal of the crusts. The nasal cavity is usually full of greenish or greyish black dry crusts covering the turbinates and septum, nasal turbinates may be shrunken is size, and the nasal mucosa appears pale. Similar changes may occur in the larynx with cough and hoarseness of voice (atrophic laryngitis).
Hearing dysfucntion may be present and is due to obstruction to eustachian tube (the thin curved tube that drains the ears) and middle ear effusion (fluid accumulates behind the ear drum because of the eustachian tube obstruction).
The disease is chronic (lasts for years) but tends to resolver spontaneously in middle age.
Treatment
1. Nasal hygiene by removal of crusts
2. Nasal irrigation and removal of crusts using warm normal saline to make the crusts softer and more loose. This should be 2 -3 times per day but later once every 2 or 3 days is sufficient.
3. Local application of antibiotics: a thin layer of Fucidin applied with a cotton tip twice daily
If you do not improve within a month or so, you need to consult an ENT specialist.
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