Ozena (foetid runny nose) is a disease of the nasal mucosa. Ozena is an atrophic process of the mucous membrane and bone walls of the nasal cavity, accompanied by the formation of a secret that dries into fetid crusts that cover the mucous membrane with a dense layer.
In contrast to a simple atrophic rhinitis, an atrophic process is characterized by spreading to the bony walls of the nasal cavity, especially to the bone of the shells, producing a rapidly drying discharge with a strong specific unpleasant odor, which does not occur with atrophic rhinitis.
With lakes, metaplasia of the ciliated cylindrical epithelium into a flat one is characteristic of most of the nasal mucosa, while with a simple atrophic rhinitis, it does not always happen and captures only small areas.
The reasons
The reasons for the development of the lake are still unclear. Some authors believe that the cause of the disease is congenital excessive width of the nose, shortening of the anterior-posterior dimensions of the nasal cavity, underdevelopment of the paranasal sinuses and a wide facial skull. Other authors associate the origin of ozena with the degeneration of the nasal mucosa. The reborn mucosa disintegrates, emitting an unpleasant odor.
In our country, ozena is relatively rare, mainly in women.
Symptoms
Patients with ozena complain of dryness in the nose, the formation of a large number of crusts, the presence of an unpleasant characteristic odor, difficulty in nasal breathing, and a sharp decrease or absence of smell. With rhinoscopy, brownish or yellow-green crusts are clearly visible in both halves of the nose, which cover the nasal mucosa and often fill almost its entire cavity, can spread to the nasopharynx, middle pharynx, and even the larynx and trachea. After removal of the crusts, the nasal cavity appears to be enlarged, in places there is a viscous yellow-green exudate on the mucous membrane.
At the beginning of the disease, the atrophic process mainly affects the lower shell, but then captures all the walls. The nasal cavity becomes so wide that during rhinoscopy the posterior wall of the nasopharynx, the mouth of the auditory tubes is visible; sometimes you can see the upper shell.
Diagnosis
The diagnosis of ozena is established on the basis of a characteristic fetid odor from the nose, the presence of an abundant amount of crusts, atrophy of the mucous membrane and bony walls of the nasal cavity. Ozena is often accompanied by severe atrophic pharyngitis, laryngitis, and sometimes atrophic tracheitis.
Treatment
Conservative treatment of ozena involves the elimination of dryness in the nose, accumulation of crusts and deodorization. Rinse the nose with a 3% solution of hydrogen peroxide, a weak pink solution of potassium permanganate, or a simple saline solution. To do this, use a special nasal watering can or Esmarch’s mug. In order for the liquid not to enter the auditory tube, washing should be done with caution: the patient tilts his head forward, slightly opens his mouth, and then the washing liquid is not swallowed, but pours out through one or the other half of the nose. Gotshtein’s tamponade is performed by a doctor: the nasal cavity is filled with a gauze swab moistened with a 1-2% solution of iodine in glycerin. The swab is left in the nose for 2-3 hours. When the tampon is removed, the fetid crusts go away.
In some cases, it is recommended to lubricate the nose every day with 2-5% iodoglycerin.
Treatment is applied with chlorophyllocarotene paste, manufactured according to the method of F. T. Solodky. One suppository from the paste is injected into both halves of the nose once every day for one month. After a few minutes, the bad smell from the nose disappears, and this condition lasts for 2 days. With the repeated introduction of the paste, the deodorization period is extended to 3-5 days. The course of treatment should be carried out 4 times during the year.
Some authors have observed an improvement in the condition of patients from the use of physiotherapeutic procedures, for example, from diathermy and iontophoresis. Good results are noted after inhalation of ionized air (therefore, patients are advised to keep an air ionizer at home).
The essence of the surgical treatment of ozena is the artificial narrowing of the nasal cavity. Of all the surgical techniques, the most gentle is the introduction of fat, bone, cartilage into the submucosal tissue. As a result of implantation of the material, a strong reaction occurs from the perichondrium and mucous membrane, which is expressed in increased formation of connective tissue, blood vessels and an increase in the size and number of mucous glands. These changes in the aftermath of the operation and cause improvement.
For later, instead of bone, foam (ivalon) is used, followed by the introduction of diseased deoxycorticosteroid acetate under the skin as a hormone that promotes the development of blood vessels and connective tissue.
A more radical surgical technique is the Lautenschläger operation, which consists in pushing the inner wall of the maxillary sinus to the nasal septum. The sinus wall is separated and fixed in the desired position with a swab. Subsequently, the separated wall is held in a new position by the fusion of the surfaces of the nasal septum and nasal conchas.