Ozena
Ozena causes and symptoms
What is Ozena?
The disease of the mucous membranes of the nose is called "ozena", or "fetid rhinitis". As a result of atrophy of the walls of the bones and mucous membranes of the nasal cavity, a specific secretion accumulates, its gradual formation into crusts with an unpleasant odor, tightly blocking the nasal passages.
An important difference between the ozena and the usual atrophic rhinitis is the fact that when ozena, atrophy affects not only the mucous membranes, but also the bony membranes, especially the shells, and the intensely secreted secret has a sharp unpleasant odor. It dries up very quickly, forming growths that make breathing difficult.
Metaplasia, that is, the transformation of tissue of one type into another, in the case of osen, leads to the transformation of the ciliated columnar epithelium into a flat one. However, with the usual atrophic rhinitis, it occurs extremely rarely and only in small areas.
Ozena reasons
To date, the causes of ozena, as well as its symptoms, are not well understood. A number of experts argue that the congenital pathology of the nasal cavity is to blame for everything: an excessively increased width of the nose, underdeveloped paranasal sinuses and a wide facial part of the skull. Opponents of this theory believe that ozena owes its origin to the degeneration of the nasal mucosa, which, as a result of this process, gradually disintegrates, giving rise to an unpleasant odor.
In Russia, ozena is a rare disease and is diagnosed in most of the known cases in women.
Ozena symptoms and diagnosis
Ozena's symptoms are severe dryness in the nose, accumulation of numerous crusts, the appearance of a characteristic unpleasant odor, difficulty breathing through the nose, loss of smell or a sharp deterioration in it.
Rhinoscopic examinations clearly show the appearance of yellow-green or brown crusts in both nasal sinuses. Often the crusts cover the nasal mucosa so tightly that they fill almost the entire nasal cavity. They can spread further: into the nasopharynx, middle section, larynx and trachea. After the crusts are removed, the cleaned nasal cavity takes on a more expanded appearance, and a viscous exudate of yellow-green color is fragmentary on the mucous membrane itself.
At the initial stage of the disease, atrophy of the lower shell occurs, and subsequently the process goes directly to the walls. The nasal cavity expands significantly. At the same time, during rhinoscopy, one can see the posterior wall of the nasopharynx, the mouth of the auditory tubes, and in especially severe cases, the superior concha.
Asking the question “What is Ozena?”, You need to remember about the accurate diagnosis of the disease, which is the first step towards effective treatment. The correct diagnosis is made on the basis of the following symptoms of ozena: a characteristic fetid odor from the nose, numerous crusts, atrophy of the mucous membranes and bony walls of the nasal cavity. Often the course of this disease is complicated by pronounced laryngitis, atrophic pharyngitis, less often - atrophic tracheitis.
Ozena treatment
Traditional treatments for ozena include nasal dryness and crusts and deodorization. In this case, the nose is washed with a 3% solution of hydrogen peroxide, potassium permanganate (pink), and a simple saline solution. For convenience, use an Esmarch mug or a nose watering can. The washing procedure is quite simple: the patient needs to tilt his head forward, opening his mouth slightly so that the medicinal liquid flows freely through one of the halves of the nose and is not swallowed. In the process of flushing, you must act carefully, make sure that the medicine does not enter the auditory tube.
The doctor may also perform a Gotstein tamponade. A tampon soaked in one to two percent solution of iodine in glycerin is placed in the nasal cavity and left for two to three hours. Then the tampon is removed, and with it the crusts with an unpleasant odor are removed. In some cases, it is recommended to lubricate the nose daily with a two to five percent solution of iodoglycerin.
It is worth mentioning the treatment with chlorophyll carotene paste, which is made according to F. T. Solodky's recipe. The patient is injected daily for one month into both halves of the nose, one candle from this paste. In just 5-10 minutes, the unfavorable smell from the nose disappears. The effect lasts for two days. With the next introduction of the paste, the period of deodorization increases. This treatment course should be carried out four times a year.
A number of studies have shown an improvement in the condition of patients with ozena after using such physiotherapeutic procedures as iontophoresis and diathermy. Positive results were obtained after patients inhaled ionized air, as a result of which patients were prescribed to use an air ionizer at home.
The essence of the surgical method for the treatment of ozena consists in the artificial narrowing of the nasal cavity. The most gentle surgical technique is the introduction of fat, bone, cartilage into the submucous tissue. After implantation, a strong reaction of the mucous membrane and perichondrium occurs, which is expressed in the strengthening of the formation of connective tissue and blood vessels, an increase in the size and number of mucous glands. Such serious changes that have occurred as a result of surgical intervention lead to an improvement in the condition of patients.
Recently, new trends have emerged in the treatment of ozena. The bone was replaced by polystyrene (ivalone) with further administration of deoxycorticosteroid acetate under the patient's skin as a hormone that stimulates the development of connective tissues and blood vessels.
Lautenschläger's surgery is considered the most radical method today. It consists in the fact that the inner wall of the maxillary sinus of the patient is pressed against the nasal septum. At the same time, the wall of the sinus is separated and, using a tampon, it is fixed in the desired position. Subsequently, the separated wall is held in a new position as a result of the fusion of the surfaces of the nasal concha and the nasal septum.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
