CHRONIC ATROPHIC RHINITIS (OZ.ENA) Formerly, all nasal affections having all offensive discharge were designated by the term ozna. In recent times, the term has become restricted, and a number of affections whch are attended by ulcerations of the mucous membranes and the osteocartilaginous framework have been separated. To this class belong the syphilitic processes (frequent destruction of the septum), and tuberculosis of the nose. The term ozaffia is now restricted to a well-defined characteristic elisease,—chronic atrophic rhinitis. It essentially consists in the transformation of the cylindrical epithelium of the nose (especially that of the inferior tur binated bone) into numerous layers of corneous and decaying pavement epithelium with atrophy of the entire mucosa. in the course of time, the subjacent, cartilag,inous and bony parts also undergo atrophy.
The etiology of oztena is still obscure. Possibly it, is engendered by specific bacteria. The frequently present bacillus mucosa ozaina is, however, a saprophyte. Usually the disease develops only after the 10th-12th year, and is therefore seldom seen in children. By way of exception it has also been diagnosticated as early as the 3rd-4th year (Bailey). Frequently, parents, sisters, and brothers, suffer from the same disease which attacks with predilection persons having broad faces, broad noses.
Girls are more frequently afflicted than boys. The disease princi pally attacks and scrofulous individuals. Hereclitary syphilis is unjustly held responsible. Ozadia most frequently develops inde pendently, at times also seeming to originate from a simple hypertrophic rhinitis.
The symptoms of ozxna in advanced eases are well marked. Usually, however, the patients are brought to the physician only when they an noy all their associates by the offensive odor. On examination the interior of the nose is found remarkably wide, so that without further trouble a large portion of the posterior pharyngeal wall may be sur veyed. The fetid breath arises from a large quantity of secretion which often covers the entire nasal cavity with tough, sticky crusts. If these crusts are removed there is found underneath a liquid purulent secre tion and a thin, smooth mucosa. In advanced stages, the highly shriv
elled condition of the inferior turbinated bone is very significant. The patients bear their affliction with great equanimity; and as they fre quently have lost their sense of smell they are unaware of the stench which emanates from the stagnated secretion. They are more apt to complain of the inability to remove the crusts from the nose, and of the troublesome pharyngitis sicea which constantly accompanies it. Ozna. cannot be cured, but the disease may be temporarily improved by rational treatment. At all events, the offensive odor may be made to disappear.
Diagnosis.—The diagnosis is made by direct inspection, but more accurately by the use of the nasal speculum and reflected light; ulti mately, by aid of the probe. In young children it suffices to allow the reflected light to fall into the nasal cavity without the aid of a specu lum by everting the tip of the nose. Marked tumefaction of the anterior portion obstructing the. Vie IV usually subsides after pencilling with co caine, whereby it is shown that one is not dealing with a true hyperplasia but with a simple congestion.
"Snuffles- during the early months of life, demands a close search for other manifestations of syphilis. Foreign bodies cause a one-sided purulent discharge. Next to rhinitis, the most frequent cause of im peded nasal breathing is found in the presence of adenoids in the naso pharynx. Where the latter predominate, the secretion is generally more scanty, and in cases of extensive obstruction, in addition to defective speech, impairment of hearing is frequently present.
Chronic atrophic rhinitis is recognized by its extremely chronic course, its fetid discharge showing a strong tendency to dry and to form tough crusts, and by the spacious nasal cavity with atrophy of the mucous membrane and of the framework. Ulcerations, foreign bodies, abscesses of the accessory cavities (very frequent), are to be excluded. Mucous polypi are exceedingly rare, and are found only in older children. They are easily recognized by their roundish pediculated shape, their mobility, and by their semi-transparent, whitish,. or pale-red, appearance.