Atrophic rhinitis is a chronic disease characterized by atrophic nasal mucosa, enlarged nasal cavity, and accumulation of crusts. Symptoms such as nasal dryness, foul odor, and nasal congestion often affect patients' quality of life. Although a complete cure is currently unavailable, scientific and systematic comprehensive treatment can effectively control symptoms and slow disease progression. This article systematically explains the treatment strategies for atrophic rhinitis from three perspectives: basic nursing care (focusing on nasal irrigation), medication, and surgical treatment.
Basic Nursing Care
Dryness and atrophy of the nasal mucosa are the core issues of the disease, so maintaining a moist environment is the foundation of treatment. Daily nasal irrigation can remove pus crusts, bacteria, and secretions, improve nasal ventilation, and reduce foul odor.
Mechanism of Action of Nasal Irrigation
Eliminating Pathogens: Patients with atrophic rhinitis often accumulate pus crusts in their nasal cavity, providing a breeding ground for bacteria (such as Staphylococcus aureus and Streptococcus). Nasal irrigation can directly flush out these pathogens, reducing the risk of infection. For example, one study showed that daily nasal irrigation can reduce nasal bacterial counts by 60%-80%.
Relieves dryness: Irrigation solutions (such as saline) form a moist film in the nasal cavity, reducing water evaporation and alleviating mucosal dryness. Furthermore, the mechanical stimulation during irrigation promotes glandular secretion, further improving moisturization.
Reduces odor: Gases such as ammonia and hydrogen sulfide produced by the decomposition of pus crusts are the primary source of nasal odor. Irrigation can remove pus crusts, reduce odor, and improve patients' quality of life.
Promotes mucosal repair: By removing inflammatory mediators and necrotic tissue, irrigation creates a clean environment for mucosal repair and accelerates epithelial cell regeneration.
Suitable Patients and Frequency of Nasal Irrigation
Suitable Patients: Nasal irrigation is recommended for all patients with atrophic rhinitis, especially those with severe symptoms (such as frequent crusting and a pronounced odor) or those with concurrent sinusitis or allergic rhinitis. Frequency: During the acute phase of symptoms (e.g., increased crusting and odor), rinse 2-3 times daily. After symptoms resolve, reduce to once daily as long-term maintenance treatment. For children and the elderly, the frequency can be adjusted based on tolerance.
Nasal Irrigation Procedure
Equipment: Select a dedicated nasal irrigator (e.g., nasal spray bottle, squeeze bottle, electric irrigator). Avoid using tap water (which may contain chlorine or pathogens). 0.9% normal saline (isotonic) or 2.3% hypertonic saline is recommended as an irrigant (as directed by a physician).
Position: Stand or sit, tilt your head slightly forward, and keep your mouth slightly open (to avoid choking). Gently insert the irrigator nozzle or catheter into one nostril.
Irrigation Procedure: Gently squeeze the irrigator bottle to allow the liquid to flow from one nostril and out through the back of the nasal cavity, either into the other nostril or into the mouth. Avoid excessive force when irrigating to avoid damaging the mucosa.
Nasal Cleansing: After irrigating, gently blow your nose with a tissue to remove any residual fluid and loosened crusts. Avoid pinching both nostrils simultaneously and blowing your nose forcefully to prevent otitis media.
Cleaning Tools: After rinsing, rinse the nasal irrigation device with clean water and air dry before use to prevent bacterial growth.
Precautions for Nasal Irrigation
Water Temperature Control: The irrigant should be close to body temperature (35-37°C). Excessively cold or hot irrigants may irritate the mucosa, causing pain or bleeding. You can warm a bottle of saline solution by soaking it in warm water, or use a constant-temperature irrigator.
Irrigation Solution Options:
Normal saline: 0.9% concentration has the same osmotic pressure as human body fluids, is mild and non-irritating, and suitable for long-term use.
Hypertonic saline (2.3%-3%): Can reduce mucosal edema, but long-term use may cause mucosal dryness and should be used under a doctor's supervision.
Avoid adding medications such as antibiotics and hormones, as these may disrupt the nasal flora balance or cause side effects.
Contraindications: Nasal irrigation should be used temporarily in patients with heavy nasal bleeding, a perforated nasal septum, or acute sinusitis (with fever or headache). The underlying condition must be treated first. Managing Adverse Reactions:
Nosebleeds: Stop rinsing immediately, apply pressure with a clean cotton ball to stop the bleeding, and apply a cold compress to the nose. If the bleeding persists, seek medical attention.
Earache: This may be caused by the irrigant entering the middle ear through the Eustachian tube. When irrigating, keep your head tilted forward and your mouth slightly open to avoid excessive pressure.
Nasal irritation: Reduce the concentration of the irrigant or reduce the frequency of irrigating. Symptoms often resolve on their own.
Nasal Irrigation Aids and Techniques
Choosing Nasal Irrigation Devices:
Nasal spray bottles: Suitable for children or first-time users, easy to use but with less force.
Squeeze bottles: Adjustable force, suitable for adults, but require proper squeezing technique.
Electric irrigators: Use pulsed water to deeply cleanse the nasal cavity. They are highly effective but more expensive.
Irrigation Techniques:
Please apply a warm towel to the nose before irrigating to soften the crust and improve irrigating effectiveness.
Coordinate your breathing while irrigating: Breathe slowly to avoid holding your breath, which can cause choking. After rinsing, use a lubricant, such as compound peppermint oil nasal drops, to further moisten the nasal cavity.
Maintain indoor humidity between 50% and 60%. A dry environment accelerates evaporation of nasal moisture, exacerbating mucosal atrophy. Humidity can be adjusted using a humidifier or a basin of water, especially in winter or when using air conditioning. Wearing a mask when going out can reduce damage to the nasal cavity from irritants such as cold air and dust, while also keeping the nasal cavity warm and moist. For example, those with nasal sensitivity to cold air can apply a warm towel to the nose before wearing a mask before going out in winter.
Dietary adjustments. Consuming foods rich in vitamins A, B2, C, and E, such as carrots, spinach, oranges, and nuts, can promote mucosal epithelial cell regeneration. Vitamin A strengthens the mucosal barrier function, while vitamin C has antioxidant properties and reduces inflammation. Avoid spicy, greasy, and overly hot foods to prevent mucosal congestion and worsen dryness. For example, those with weak spleen and stomach can supplement with spleen-tonifying foods such as yam and lotus seeds to enhance nutrient absorption.
Drug treatment
Drug treatment should be stratified according to the cause and symptoms. Topical medications are the first choice:
Lubricants: Nasal drops such as compound peppermint oil and paraffin oil can form a protective film to reduce moisture evaporation and relieve dryness. Apply to the nasal lining 2-3 times daily, but be careful not to block the nasal cavity with oily substances.
Antibiotic nasal drops: For patients with concurrent bacterial infections, 1%-3% streptomycin solution can be used as nasal drops to inhibit bacterial growth and reduce crust formation. For example, after two weeks of continuous use, nasal odor reduction rates reached 65%.
Estrogens: Nasal drops such as 0.5% diethylstilbestrol oil can promote mucosal vasodilation, improve local blood circulation, and stimulate glandular secretions. They are suitable for patients with severe mucosal atrophy, but dosage should be strictly controlled according to a doctor's instructions.
Glucocorticoid sprays: Such as budesonide nasal spray, have anti-inflammatory and anti-edema properties and can reduce mucosal inflammation. However, long-term use may cause nasal dryness and should be used with a lubricant.
Systemic medications should be used with caution:
Vitamin supplementation: Oral administration of vitamins A, D, and E, as well as iron, improves mucosal nutrition and promotes repair. For example, vitamin D deficiency is closely associated with mucosal atrophy, and supplementation can significantly improve symptoms.
Antibiotics: In cases of concurrent sinusitis or severe infection, oral antibiotics are necessary to control inflammation, but overuse, which can lead to drug resistance, should be avoided.
Surgical treatment
For patients who fail conservative treatment or have severe nasal structural abnormalities, surgery can effectively improve symptoms. Common procedures include:
Subperiosteal nasal implantation: Autologous cartilage, bone chips, or bioceramics are implanted beneath the nasal mucoperiosteum to reduce nasal volume and minimize water evaporation.
Lateral nasal wall medialization and fixation: By medializing and fixing the nasal concha, direct airflow impacts the mucosa and alleviates dryness symptoms. This procedure is suitable for patients with significant nasal concha atrophy, but caution should be exercised regarding the potential for lateral wall repositioning after surgery, necessitating the use of additional fixation materials for improved efficacy.
Anterior nares closure: For patients with extremely severe atrophy, a portion of the nostrils is temporarily closed to retain nasal moisture, and then reopened after mucosal function has recovered. This procedure can significantly improve malodor symptoms, but it requires strict adherence to indications to avoid structural changes in the nasal cavity caused by prolonged closure.
Treatment of atrophic rhinitis is a systematic, long-term process. Nasal irrigation, as a fundamental and crucial nursing measure, must be consistently and consistently performed in a standardized manner. Medication therapy requires strict adherence to doctor's instructions, with timely adjustments made based on changes in the condition. Surgical treatment requires precise adherence to indications to ensure safety and effectiveness. Furthermore, daily routine care, such as maintaining nasal cleanliness, avoiding irritants, and maintaining a balanced diet and rest schedule, is crucial. Only by integrating comprehensive treatment with daily care can the disease be optimally controlled and its progression slowed.
