Ozaena is a disease that affects the mucous membrane of the nose. The disease term is derived from the Greek words for ‘stink’ and ‘bad-smelling nasal polyp’. The disease is sometimes called ‘rhinitis atrophicans cum foetore’. In common parlance, ozaena is also known as stinky nose. Ozaena is relatively uncommon.
What is ozaena?
In ozaena, the nasal mucosa is affected by pathological changes. The disease occurs with very low prevalence in the average population. Medical science primarily distinguishes between two different forms of ozaena. These are primary and secondary ozaena. Primary ozaena is thought to be caused by genetic factors. In this form of the disease of the nasal mucosa, there is no association with other diseases. The secondary form of ozaena develops mainly in association with other diseases or various external factors, for example as a result of surgery. Typical for both forms of ozaena is the decrease of tissue in the area of the mucous membrane of the nose. This phenomenon is called atrophy in medical terminology. As a result of this loss of mucosal tissue, a habitat for bacterial pathogens is formed. These increasingly settle in the nose and lead to a strong unpleasant odor. For this reason, ozaena bears the colloquial name stinky nose.
Causes
The exact causes of the development of ozaena are still mostly unexplored. This uncertainty regarding the causes relates particularly to the primary form of ozaena. In this case, however, doctors assume that a hereditary component is involved in the development of the disease. This type of ozaena primarily affects female patients from the pubertal stage onwards. In addition, observations show that the disease occurs more frequently in certain families. In the secondary form of ozaena, the causes for the development of the disease are better understood. Here, external factors are primarily responsible, leading to a decrease in the nasal mucosa. Enlarged sinuses of the nose also come into question as development factors. Other external influences of secondary ozaena include, for example, damage to the sinuses or nose, tumors in the area of the nose, and surgical interventions in the nasal region. Other risk factors include intensive use of nasal sprays with an anti-swelling effect and abnormalities in the anatomy of the nasal septum.
Symptoms, complaints, and signs
Various symptoms and complaints characterize the clinical picture of ozaena. The leading symptom of the disease is a strong, malodorous odor emanating from the diseased nose. The smell is formed as a result of loss of mucosal tissue inside the nose. This is because special types of bacteria are able to spread inside the nose as a result. These bacterial pathogens cause a slimy coating to form in the nose. The coating gives off the characteristic odor of ozaena, which smells foul. Not only the mucous membranes, but also the mucous glands are affected by the decline of the mucous membrane in the nose. As a result, a progressive drying of the inner part of the nose develops. In addition, a typical bark develops, which is usually yellowish to black in color. The bark may have a negative effect on breathing through the nose. If the bark detaches inside the nose, there is often increased bleeding. In addition, the olfactory nerves are also affected by the receding tissue. As a result, in numerous cases the sense of smell of the diseased patients deteriorates. In addition, the sense of taste is sometimes also reduced. Due to the deteriorated sense of smell, affected individuals are unable to realize the malodorous stench coming from their nose. Other potential complaints of ozaena include pain of the nose and head and pus formation. In particularly severe courses of the disease, regression of the bony portion of the turbinate occurs.
Diagnosis and course of the disease
The diagnosis of ozaena is usually made by an ear, nose, and throat specialist. The patient first presents his main complaints and the circumstances of their development. Then, the attending specialist physically examines the affected patient.For example, the doctor analyzes the condition of the mucous membrane of the nose using a rhinoscope. This reveals, among other things, the typical bark and other abnormalities. In addition, the doctor usually takes a swab from the mucous membrane of the nose. This allows the bacterial pathogens present to be precisely identified, so that targeted therapy is possible. An important criterion for the diagnosis of ozaena is the characteristic odor, by which the physician usually quickly recognizes the disease.
Complications
In this disease, the affected person suffers from a very foul and unpleasant odor, which usually emanates from the nose. In this case, this smell cannot be removed even with the help of frequent washing and blowing of the nose. In many cases, this leads to inferiority complexes or significantly lowered self-esteem of the patient. The affected person is very often ashamed of the complaint and social difficulties arise. In children, ozaena can lead to complaints of bullying or teasing. If the disease is not treated, the olfactory nerves in the nose are irreversibly destroyed, so they cannot be restored even after treatment. Pain in the nose or head also occurs due to the disease and significantly reduces the patient’s quality of life. Unfortunately, the disease cannot be completely cured. However, the symptoms themselves can be alleviated with the help of sprays. As a rule, no particular complications occur. The patient’s life expectancy is also not negatively affected by the disease.
When should one go to the doctor?
Ozaena does not initially cause any major symptoms. A doctor should be consulted if the nose is unusually dry or the typical odor is noticed. Yellowish-green or black discoloration should also be clarified quickly. The ENT physician can diagnose the disease on the basis of the characteristic discharges and take further measures. Removal of the crusts and pus can relieve the symptoms. The doctor must surgically treat the causative malformation of the bony structure of the nose. If the above-mentioned signs of the disease occur during female puberty, it is possibly ozaena. Injuries of the nose, tumors in the nasal cavity as well as malformations can also cause rhinitis atrophicans cum foetore. Anyone who emits unusual odors from the nose after surgery in the area or after excessive use of nasal sprays should inform the responsible physician. A specialist in ear, nose and throat medicine or a specialist in bone diseases is responsible. Since the commonly prescribed vitamin and zinc preparations can cause various side effects, close consultation with the doctor should take place. If the prescribed remedies have no effect or the complaints occur repeatedly, surgical intervention may be necessary. For this, a specialist ENT center must be consulted.
Treatment and therapy
Primary ozaena is often not completely curable. However, patients can use measures to alleviate and improve the symptoms, which are also used in secondary ozaena. It is particularly important to constantly moisten the mucous membrane of the nose. For this purpose, individuals drink plenty of water, use oily nose drops and special nasal douches.
Outlook and prognosis
The prognosis of stinky nose often turns out differently. For example, in most cases, it cannot be completely cured. However, there are some options available to significantly reduce the symptoms as well as the unpleasant smell in the nose. Because ozaena is primarily caused by a dried-out nasal mucosa and its protective function is therefore lost, it is important to keep the nose moist. If the nasal mucosa is consistently kept moist, the prognosis for stinky nose is usually more favorable. Especially in the winter months, the patient must avoid dry rooms. In addition, the room climate can be improved by water scales on the heaters. Sufficient intake of fluids also has a positive effect. This means that the affected person should drink at least two liters of water or other unsweetened beverages in order to favorably influence the course of the condition. The environment of the nasal mucosa can also be kept moist with the help of special nasal ointments available from pharmacies.Inhalation solutions with saline also serve as support. Regular professional nasal cleaning by an ear, nose and throat specialist also has a positive effect on the prognosis. Furthermore, bark in the nasal cavity should be regularly softened and detached. If the patient consistently adheres to these measures, the symptoms of ozaena can be well controlled, effectively halting its progression.
Prevention
Prevention of primary ozaena is difficult, whereas secondary ozaena can be partially prevented by avoiding the risk factors.
Follow-up care
In ozaena, there are usually few measures of direct aftercare available to the affected person. In the first place, a very early diagnosis is necessary in this disease to avoid further complications or discomfort. Since ozaena cannot be completely cured, the focus of aftercare is rather on alleviating the accompanying symptoms. This usually involves taking medication. The doctor’s precise instructions should be followed. Sometimes it can be helpful to seek professional mental support, as the disease is often accompanied by many feelings of shame. The feeling of smelling unpleasant can lead to reduced self-confidence in sufferers. Special hygiene measures should be followed to reduce the odor persistently.
What you can do yourself
Ozaena, which is also popularly known as “stinky nose”, is extremely difficult to treat. Often there may be no complete cure, especially in the case of primary ozaena, that is, if it is genetic. Treatment focuses mainly on reducing the predominant symptoms. Most of those affected are particularly disgusted by the unpleasant odor, which is why they look for ways in everyday life to get rid of it accordingly. Most importantly, patients try to keep the nasal mucosa moist. Regular and adequate hydration as well as intensive care of the nose are crucial in this regard. It is particularly bad for sufferers in the colder months of the year, as dry heating air or air conditioning make the situation even worse. Patients should therefore avoid dry room air at all costs and deliberately humidify the air. This can be achieved with special measures, such as hanging damp cloths in the room, placing water in bowls on the radiator, ventilating regularly or attaching humidifiers to the radiator. In addition, sufferers should drink at least two to three liters of water a day. Regular nasal douches with salt water also help to restore quality of life despite ozaena. This ensures that the nasal mucosa is sufficiently moistened and the encrustations can be loosened more easily. Taking zinc or vitamin A and vitamin E can also bring about a positive change in the clinical picture.
