Staph infection in nose: Symptoms, treatment, and diagnosis

A staphylococcus, or staph, infection is an infection caused by the bacteria Staphylococcus aureus.

Many people carry Staphylococcus aureus (S.aureus) on their skin or within their nose.

Here we look at the various causes and symptoms of a staph infection in the nose. We also outline the available treatment options for a nasal staph infection, as well as some tips for prevention.

Share on PinterestExcessively blowing or rubbing the nose is a possible cause of a staph infection in the nose.

The bacteria S. aureus cause staph infection.

Between 20–80% of humans carry S. aureus within their nasal passages. Most of the time, the bacteria do not cause any harm. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause an infection.

Damage to the surface of the skin may trigger a mild to a moderate staph infection. Damage to the deeper layers of the skin may trigger a severe or even life-threatening staph infection.

Staph bacteria are contagious and can spread to other people through:

• skin-to-skin contact
• sharing personal items, such as toothbrushes, razors, or washcloths
• coughing or sneezing, although these types of transmission are less common

A staph infection in the nose can occur as a result of a scratch, sore, or other types of damage to the skin of the nose.

Some potential causes of a nasal staph infection include:

• nose picking
• excessively blowing or rubbing the nose
• plucking or tweezing nasal hairs

A person who has a nasal staph infection may develop the following symptoms:

• redness and swelling of the nose
• crusting around the nostrils
• boils inside one or both nostrils
• facial swelling
• pain
• fever

In some cases, a staph infection may resolve by itself. In other cases, a person will require treatment to clear the infection and prevent further complications.

Some people may succeed in treating minor nasal infections at home. People can soothe sores and crusting by holding a clean, warm, damp cloth onto affected areas. It is important to wash the cloth afterward to avoid spreading the bacteria.

Some people may develop pus-filled boils inside the nostrils. A doctor will need to drain the boil in order to treat the infection and promote wound healing. This procedure typically involves the use of a local anesthetic.

If a nasal staph infection does not clear up by itself, a person may need to take oral antibiotics or apply topical antimicrobial treatments.

Without treatment, staph infections may recur. This is because S.aureus remains inside the nasal passages.

Prescription antibiotic treatments can reduce numbers of staph bacteria, thereby helping to prevent the staph infection from recurring.

Researchers have been investigating the best treatment to prevent recurrent staph infections. According to a 2015 review, topical antimicrobial medications may be more effective than oral antibiotics. This is because S. aureus may have a lower resistance to topical treatments.

Practicing good personal hygiene may also help to reduce the risk of repeat infections.

If a staph infection enters the bloodstream, it can cause serious complications. We list some potential complications below.

Facial cellulitis

Facial cellulitis is a bacterial infection affecting the deeper layers of the skin. Without treatment, the condition can be life-threatening.

Symptoms of facial cellulitis include:

• tenderness and pain in the face
• rash
• skin redness
• lockjaw
• a fever
• chills
• loss of appetite

Cavernous sinus thrombosis

A cavernous sinus thrombosis (CST) is a blood clot that forms in the cavernous sinuses. This is the hollow space between the brain and the eye sockets.

A CST can develop when an infection in the face or skull spreads to the cavernous sinuses. Although rare, the condition can be life-threatening.

Symptoms of a CST include:

• a fever
• a severe headache
• swelling around the eyes
• a weakness of the eye muscles, resulting in drooping eyelids, or double vision
• severe eye pain

Endocarditis

An infection can sometimes spread to the inner lining of the heart chambers and valves. The medical term for this is endocarditis.

Symptoms of endocarditis include:

• a fever
• chills
• fatigue
• aching muscles and joints
• difficulty breathing
• nausea and vomiting
• blood in the urine

Pneumonia

Pneumonia is the medical term for inflammation of one or both lungs. It typically occurs as a result of infection.

In pneumonia, the tiny air sacs, or alveoli, within the lungs fill with fluid or pus. This makes it difficult for a person to breathe.

Some common symptoms of pneumonia include:

• rapid or shallow breathing
• breathlessness, even when resting
• chest pain that worsens when breathing or coughing
• rapid heartbeat
• a fever
• chills
• feeling generally unwell
• loss of appetite

Sepsis

Sepsis is a potentially life-threatening condition in which the body’s immune system overreacts to an infection. This overreaction leads to a toxic build-up of chemicals within the blood.

Symptoms of sepsis include:

• rapid breathing
• increased heart rate
• a fever
• chills
• feeling confused or disorientated

Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare condition in which staph bacteria release dangerous levels of toxins into the bloodstream. TSS can be life-threatening.

The symptoms of TSS come on suddenly and worsen rapidly. They include:

• a fever
• flu-like symptoms, such as a headache, body aches, and a sore throat
• nausea and vomiting
• diarrhea
• a widespread skin rash that appears similar to sunburn
• a bright red coloring of the lips, tongue, and eye-whites
• difficulty breathing
• fainting
• confusion

There are steps a person can take to reduce their risk of developing or spreading a staph infection of the nose or skin. These include:

• regularly washing hands with soap and clean water
• showering or bathing daily to keep skin clean
• covering any cuts or wounds with sterile bandaids or dressings
• avoiding sharing personal items, such as toothbrushes, razors, and washcloths
• covering the mouth and nose when coughing or sneezing
• disposing of tissues after blowing the nose
• avoiding picking the nose
• using only sterile equipment to pluck or tweeze nasal hair, or avoiding these practices altogether

Some staph infections may resolve by themselves, while others may require treatment.

People should see a doctor if the staph infection:

• is severe
• lasts longer than a week, or keeps coming back
• is getting worse, or spreading to other parts of the face
• causes a skin rash or redness
• causes fever or chills
• causes breathing difficulty, or a change in heart rate

Anyone who has a weakened immune system should see a doctor at the first sign of a staph infection. This includes people who:

• are elderly
• have an autoimmune disease
• are receiving chemotherapy
• have received an organ transplant

Staph bacteria commonly live inside the nose and are usually harmless. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause infection.

A person who has a nasal staph infection may develop redness, sores, or crusting around the nostrils. A person may need antibiotics or topical antimicrobial medications to treat the infection.

People should seek treatment if their infection is severe or persistent or accompanied by other symptoms. People who have a weakened immune system should seek treatment as soon as possible to reduce the risk of complications.

Staph infection in nose: Symptoms, treatment, and diagnosis

A staphylococcus, or staph, infection is an infection caused by the bacteria Staphylococcus aureus.

Many people carry Staphylococcus aureus (S.aureus) on their skin or within their nose.

Here we look at the various causes and symptoms of a staph infection in the nose. We also outline the available treatment options for a nasal staph infection, as well as some tips for prevention.

Share on PinterestExcessively blowing or rubbing the nose is a possible cause of a staph infection in the nose.

The bacteria S. aureus cause staph infection.

Between 20–80% of humans carry S. aureus within their nasal passages. Most of the time, the bacteria do not cause any harm. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause an infection.

Damage to the surface of the skin may trigger a mild to a moderate staph infection. Damage to the deeper layers of the skin may trigger a severe or even life-threatening staph infection.

Staph bacteria are contagious and can spread to other people through:

• skin-to-skin contact
• sharing personal items, such as toothbrushes, razors, or washcloths
• coughing or sneezing, although these types of transmission are less common

A staph infection in the nose can occur as a result of a scratch, sore, or other types of damage to the skin of the nose.

Some potential causes of a nasal staph infection include:

• nose picking
• excessively blowing or rubbing the nose
• plucking or tweezing nasal hairs

A person who has a nasal staph infection may develop the following symptoms:

• redness and swelling of the nose
• crusting around the nostrils
• boils inside one or both nostrils
• facial swelling
• pain
• fever

In some cases, a staph infection may resolve by itself. In other cases, a person will require treatment to clear the infection and prevent further complications.

Some people may succeed in treating minor nasal infections at home. People can soothe sores and crusting by holding a clean, warm, damp cloth onto affected areas. It is important to wash the cloth afterward to avoid spreading the bacteria.

Some people may develop pus-filled boils inside the nostrils. A doctor will need to drain the boil in order to treat the infection and promote wound healing. This procedure typically involves the use of a local anesthetic.

If a nasal staph infection does not clear up by itself, a person may need to take oral antibiotics or apply topical antimicrobial treatments.

Without treatment, staph infections may recur. This is because S.aureus remains inside the nasal passages.

Prescription antibiotic treatments can reduce numbers of staph bacteria, thereby helping to prevent the staph infection from recurring.

Researchers have been investigating the best treatment to prevent recurrent staph infections. According to a 2015 review, topical antimicrobial medications may be more effective than oral antibiotics. This is because S. aureus may have a lower resistance to topical treatments.

Practicing good personal hygiene may also help to reduce the risk of repeat infections.

If a staph infection enters the bloodstream, it can cause serious complications. We list some potential complications below.

Facial cellulitis

Facial cellulitis is a bacterial infection affecting the deeper layers of the skin. Without treatment, the condition can be life-threatening.

Symptoms of facial cellulitis include:

• tenderness and pain in the face
• rash
• skin redness
• lockjaw
• a fever
• chills
• loss of appetite

Cavernous sinus thrombosis

A cavernous sinus thrombosis (CST) is a blood clot that forms in the cavernous sinuses. This is the hollow space between the brain and the eye sockets.

A CST can develop when an infection in the face or skull spreads to the cavernous sinuses. Although rare, the condition can be life-threatening.

Symptoms of a CST include:

• a fever
• a severe headache
• swelling around the eyes
• a weakness of the eye muscles, resulting in drooping eyelids, or double vision
• severe eye pain

Endocarditis

An infection can sometimes spread to the inner lining of the heart chambers and valves. The medical term for this is endocarditis.

Symptoms of endocarditis include:

• a fever
• chills
• fatigue
• aching muscles and joints
• difficulty breathing
• nausea and vomiting
• blood in the urine

Pneumonia

Pneumonia is the medical term for inflammation of one or both lungs. It typically occurs as a result of infection.

In pneumonia, the tiny air sacs, or alveoli, within the lungs fill with fluid or pus. This makes it difficult for a person to breathe.

Some common symptoms of pneumonia include:

• rapid or shallow breathing
• breathlessness, even when resting
• chest pain that worsens when breathing or coughing
• rapid heartbeat
• a fever
• chills
• feeling generally unwell
• loss of appetite

Sepsis

Sepsis is a potentially life-threatening condition in which the body’s immune system overreacts to an infection. This overreaction leads to a toxic build-up of chemicals within the blood.

Symptoms of sepsis include:

• rapid breathing
• increased heart rate
• a fever
• chills
• feeling confused or disorientated

Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare condition in which staph bacteria release dangerous levels of toxins into the bloodstream. TSS can be life-threatening.

The symptoms of TSS come on suddenly and worsen rapidly. They include:

• a fever
• flu-like symptoms, such as a headache, body aches, and a sore throat
• nausea and vomiting
• diarrhea
• a widespread skin rash that appears similar to sunburn
• a bright red coloring of the lips, tongue, and eye-whites
• difficulty breathing
• fainting
• confusion

There are steps a person can take to reduce their risk of developing or spreading a staph infection of the nose or skin. These include:

• regularly washing hands with soap and clean water
• showering or bathing daily to keep skin clean
• covering any cuts or wounds with sterile bandaids or dressings
• avoiding sharing personal items, such as toothbrushes, razors, and washcloths
• covering the mouth and nose when coughing or sneezing
• disposing of tissues after blowing the nose
• avoiding picking the nose
• using only sterile equipment to pluck or tweeze nasal hair, or avoiding these practices altogether

Some staph infections may resolve by themselves, while others may require treatment.

People should see a doctor if the staph infection:

• is severe
• lasts longer than a week, or keeps coming back
• is getting worse, or spreading to other parts of the face
• causes a skin rash or redness
• causes fever or chills
• causes breathing difficulty, or a change in heart rate

Anyone who has a weakened immune system should see a doctor at the first sign of a staph infection. This includes people who:

• are elderly
• have an autoimmune disease
• are receiving chemotherapy
• have received an organ transplant

Staph bacteria commonly live inside the nose and are usually harmless. However, if the skin of the nose becomes damaged, the bacteria can enter the wound and cause infection.

A person who has a nasal staph infection may develop redness, sores, or crusting around the nostrils. A person may need antibiotics or topical antimicrobial medications to treat the infection.

People should seek treatment if their infection is severe or persistent or accompanied by other symptoms. People who have a weakened immune system should seek treatment as soon as possible to reduce the risk of complications.

90,000 causes, diagnosis and treatment| Sinupret

Publication date: 07/08/2022
Updated: 07/08/2022

Contents:

Pain in the nose and associated symptoms

900 02 Causes of pain in the nose

Mechanical injuries and damage nose

Neoplasms in the nasal cavity

Other causes

Diagnostic methods

Treatment of pain in the nose

Pain in the nose is a symptom that everyone experiences from time to time. It happens that discomfort occurs after trauma to the nose and damage. Usually a person understands what exactly caused the pain.

However, sometimes an unpleasant symptom occurs for no apparent reason and may indicate inflammation and other processes in the nasopharynx. You can figure out the cause of the pain in the nose, if you take into account the other symptoms.

Nasal tenderness usually occurs in combination with other symptoms, such as:

• swelling of the mucous membrane – nasal congestion, shortness of breath;

• nasal discharge, clear, mucoid, whitish, green or yellow;

• feeling of pressure, fullness in the region of the nose;

• impairment or loss of smell, distortion of odor perception;

• epistaxis;

• crusts in the nose;

• fever;

• headaches, pains in the region of the bridge of the nose, forehead and eyes.

Depending on what causes the pain in the nose, a specific cause can be assumed.

Rhinitis

The most common cause of pain inside the nose. The symptom occurs against the background of a chronic runny nose, in which the state of the nasal mucosa changes. Severe pain can develop due to atrophic rhinitis, because the mucous membrane dries up, thins and may crack. The pain is accompanied by a burning sensation, a feeling of dryness and discomfort, especially when blowing your nose, inhaling warm and dry air.

Pain in acute coryza may be associated with rubbing of the skin with a handkerchief and frequent blowing of the nose. Then we can talk about pain in the tip of the nose and in the area of ​​\u200b\u200bthe wings of the nose. The skin of the nose may turn red. Sometimes pain is a consequence of the use of nasal drops, especially with antibiotics, antiseptics or vasoconstrictor components in the composition. If the pain becomes unbearable, it may indicate complications of the common cold.

Sinusitis

Inflammation of the paranasal sinuses, or sinusitis, is a disease characterized by constant pressing pains. Unpleasant sensations are aggravated by tilting the head down, trying to rinse the nasal cavity with water or saline. The localization of pain depends on which sinuses are inflamed. So, with frontal pain, pain occurs near the bridge of the nose, with sinusitis – near the wing of the nose on one or both sides.

The pain associated with sinusitis can be sharp, throbbing. The disease is accompanied by swelling of the skin in the area of ​​​​inflammation, and when touched, the pain intensifies. From the nose comes yellow-green mucus with an unpleasant odor, sometimes streaked with blood. Also, a person suffers from a headache, fever, general severe malaise.

Sinusitis usually develops against the background of a cold. The most common cause is an acute respiratory viral infection (ARVI), namely untreated rhinitis. The herbal drug Sinupret® will help reduce the likelihood of complications. The use of the drug from the first days of the disease helps prevent the development of complications that may occur as a result of a poorly treated rhinitis.

Purulent processes – abscesses and boils

Severe pain with a feeling of fullness may be a sign of an abscess of the nasal septum. At first, there are difficulty breathing and minor discomfort. As the pus accumulates, the pain intensifies and becomes constant. Unpleasant sensations are aggravated by wrinkling the nose and blowing your nose. An unusual thickening or change in the visible part of the nasal septum can be observed.

Jerking, throbbing pain inside the nose may be associated with the maturation of the boil. It is formed on the wing or tip of the nose, in the region of the septum. Usually, symptoms occur suddenly – when probing the nose, a seal is detected. When smiling, sneezing, chewing, discomfort increases.

The boil increases in size, the skin in this area turns red, and the pain intensifies. On average, a week passes from the onset of symptoms to the maximum increase in education and its breakthrough. After the release of pus, the pain begins to subside.

Foreign body in the nose

The severity of pain is affected by the size and configuration of the foreign body. So, the bead will not cause severe discomfort and can only provoke one-sided nasal congestion. But in the case of a larger object with sharp edges, sneezing and sharp, arching pains with a feeling of pressure, as well as copious discharge from the nose, may occur.

The pain may radiate to the cheek and forehead, accompanied by severe epistaxis or occasional bleeding from the nose. The displacement of a foreign body is indicated by scratching pains in the throat.

Sometimes sudden pain in the nose is the result of a bruise or fracture of the nose. The unpleasant symptom persists and is aggravated by blowing the nose. With a severe injury, nasal congestion may occur due to swelling of the mucous membrane, a hematoma (bruise) in the area of ​​​​the septum. This forces a person to breathe through the mouth, so dryness in the oral cavity also joins the pain. Trauma is fraught with nosebleeds and can lead to changes in the contours of the face.

The cause of pain in the nose without a runny nose can be both mechanical and chemical, electrical and thermal damage. With a burn of the skin of the nose or mucous membranes, a person is tormented not only by pain, but also by a strong burning sensation.

Some benign neoplasms of the nose – papilloma, osteoma, chondroma – may be characterized by pain, but more often people notice a feeling of a foreign body and complain of breathing problems, and pain develops later if the neoplasm has greatly increased.

The symptom is often accompanied by decreased sense of smell, congestion on one side. Bleeding is sometimes observed, usually with tumors of a vascular nature.

There are also less common diseases that are accompanied by pain in the nose. Among them are the following ailments:

• Neuralgia of the nasociliary nerve. This disease usually develops in young people. It is characterized by severe pressing pains in the nose, eyes, forehead. The pain is paroxysmal, and the attack usually lasts no more than 60 minutes, more often occurs at night.

• Ganglioneuritis. This is an inflammation of the nerve node, in which there is severe pain in the nose. It can radiate to the eyes, the area of ​​the teeth and gums, the back of the head, the temple, the neck, etc.

• Eye diseases. Sometimes pain in the nose develops against the background of various eye diseases.

• Diseases of the skin. Symptom may occur with eczema of the skin of the nose, herpes, etc.

Why bother with pain in the nose, the otorhinolaryngologist (ENT) will determine during the diagnosis. At the first appointment, the ENT will examine the nasal cavity, can perform a rhinoscopy, probe the nose, and also listen to the patient’s complaints.

It is important to tell when and under what circumstances the pain appeared, what symptoms accompany it, whether any illnesses and injuries were transferred. Based on the available information, the doctor will prescribe additional examinations, such as:

• Rhinoscopy. It is carried out both as part of the initial appointment and during an additional examination. The specialist introduces a special mirror and examines the nasal cavity. If further diagnosis is required, mid or posterior rhinoscopy is performed using longer or special speculums, vasoconstrictor drugs, and local anesthetics. This is necessary for a deeper study, including the study of the openings of the nasal sinuses and other areas.

• Nasal endoscopy. The procedure is necessary when the use of mirrors is not enough. It involves the introduction of a thin flexible tube with a mini-video camera into the nasal cavity. The method allows you to consider under magnification all the structures of the nose, the state of the mucous membrane and deeply located tissues.

• Bacteriological research. Assume the analysis of a swab from the nose to identify the causative agent of inflammation. This method is used when an inflammatory disease is suspected, as well as when signs of purulent formation are detected. Bacpose culture is also used to determine the sensitivity of bacteria to antibiotics and select the correct treatment.

Rarely, a biopsy is required – taking a piece of tissue for examination in a laboratory. And with past injuries, sometimes a consultation with a neurologist or neurosurgeon is necessary. In addition, if you suspect a pathology on the part of the organs of vision, the otorhinolaryngologist will definitely recommend visiting an ophthalmologist.

How to treat nasal pain before visiting a doctor depends on the cause of the unpleasant symptom: in case of a burn, it is important to rinse the burnt area with cool water. If there is bleeding, one should sit down with the head tilted down and apply dry cold to the bridge of the nose.

When the body temperature is elevated and there are signs of a purulent disease or inflammation, it is important not to heat the nose area and not to try to open the abscesses on your own. It is better to see a doctor as soon as possible. If the pain occurs in isolation, without other symptoms, a consultation with a ENT specialist is necessary to identify the causes and prescribe the correct treatment.

The common cold and its complications are treated with medication. In cases of acute bacterial infections confirmed by test results, systemic antibiotics may be prescribed. For the treatment of viral rhinitis, the ENT may prescribe vasoconstrictor topical drugs or oral medications.

Sinupret® is one of the commonly prescribed cold medications. Taking “Sinupret”, started from the first day of SARS, will reduce the likelihood of complications.

The drug helps to relieve nasal congestion, and also has an antiviral effect. It is available in the form of tablets and drops for oral administration. Drops are allowed to be given to children from 2 years of age.

Surgical treatment can only be indicated for pain associated with the formation of abscesses and boils, the ingress of foreign bodies into the nasal cavity, trauma or the formation of neoplasms.

Atrophic rhinosinusitis: symptoms and treatment

Atrophic rhinitis is a clinical syndrome of progressive atrophy of the nasal mucosa.

It is characterized by paradoxical nasal congestion and thick, unpleasant discharge from it. Most patients are diagnosed with concomitant sinusitis, and therefore this disease is more correctly called atrophic rhinosinusitis .

Atrophic rhinosinusitis can be divided into two forms: primary and secondary.

Primary atrophic rhinosinusitis

Primary atrophic rhinosinusitis is more commonly diagnosed in patients from low socioeconomic groups living in geographic areas with a warm climate. Areas of high prevalence include southern Saudi Arabia, China, Africa, India, the Mediterranean, and the Philippines.

Atrophic rhinosinusitis is more common in women. At a young age, it is diagnosed more often than in the elderly.

Clinical picture

Patients have a constant sensation of bad breath in the nose (this smell disorder is called cacosmia). At the same time, there is also an unpleasant smell from the mouth, noticeable to others. Hence the term “ozena” (“stench”), which is sometimes used as a synonym for severe primary atrophic rhinosinusitis.

Other symptoms include loss of smell (anosmia), epistaxis, nose pain, sleep disturbance and choking due to heavy crusting.

Patients complain of nasal congestion even with excessively wide nasal passages, which is better characterized by the concept of “lack of breath sensation”. Nasal congestion occurs due to improper passage of air through the nasal cavity, lack of resistance and a sense of air flow due to the loss of tissue containing sensory receptors. The same phenomenon is observed in patients with perforation of the nasal septum.

The disease is characterized by the replacement of normal pseudostratified columnar epithelium by squamous epithelium. This tissue lacks cilia and mucus-producing goblet cells.

The most common culprits of the bacterial process in the nose are Klebsiella ozaenae, Proteus, Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae.

ENT examination

During rhinoscopy (examination of the nose), the doctor sees a shiny, thin, pale, and sometimes ulcerated mucous membrane, covered with thick yellow, brown or green crusts, sometimes bloody, covered with purulent plaque. Resorption (destruction) of the underlying cartilage and bone leads to an increase in the volume of the nasal cavity. Some patients are diagnosed with perforation of the nasal septum and secondary saddle deformity of the external nose (retraction of the back of the nose).

Predisposing factors for the development of primary atrophic rhinosinusitis are not completely known. It is discussed that these can be endocrine, vascular, infectious and autoimmune diseases, as well as occupational harm (work in dusty polluted rooms with chemical or technical dust).

Computed tomography of the nose and paranasal sinuses

Possible findings include:

• mucosal atrophy of the inferior and middle turbinates and bone resorption;
• resorption of cells of the cribriform and uncinate labyrinth;
• an increase in the volume of the nasal cavity with the destruction of its side walls;
• thickening of the mucous membrane of the paranasal sinuses;
• hypoplasia (reduction) of the maxillary sinuses with a decrease in their pneumatization (airiness).

Secondary atrophic rhinosinusitis

Secondary atrophic rhinosinusitis is preceded by trauma or surgery, which subsequently leads to an inflammatory process in the nose, reaching the highest degree of damage to the mucous membrane and superinfection.

Patients with atrophic rhinosinusitis differ from patients with standard chronic rhinosinusitis in the intractable nature of symptoms and the presence of persistent purulent discharge from the nose.

There are two subtypes of secondary atrophic rhinosinusitis: “wet” and “dry” forms.

Clinical picture

The typical “wet” form is a patient who has undergone several intranasal interventions and suffers from chronic rhinosinusitis with purulent discharge. During bacteriological examination, coliform bacteria (Escherichia coli, Escherichia coli) are usually isolated from the nose. Most patients have already been treated with multiple courses of antibiotics, resulting in the presence of multidrug-resistant (resistant to many antibiotics) bacterial strains. Systemic antibiotic therapy ultimately does not improve, but rather worsens the patient’s condition.

Patients with a “dry” form of secondary atrophic rhinosinusitis have dryness of the nasal mucosa with abundant bloody crusts, which patients sometimes have to remove with tweezers. The most common cause of this condition is sarcoidosis of the upper respiratory tract.

Repeated and extensive operations for “chronic sinusitis” in the paranasal sinuses (including radical interventions on the middle and lower turbinates) – in an attempt to improve the situation – only lead to a worsening and more aggressive course of the disease. This form of partially iatrogenic rhinosinusitis is sometimes referred to as “empty nose syndrome”. Some patients are “nasal cripples”, which significantly reduces their quality of life.

In the “dry” form of nasal culture, Pseudomonas aeruginosa and Staphylococcus aureus (S. aureus) are isolated. At the same time, it is often very difficult to answer the question whether these microorganisms are associated with the inflammation present at the moment or whether they already represent a “typical colonization” of the damaged epithelium.

ENT examination

During rhinoscopy, the doctor sees a thin, edematous or granular mucous membrane covered with purulent crusts.

Computed tomography of the nose and paranasal sinuses

Postoperative atrophic rhinosinusitis can be manifested by the absence or reduction in the size of the middle or lower turbinates, the almost complete absence of the septa of the ethmoid sinuses, thickening of the mucous membrane of the paranasal sinuses.

Granulomatous and post-radiation atrophic rhinosinusitis can be manifested by diffuse changes in the mucous membrane in the paranasal sinuses and marked swelling of the soft tissues of the turbinates.

Diagnosis

The diagnosis is based on the history of the disease, rhinoscopy and computed tomography of the nose and paranasal sinuses.

Treatment of atrophic rhinosinusitis

Controlled studies evaluating the treatment of atrophic rhinosinusitis have not been conducted, the available data are limited to observational studies and case reports.

Patients are advised to wash the nose on a regular basis to prevent the formation of new crusts and dryness of the already atrophied mucosa. Rinse the nose with warm isotonic saline at least twice a day. It is recommended to use devices in the form of cylinders, watering cans (Dolphin, Revyline Nasal and similar products). The nasal cavity should be flushed with a sufficient volume of solution (> 200 ml in each half of the nose in one flush).

Xylitol saline sprays (such as Xlear) are also beneficial when used regularly.

After washing the nose, it is recommended to lubricate the mucous membrane with oils, creams and ointments. Acceptable products include petroleum jelly, glycerin.

There is insufficient data on the effectiveness of antibiotics added to flush solutions for atrophic rhinosinusitis. There are only isolated case reports and small series of patients in which the usefulness of this treatment method has been shown. It is not yet possible to recommend it on a regular basis to all patients, further study of the issue is required.

In cases where an antibiotic is added to therapy, it should be selected based on current nasal cultures. The duration of nasal lavage with antibiotics varies. There is a conditional recommendation – until the moment when the patient stops noticing purulent discharge from the nose.

The use of mupirocin as an intranasal ointment is also recommended. The duration of the course also varies and is determined by the doctor in each case.

For patients with secondary atrophic rhinosinusitis and active inflammation in the nose, some researchers recommend the use of glucocorticoids in the form of nasal sprays or lavages, while others strongly oppose this use.

In atrophic rhinosinusitis, any vasoconstrictor agents, both oral and local, are contraindicated, as they lead to an even greater deterioration in the blood supply to the nasal mucosa.

Several types of surgical procedures have been proposed. Procedures have included temporary closure of the nostrils to facilitate epithelial repair (Jung’s procedure), surgical implantation of acrylic, Teflon, or polyethylene materials to reduce nasal volume, procedures involving the injection of allogeneic bone, fat, or placental tissue. As no adequate scientific studies have been conducted, these procedures are not recommended.

Prognosis

In many cases, atrophic rhinosinusitis persists for life. There is evidence that the “wet” form of secondary atrophic rhinosinusitis in some patients spontaneously “burns out” and becomes “dry”.

How is atrophic rhinosinusitis treated at Rassvet Clinic?

Correct diagnosis is essential for treatment. It is necessary to differentiate exacerbation of chronic rhinosinusitis from secondary atrophic rhinosinusitis, since the management of patients is fundamentally different.

Rhinoscopy alone is not enough to make a diagnosis. We perform an endoscopic examination of the nasal cavity for all patients, which allows us to more fully assess the degree of existing changes, which is also important for subsequent treatment.

Routine sinus radiography should not be used in this group of patients. We always give preference to computed tomography.