Ozena - Symptoms and Diagnosis

The disease is most often diagnosed in young women. Patients complain of severe dryness and the formation of a large number of crusts in the nose, the presence of an unpleasant foul odor from the nose, which patients themselves usually do not notice, difficulty breathing through the nose and the absence of the sense of smell (anosmia). The foul odor is so pronounced that others avoid the patient's presence, and this affects his mental state, interpersonal relationships - the patient becomes socially withdrawn. At the very beginning of the disease, olfactory impairment is usually due to the presence of crusts covering the olfactory region of the nasal cavity, later anosmia occurs due to atrophy of the olfactory receptors. In some cases, a saddle-shaped nose is observed with ozena.

One of the constant signs of ozena is crusts. In the initial stage they are thin, do not cover the surface of the mucous membrane, then they become multilayered thick and fill the entire surface of the nasal cavity. In severe cases, the crusts spread to the nasopharynx, pharynx, larynx and trachea. Between the crusts and the surface of the mucous membrane there is a thin layer of mucus, due to which these crusts are easily removed, sometimes in whole casts of the nasal cavity.

Along with atrophy and a large number of crusts, the disease is characterized by an unpleasant foul odor. Its appearance depends on the form of the disease and the presence of crusts. After the crusts are removed, the odor disappears, then crusts quickly form again and the odor reappears. The odor is felt by people around the patient. The patient himself does not feel it, since his sense of smell is reduced to the level of anosmia.

Diagnosis of ozena

Diagnosis of ozena is not difficult at the height of the disease. According to the anamnesis, a gradual change in sensations from the nasal cavity should be noted. At the beginning of the disease, mucous discharge (wet nose) is characteristic, then dryness, the presence of crusts and odor, loss of smell. The patient is mainly concerned about the presence of crusts and odor. Partial removal of crusts by rinsing the nasal cavity and placing tampons with ointments alleviates the patient's condition.

During anterior rhinoscopy, brownish or yellow-green crusts are visible in both halves of the nose, filling the entire nasal cavity, spreading to the nasopharynx and underlying respiratory tract. After removing the crusts, the nasal cavity becomes so wide that during rhinoscopy, the superior turbinate and superior nasal passage, the posterior wall of the nasopharynx, the pharyngeal openings of the auditory tubes and even the tubal ridges are visible. In severe cases of the disease, the bone structures of the middle nasal passage undergo atrophy, then the nasal cavity turns into a huge empty space. Ozaena is characterized by the absence of a violation of the integrity of the mucous membrane. There are no infiltrates, scars, ulcers.

Examination of the respiratory and olfactory functions may reveal various changes depending on the form of the disease. In a mild form, these functions may not be impaired, while in moderate and severe forms, severe disorders are observed. After removing the crusts, the respiratory function is temporarily restored by the formation of new ones. The olfactory function is not restored. There is no need for in-depth examination methods.

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Laboratory research

Determination of the cause of the disease is based on microbiological examination of nasal discharge. In more than 90% of cases, Klebsiella pneumoniae ozaenae is detected. If there is microbiological confirmation of the disease, the diagnosis should not be in doubt.

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Instrumental research

Anterior and posterior rhinoscopy, pharyngoscopy, indirect laryngoscopy, rhinometry and olfactometry. Anterior rhinoscopy reveals atrophy of the mucous membrane, crusts, and expansion of the nasal cavity; and a foul odor also supports the diagnosis of ozena.

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Differential diagnostics

The disease should be differentiated in the initial period from catarrhal inflammation, and in the late period from scleroma in the stage of atrophic changes.

Ozena differs from acute and chronic rhinitis in its initial stage by its persistent progressive course; microbiological examination reveals Klebsiella pneumoniae ozaenae.

In scleroma, an infiltrate and scars, which are not present in ozena, are initially detected, and only later is atrophy of the mucous membrane revealed. When studying the microflora, Klebsiella scleroma is found. In addition, scleroma is characterized by endemic foci of distribution in Belarus, Western Ukraine, and the Far East, while ozena is found everywhere.

When diagnosing, it is necessary to determine the form of the disease, since the patient's ability to work depends on it. In a severe form with the spread of the process to the pharynx and larynx, the patient may be limited or completely incapacitated.

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