Ozena - Symptoms and Diagnosis
Last reviewed: 08.06.2019
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The disease is more often diagnosed in young women. Patients complain of pronounced dryness and the formation of a large number of crusts in the nose, the presence of an unpleasant fetid odor from the nose, which patients usually do not feel themselves, difficulty in nasal breathing and the absence of smell (anosmia). The fetid odor is so pronounced that others avoid the presence of the patient, and this is reflected in his mental state and interpersonal relations — the patient becomes socially isolated. At the very beginning of the disease, an impaired sense of smell is usually caused by the presence of crusts covering the olfactory region of the nasal cavity, and further anosmia occurs due to the atrophy of the olfactory receptors. In some cases, when ozena observed saddle nose.
One of the constant signs ozena - peel. In the initial stage, they are thin, do not cover it with the surface of the mucous membrane, then become multi-layered, thick, and perform 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, so that these crusts are easily removed, sometimes with whole casts of the nasal cavity.
Together with atrophy and a large number of crusts, an unpleasant fetid odor is characteristic of the disease. Its appearance depends on the form of the disease and the presence of crusts. After removing the crusts, the smell disappears, then the crusts form quickly again and the smell reappears. The smell is felt by people around the patient. The patient himself does not feel it, because his sense of smell is reduced to the degree of anosmia.
Ozena diagnostics
Diagnosing ozena is not difficult in the midst of the disease. According to anamnesis, it should be noted a gradual change in sensations from the nasal cavity. At the beginning of the disease is characterized by mucous discharge (wet nose), then dryness, the presence of crusts and odor, loss of smell. The main concern for the patient is the presence of crusts and smell. Partial removal of crusts by washing the nasal cavity and laying tampons with ointments facilitates the patient's condition.
With anterior rhinoscopy, brownish or yellow-green crusts are visible in both halves of the nose, filling the entire nasal cavity, with a spread to the nasopharynx and the lower respiratory tract. After removing the crusts, the nasal cavity becomes so wide that when rhinoscopy the upper nasal concha and upper nasal passage, the back wall of the nasopharynx, the pharyngeal openings of the auditory tubes and even the tubules are visible, in severe cases of atrophy, the nasal cavity is exposed into a huge empty space. For ozena is characterized by the lack of integrity of the mucous membrane. No infiltrates, scars, ulcerations.
Examination of the respiratory and olfactory functions can reveal various changes depending on the form of the disease. In mild form, these functions may not be impaired, and in moderate and severe, marked disorders are observed. After removing the crusts, the respiratory function is temporarily restored by the formation of new ones. The sense of smell is not restored. There is no need for in-depth examination methods.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]
Laboratory research
Determining the cause of the disease is based on a microbiological study of nasal discharge. In more than 90% of cases, Klebsiella pneumoniae ozaenae is found. In the presence of microbiological confirmation of the disease, the diagnosis should not cause doubt.
Instrumental studies
Anterior and posterior rhinoscopy, pharyngoscopy, indirect laryngoscopy, rhinometry and olfactometry. In anterior rhinoscopy, atrophy of the mucous membrane, peel, expansion of the nasal cavity is detected; And the fetid odor is indicative of the diagnosis of Ozena.
Differential diagnostics
Differentiate the disease should be in the initial period with catarrh, and in the late - with scleroma in the stage of atrophic changes.
From the acute and chronic rhinitis, the initial stage of the stage is distinguished by a stubborn progressive course, with microbiological examination, Klebsiella pneumoniae ozaenae is found.
When the scleroma is initially detected infiltration, scars, which are not present with ozen, and only in the future atrophy of the mucous membrane. In the study of microflora find Klebsiella scleroma. In addition, scleroma is characterized by endemic foci of spread in Belarus and Western Ukraine in the Far East, while ozena is found everywhere.
When diagnosing, the form of the disease should be determined, since the working ability of the patient depends on it. In severe form with the spread of the process on the pharynx and larynx, the patient may be limited or completely disabled.