Primary Atrophic Rhinitis in Three Adults: A Case Series

Background: Primary atrophic rhinitis, or ozaena, is an uncommon chronic inflammatory-degenerative disorder of the nasal cavity. It is characterized by mucosal and turbinate atrophy, widened nasal cavities, adherent crusts, fetor, and variable olfactory dysfunction. Diagnosis is mainly clinical and is strengthened by nasal endoscopy, microbiological assessment, and computed tomography of the paranasal sinuses in selected patients. Case presentation: Three adults presented with long-standing bilateral nasal obstruction and reduced smell perception. Recurrent crust expulsion was present in two patients. Endoscopic findings included dry pale mucosa, roomy nasal cavities, inferior turbinate atrophy, adherent crusts, and fetor. One patient had a small anterior septal perforation. Nasal swab culture isolated Klebsiella ozaenae in two cases, while the third case showed mixed commensal nasal flora without Klebsiella ozaenae growth. Computed tomography supported the presence of widened nasal cavities and turbinate volume loss without destructive sinonasal disease. Management and outcome: All patients were managed conservatively with endoscopic crust removal, regular alkaline nasal douching, saline irrigation, and topical lubrication. Culture-positive cases received sensitivity-guided oral ciprofloxacin and topical mupirocin. Follow-up showed reduction in fetor, crust burden, mucosal dryness, and nasal obstruction. Hyposmia persisted mildly in two patients despite clinical improvement. Conclusion: Primary atrophic rhinitis remains a clinically recognizable but underreported nasal disorder. Complete reporting requires symptom duration, nasal endoscopic findings, microbiological status, imaging findings when available, treatment details, and follow-up response.

Keywords: Atrophic rhinitis; Ozaena; Nasal crusting; Merciful anosmia; Klebsiella ozaenae; Nasal endoscopy; Case series.