Ozena – This is a disease of the nasal mucosa. Women get sick more often than men.
Predisposing factors for ozone development are unsatisfactory living conditions (poor housing, insufficient nutrition).
The reasons for the development of ozena are still unexplained. Some authors believe that the cause of the disease is congenital excessive width of the nose, shortening of the anterior- posterior dimensions of the nasal cavity, hypoplasia of the paranasal sinuses and a wide facial skull.
Other authors have attributed the origin of ozena to the rebirth of the nasal mucosa. Reborn mucous disintegrates, emitting an unpleasant smell. Scheenemann ( Schonemann ) found mucosal degeneration in 65 of 75 patients with ozone. Bayer ( Woweg ) and Tsarniko ( Zarniko ) believe that ozena is caused by a malnutrition of tissues leading to the destruction of bone and the regeneration of the epithelium.
Microbiology research has proven a wide variety of microflora in the nasal mucus of ozen patients, and this fact has allowed some authors to consider ozen as an infectious disease.
Of all the hypotheses, the most reliable can be considered the one according to which ozena develops when nerve function is impaired, in particular when it is damaged, irritated, etc. pterygopalatine node.
With a completely free nasal breathing, painful dryness in the nose and the presence of something foreign are felt.
These manifestations cause the need to clear the nose, and the patient tries to remove the accumulated crusts. In some cases, the crusts accumulate in such large quantities that they completely clog the nasal cavity. Then comes the difficulty of nasal breathing, which quickly passes after vigorous blowing out or mechanical removal of crusts.
Another manifestation of ozena is the loss of smell. The patient, being a carrier in the nose of fetid crusts, does not smell them and learns about it only from those around them. Loss of smell is due to the death of the olfactory receptor. The stench from the nose reaches such strength that others avoid the presence of the patient. The patient notices this and avoids society himself.
Frequent concomitant disease is inflammation of the auditory tube and middle ear, which leads to tinnitus and hearing loss. Ozena can spread to the mucous membranes of the pharynx, larynx and trachea. Then there is dry throat, hoarseness and difficulty in breathing, especially when there is a heavy accumulation of crusts in the trachea.
Diagnosis is made ozeny ENT doctor. When rhinoscopy revealed signs characteristic of ozena – the presence of fetid crusts, the removal of which is visible overly wide nasal cavity.
Conservative treatment of ozena involves the elimination of dry nose, accumulation of crusts and deodorization. Wash your nose with 3% hydrogen peroxide solution, a weak pink solution of potassium permanganate or a simple saline solution. To do this, use a special nasal watering can or Esmarch mug.
In order to prevent the liquid from entering the auditory tube, flushing should be done with caution: the patient tilts the head forward, opens the mouth slightly, and then the washing liquid is not swallowed, but is poured out through one or the other half of the nose. Gottstein’s tamponade is made by a doctor: the nasal cavity is filled with a gauze pad moistened with a 1-2% solution of iodine in glycerin. The tampon is left in the nose for 2-3 hours. At removal of a tampon fetid crusts leave.
In some cases, daily nasal lubrication with 2-5% iodoglycerol may be recommended.
The treatment is applied with chlorophyll- carotene paste, manufactured according to F. T. Solodky’s method. One candle is inserted from the paste into both halves of the nose once a day for one month. After a few minutes, the bad smell from the nose disappears, and this state lasts for 2 days. With the re-introduction of the paste, the period of deodorization is extended to 3-5 days. The course of treatment should be carried out 4 times during the year.
Some authors have observed an improvement in the condition of ozone patients from the use of physiotherapeutic procedures, for example, from diathermy and iontophoresis. Good results are observed after inhaling ionized air (therefore, patients are advised to keep an air ionizer at home).
The essence of the surgical treatment of ozena lies in the artificial narrowing of the nasal cavity. Of all surgical techniques, the most benign is the introduction of fat, bone, and cartilage into the submucosal tissue. As a result of the implantation of the material, there is a strong reaction from the perchondrium and the mucous membrane, expressed in enhanced formation of connective tissue, blood vessels and an increase in the size and number of mucous glands. These changes after surgery and cause improvement.
Recently, instead of bone, foam plastic ( hyalon ) is used, followed by the introduction of deoxycorticosteroid acetate as a hormone under the skin of a patient, promoting the development of blood vessels and connective tissue.
A more radical surgical technique is the operation of Lautenschleger , which consists in pushing the inner wall of the maxillary sinus to the nasal septum. The wall of the sinus is separated and fixed in the desired position with a swab. Subsequently, the separated wall is held in a new position by the fusion of the surfaces of the nasal septum and nasal conchas.