Question: I live in Denver, CO which is very dry, and I have had chronic colds since last November. I was recently diagnosed with atrophic rhinitis. My allergist recommended that I do a sinus wash daily (NeilMed or a neti pot). He also wants me to swab my sinuses with olive oil twice a day. My doctor didn’t seem alarmed by what I have, but I researched this disease on the Internet and it seems more serious than he made it out to be. My doctor told me that if I follow these directives, I shouldn’t have as many colds next winter. He never recommended an antibiotic or antibiotic ointment. What do you think?
Answer: Atrophic rhinitis can be quite a problem and can vary greatly in its severity- from a little dryness, to foul smelling crusting and infection. It can be caused by chronic infection or chronic irritation, aggressive surgery or at times we don’t know the cause. The nose works as a filter. The mucous in the nose traps particles- including bacteria, viruses, allergens and others and pushes them down into the stomach where stomach acid can destroy them. The nose also is a humidifier and temperature regulator. By the time inhaled air reaches the back of the throat, it is both 100 per cent humidified and brought to body temperature. With atrophic rhinitis, one or all of these functions are reduced or eliminated.
First, one should try to find the cause of the problem. Unusual infections such as rhinoscleroma, or inflammations such as sarcoidosis can be treated. Symptomatic treatment for atrophic rhinitis aims at replacing or reinforcing the lost functions. Hypertonic saline (extra-salty) nasal rinses are aimed at helping the nose clean itself of the particles discussed above. Topical application of ointment once or twice a day to the anterior part of the nose will help trap particles and moisturize the nasal cavity. Theoretically, these should be water soluble- such as rhinaris nasal gel- but others such as petroleum based triple antibiotic ointments like bacitracin have been used. A room humidifier, kept clean, will help in the heating months.
When there is an infection, we treat with appropriate antibiotics, preferably based on culture. For brief periods one may need oral antibiotics, but generally we rely on antibiotic ointments- such as bactroban, or appropriate antibiotic washes- I don’t recommend continuing on antibiotics topically or using oral antibiotics persistently without another indication. It may lead to getting infections that are resistant to antibiotics.
Robert L. Pincus MD
NY Sinus Center