RHINITIS 37 This leaves the patient liable to crust formation, and he is often more miserable than before the operation. Diminution of the fringe by cryosurgery or by cautery is less destructive, while shrinkage of the concha by submucous diathermy will preserve the mucous lining. No after-treatment of surgery should be necessary. ATROPHIC RHINITIS Atrophic rhinitis is a chronic disease which may or mayjipt be associated with foetor. If there is foetor, the condition is called ozaena. Tne" aetiology of o^Sena is uncertain. It has been ascribed to an unsuspected chronic infection, or to a severe nasal infection in patients suffering from vitamin or endocrine deficiency, or whbliave an inadequate diet. Many organisms may be cultured from the nose—Coccobacillus foetidus* B. mucosus and diphtheroids—but they are thought to be secondary invaders wEIch may produce the foetor. The disease is familjal in many instances, and appears to be more prevalent in equatorial races. It is much more common in women than in men, and usually starts about guberty, although it may be seen in children. Its occurrence at puberty has raised the possibility of some endocrine disturbance playing a part. Fortunately ozaena is becoming a relatively rare disease, because it is a most distressing one to the patient. The reason for this reduced frequency is not known. Atrophic rjiinitis without foetor is very commonly due to over- exuberant surgery, with removal of large parts of the inferior conchae to leave large raw surfaces of the bone, and a consequent wide nasal cavity. PATHOLOGY. The atrophicj^anjgesJuoJlie mucosa haye^beerLascribed to a chronic i"ffamr"fltrtry prnraSsTprnHnrang endaitfiritis and periarteiitis of the terminal arteriples, resulting in a diminished blood, supply to the nasal mucosa. There is a progressive atrophyjofthe mucosa with conversion of the ciliated epithelium to cuboidaj_orJstratiJBed«squanious epithelium. Thejbone of the inferior conchajn^^haxfe in the atrophic process. A thick viscid secretion is exudedTanxTthis dries rapidly to form crusts which emit the characteristic foetor. Both sides of the nose are usually affected in ozaena, but the postoperative atrophy may be unilateral, depending on the surgery. SYMPTOMS. The most characteristic symptom of ozaena is the foster, which varies in intensity, and is sometimes worse_^duj:mg menstruation. It may be noticed at some distance from the patient, who, because of anosmia, is unaware of it. Nasal crusting causes obstruction, and drynessjof the throat may be troublesome, and crusting may be seen in the pharynx. Headaches are frequent. Epistaxisjnay occur when the crusts separate, and crustsTareT blown out of the nose, although some are too large to be got rid of in this way. In atrophic rhinitis without foetor there are similar symptoms—anjosmia, headache, epistaxis, nasal obstruction and crust jgrmation. CLINICAL FEATURES. The nasal cavities contain greenish crusts and, on posterior rhinoscopy, these may be seen in the nasopharynx. When the crusts are removed the nasal cavities are unduly wide, so that the posterior nares, auditory tubes and the posterior wall of the nasopharynx may be seen, while during speech the movement of the soft palate is visible from the anterior nares. The absence of ulceration distinguishes atrophic rhinitis from tertiary syphilis.