Atrophic Rhinosinusitis with Widening of the Nasal Cavity — Surgical Protocol When Conservative Medical Management Has Not Reduced Crusting or Restored Nasal Hydration

This protocol addresses primary atrophic rhinitis with spontaneous onset in patients who have already undergone conservative medical management without achieving the required reduction in nasal crust formation and adequate increase in nasal hydration.

Clinical scenario

The patient presents with the characteristic triad of primary atrophic rhinitis: widening of the nasal cavity, greenish nasal crusts, and foul nasal odor (foeter). Onset is spontaneous, and the condition progresses slowly over time.

Prior treatment — failure condition

Conservative medical management (administered locally or systemically) was the first-line approach. This line is considered to have failed when it does not achieve a sufficient decrease in nasal crust formation or an adequate increase in nasal hydration, warranting escalation to the current protocol.

Next-line approach (partial overview)

The next step involves surgical management aimed at reducing the size of the nasal cavities and promoting regeneration of normal nasal mucosa. Multiple surgical techniques have been studied in this setting — the complete structured protocol details the specific options and individual considerations.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1177/01455613231185022

Primary AR is characterized by a triad comprising widening of the nasal cavity, greenish crusts, and foul nasal odor (foeter).

Primary AR presents with spontaneous onset and progresses slowly with time.

Surgical approaches have been used to manage AR.

They aim to decrease the size of the nasal cavities to increase nasal resistance.

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