Ozäna: What helps against the "stinky nose"

With the Ozäna or smelly nose, the nose gives off a foul smell that those affected do not notice themselves. The means of choice are careful nose care and antibiotics

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Cause of a "stinky nose"

In healthy people, the nasal cavity hardly deserves the word "cave": it usually contains slit-shaped passages that subdivide three turbinates on each side. These turbinates are cavernous bodies that regulate the width of the nasal cavity. When you breathe in, the air is specifically sucked along the turbinates towards the lungs. The air is heated and humidified in the process. "To prevent the airways in the nose from drying out completely, one of the nasal passages swells over and over again during the day so that the mucous membranes can recover," explains Professor Dr. Jan Peter Thomas, senior consultant at the ENT clinic at St. Elisabeth Hospital at the University of Bochum.

Structure of the nose in longitudinal section. The turbinates divide the nasal cavity

© F1online / Gabriele Huber

As a result of some diseases, the nasal cavity expands. Then there is turbulence in the air flow in the nasal cavity and the mucous membranes dry out more strongly. Also because there are no breaks due to the regularly swelling nasal concha. "Paradoxically, despite having a larger cavity, those affected then have the feeling that they can breathe less well," reports Thomas.

In the enlarged nasal cavity, crusts and crusts form from dried nasal secretions. These are the breeding ground for stinking bacterial strains such as Klebsiella ozaenae, which form a greenish-yellow, greasy coating. The olfactory nerve fibers are also destroyed, so that the sense of smell decreases. Because of the enlarged cavity, the disease is called "empty nose syndrome", which translates as "empty nose syndrome".

What is an Ozena?

But how does an enlarged nasal cavity come about? In the primary Ozena, for unknown reasons, the nasal mucous membrane continues to recede, including the vessels and glands and even the bony parts of the turbinates in the nasal cavity. This form mainly affects women and younger people.

In the secondary ozena, the nasal cavity expands due to other diseases and interventions. For example, the surgical removal of a malignant tumor in the nose can create appropriate cavities. "In earlier times, the turbinates were also removed generously when breathing was obstructed," says Thomas. This inadvertently created space for crusts, crusts and bacteria. Excessive use of nasal sprays can also cause the nasal lining to recede.

Signs that you have an ozena

Those affected often complain about subjectively impaired nasal breathing. "Some also report a diffuse head pressure," adds Thomas. Nosebleeds or a reduced sense of smell can also occur. When it comes to the smell, people are usually the first to be annoyed. An examination with an endoscope usually confirms the diagnosis.

Sometimes there are also other causes for the symptoms. "When foul-smelling pus runs out of a child's nostril, there is often an inserted foreign body behind it like a pen cap," says Thomas. In adults, purulent sinusitis can also cause bad smells, especially if the roots of the teeth are also inflamed.

Crusts in the nose can also be caused by tumors or the autoimmune disease Wegener's disease (granulomatosis with polyangiitis), in which inflammatory nodules form in the nose and other organs. This is why it is sometimes important to take a tissue sample to check your nose for bacterial infections.

Treatment of the Ozena

Nose care is important for the treatment of the Ozäna. Nasal ointments or nasal rinses with saline solutions soften the crusts and crusts so that the doctor can suck off the pus and detach the crusts. How often this is necessary can vary from person to person and depends on how strong the crust formation is. The bacterial infection can be fought with antibiotics. "In the case of extensive infections, it is best to test in advance on the smear which antibiotic is effective," explains Thomas.