Neglected Old Nasal Foreign Body V/S Atrophic Rhinitis: A Diagnostic Dilemma

Abstract Background: Atrophic rhinitis is a chronic nasal condition marked by progressive atrophy of the nasal mucosa and bone, leading to a roomy nasal cavity with thick, dry crusts. Common symptoms include foul odor (ozena), crusting, nasal obstruction, epistaxis, anosmia or cacosmia, and secondary infections, sometimes with maggot infestation. It is more prevalent in tropical regions and primarily affects young to middle-aged females. Methodology: A 1.5 year old female child presented with foul smelling nasal discharge from bilateral nasal cavity with on and off episodes of nasal bleed since 8 months. Detailed history taken, examination of ear nose and throat was done followed by which routine investigations and culture sensitivity was sent. Diagnostic nasal endoscopy showed no foreign body but bilateral roomy nasal cavity with greenish dry crusts adherent to the nasal cavity. Left side showed extensive crusting covering the middle turbinate. CT Nose & PNS showed F/S/O rhinosinusitis. After all the necessary investigations the child was taken up for DNE with biopsy under General Anesthesia. Results : The intra operative findings were found to be in consistent with features of atrophic rhinitis, the HPE reports confirmed the same by showing metaplasia of stratified squamous epithelium that ruled out the possibility of old nasal foreign body. Conclusions: Though the initial findings were towards the nasal forging body this case turned out to be a case of atrophic rhinitis in the youngest child reported till date.