Ozena and tinnitus

Q I have a long-standing problem with my nose, a disease called ozena. A foul odour fills the air when I go in among a crowd like in a church. It’s deeply embarrassing. I went to a nose specialist who could not find anything wrong. I am at the stage now where I will have to stop going out. It’s destroying my self-confidence.

A Ozena, otherwise known as atrophic rhinitis, was first diagnosed in the early 1800s, and is relatively uncommon today. One of the main clinical features of this disease is the accompanying odour. Other key symptoms include inflammation and atrophy of the mucosa of the nose, and a loss of smell. The thinning of the mucosa leads to a roominess in the nostrils along with crusting (which is the cause of the odour).

While it is unusual, it can run in families, so check out your family history if possible. Other common causes are hormonal — particularly during the onset of adolescence, pregnancy, or menopause — or a deficiency in vitamins A, D and iron. The bacteria Klebsiella ozaenae is usually found in the nasal area (hence the name, ozena/ozaena), although Proteus vulgaris or E. coli can also be present. If testing shows the presence of any of these bacteria, then a topical antibiotic is typically prescribed. The same goes for nutrient deficiencies — therapeutic supplementation using vitamins A, D and iron can help if this is indicated.

Long-term sinusitis may gradually cause the atrophy of the nasal mucosa, turbinate bones (spongy bones found in the nasal cavity), glands, and nerves supplying the nose. Other infections which have triggered Ozena include tuberculosis, leprosy, and syphilis.

Another important factor to consider is whether the Ozena is primary or secondary. Primary cases are almost always a result of infection with Klebsiella ozaenae — this form of the disease is very rare in Ireland. Secondary cases are more usual, and can appear as a result of sinus surgery, radiation treatment, trauma or infectious diseases.

Interestingly, surgery can also be part of the treatment, with the most success achieved through graft procedures to help reduce the volume of the nasal cavity. Another therapy which is less invasive is deep nasal acupuncture. One thing that the studies agree upon for success, is the adoption of multiple treatment modalities, so investigate more than one therapy if you choose to take action. This condition has been reported to resolve itself or lessen dramatically with age (particularly in patients over the age of 40), so time and patience are also important factors in your treatment plan.

Q About five weeks ago you wrote about tinnitus and mentioned some vitamin tablets that may be of benefit to sufferers of the condition. Could you please explain how a vitamin supplement could make a difference?

A Tinnitus is far more common than most people realise. The sensation of a sound in the ear or head, often a ringing or buzzing noise, tinnitus can occur as a continual irritation or intermittently. Typical causes are working with loud machinery, musical equipment, or as a side effect of illness or medications. The one thing that all sufferers have in common is a sense of extreme frustration. The tablets that I have mentioned in my previous reply are vitamin B12 — you will need to take 1000 micrograms, twice daily. B12 is effective in reducing or even eliminating symptoms because it is a crucial nutrient in the development of the myelin sheaths which protect nerve cells within the body, including those in the inner ear.

Take the tablets as recommended above for one month, then reduce the dosage to one 1000mcg tablet daily. Solgar make a 1000mcg vitamin B12, €11.85 for 100 nuggets.

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