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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Otolaryngology

Evaluating Your Nose: The Path to Diagnosis

At a Glance

Atrophic rhinitis has no single test that confirms it. Doctors combine your history with nasal endoscopy, which can show a dry, thin lining, crusting, and a widened cavity; CT scans, cultures, or a biopsy may be added to clarify the diagnosis or rule out similar conditions.

Because atrophic rhinitis is rare, the process of reaching a diagnosis is often one of exclusion—doctors must first rule out more common or more dangerous conditions that mimic its symptoms [1][2]. There is no single “gold standard” test for this condition; instead, a diagnosis is built using a combination of your clinical history, a visual exam, imaging, and sometimes selected laboratory testing [3][4].

The Clinical Findings

Most specialists look for specific findings to confirm atrophic rhinitis:

  1. Mucosal Atrophy: Visible thinning of the nasal lining [3].
  2. Abundant Crusting: Thick debris that often fills the nasal cavity [5].
  3. Fetid Nasal Odor: An objective foul smell that others may notice, particularly in primary ozena [4].

The Role of Nasal Endoscopy

A nasal endoscopy—where a doctor uses a thin, flexible camera to look deep inside your nose—is the most important tool for evaluating your condition [5].

During this exam, the doctor is looking for:

  • Cavity Roominess: An unusually wide space where the turbinates (the bony shelves that humidify air) appear shrunken or are surgically absent [5][6].
  • Mucosal Status: Whether the lining looks pale, dry, or glass-like instead of pink and moist [7].
  • Crust Distribution: Where the crusts are forming and whether there is active infection underneath them [5].
  • Septal Health: Checking for holes (perforations) in the wall between your nostrils, which can occur in advanced or secondary cases [8].

Imaging: What CT Scans Show

A CT scan provides a detailed map of the bone and tissue. In atrophic rhinitis, the scan may show an enlarged nasal cavity and a reduction of the delicate bone structures of the turbinates [9][10].

However, it is important to know that the “roominess” seen on a CT scan does not always match how severe your symptoms feel [11]. Furthermore, turbinate loss can reflect prior surgery, remodeling, or trauma; a CT finding of a widened cavity does not by itself prove active, aggressive disease. Your ENT specialist will interpret any bony resorption in the context of your specific history [12][3].

Nasal Cultures and Biopsies

The following tests are not required for every patient but may be considered when indicated by your specific symptoms.

Nasal Cultures

Your doctor may take a swab of the mucus or a crust to send to a lab. This culture helps identify specific bacteria, such as Klebsiella ozaenae [3][13]. While this bacterium may be associated with primary atrophic rhinitis, its presence alone isn’t a “positive test” for the disease, as it can simply colonize noses that are already damaged [13][12]. It is most useful for guiding treatment if a true infection requires care.

Why a Biopsy is Sometimes Considered

A biopsy—removing a tiny piece of tissue for microscopic study—is not a routine requirement, but it can help rule out certain “look-alikes” [14]. A doctor may recommend a biopsy if:

  • Your symptoms are not responding to standard treatments or are rapidly changing [1].
  • There is a visible mass or suspicious ulceration [15].
  • They suspect conditions like NK/T-cell lymphoma, granulomatosis with polyangiitis (GPA), or sarcoidosis, which can all cause similar crusting [1][16]. A biopsy is just one tool; a negative sample does not automatically exclude all look-alike conditions.

Individualizing Your Evaluation

A thorough evaluation is tailored to you. It will heavily involve:

  • Full Medical History: Discussing past nasal surgeries, facial trauma, and any systemic symptoms (like joint pain or lung issues).
  • Comprehensive Nasal Endoscopy: A visual inspection of both nasal cavities.

Additional tools like CT scans, cultures, formal olfactory (smell) testing, and biopsies will be selected by your clinician if they are necessary to clarify the diagnosis or change the treatment plan [17][14][2].

Common questions in this guide

How do doctors diagnose atrophic rhinitis?
There is no single test that confirms atrophic rhinitis. Doctors combine your medical history with a nasal examination, especially nasal endoscopy, and may add a CT scan, culture, smell test, or biopsy when needed to clarify the diagnosis or rule out similar conditions.
What can a nasal endoscopy show in atrophic rhinitis?
A nasal endoscopy lets the doctor inspect the deeper nasal passages. It may show a thin, pale, dry lining; thick crusts; an unusually wide cavity with shrunken or absent turbinates; infection; or a hole in the nasal septum.
Can a CT scan confirm atrophic rhinitis?
A CT scan may show an enlarged nasal cavity and loss or thinning of the turbinate bones, but these findings do not prove active atrophic rhinitis on their own. Prior surgery, trauma, or natural remodeling can also change the nasal structures, and scan findings may not match symptom severity.
Does finding Klebsiella ozaenae confirm primary ozena?
No. Klebsiella ozaenae can be present in a damaged nose without being the cause of atrophic rhinitis, so a culture result alone is not a definitive diagnosis. The result may still help guide treatment when a true bacterial infection needs care.
When is a biopsy needed for suspected atrophic rhinitis?
A biopsy is not routinely needed, but a doctor may recommend one if symptoms change quickly, fail to respond to standard care, or involve a mass or suspicious ulcer. It can help investigate conditions that resemble atrophic rhinitis, such as granulomatosis with polyangiitis, NK/T-cell lymphoma, or sarcoidosis; a negative sample does not rule out every look-alike condition.

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References

References (17)
  1. 1

    Extranodal NK/T cell lymphoma, nasal type, with retrobulbar extraconal phlegmon and naso-oral fistula.

    Wong DJY, Parry LA, Bloch AE, Agar N

    BMJ case reports 2019; (12(3)) doi:10.1136/bcr-2018-227160.

    PMID: 30852512
  2. 2

    A Case of Saddle Nose Deformity Secondary to Lepromatous Leprosy.

    Pokala U, Poondru AR, Laxmi Santhi Swetha M S, et al.

    Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 2025; (77(2)):1014-1018 doi:10.1007/s12070-024-05238-x.

    PMID: 40065940
  3. 3

    Ozena in Immigrants of Differing Backgrounds.

    Yelenich-Huss MJ, Boyer H, Alpern JD, et al.

    The American journal of tropical medicine and hygiene 2016; (95(1)):35-7 doi:10.4269/ajtmh.15-0885.

    PMID: 27114295
  4. 4

    Therapeutic Management of Primary Atrophic Rhinitis (Ozene): About 4 Cases.

    Maalej F, Chaabouni MA, Ayadi S, et al.

    Ear, nose, & throat journal 2024; 1455613241252586 doi:10.1177/01455613241252586.

    PMID: 38742474
  5. 5

    Topical Mitomycin-C can help as an adjunct to alkaline nasal wash and rifampicin in primary atrophic rhinitis.

    Abdel-Naby Awad OG, Hasan MM

    American journal of otolaryngology 2019; (40(2)):137-142 doi:10.1016/j.amjoto.2019.01.007.

    PMID: 30670313
  6. 6

    Role of α-Tocopherol Acetate on Nasal Respiratory Functions: Mucociliary Clearance and Rhinomanometric Evaluations in Primary Atrophic Rhinitis.

    Testa D, Marcuccio G, Lombardo N, et al.

    Ear, nose, & throat journal 2021; (100(6)):NP290-NP295 doi:10.1177/0145561319870483.

    PMID: 31578104
  7. 7

    Serum Hormone Levels in Female Patients With Atrophic Rhinitis.

    Bhoi S, Panda S, Pradhan P, et al.

    Cureus 2025; (17(3)):e80309 doi:10.7759/cureus.80309.

    PMID: 40206888
  8. 8

    Histopathological Findings in an Unclassifiable Case of Empty Nose Syndrome with Long-term Follow-up.

    Dzhenkov DL, Stoyanov GS, Georgiev R, Sapundzhiev N

    Cureus 2018; (10(5)):e2655 doi:10.7759/cureus.2655.

    PMID: 30042906
  9. 9

    Is Ozone (O3) Treatment Effective in Atrophic Rhinitis? Experimental Animal Study.

    Altaş B, Koçak HE, Altınay S, et al.

    Otolaryngologia polska = The Polish otolaryngology 2018; (72(5)):37-44 doi:10.5604/01.3001.0012.1265.

    PMID: 30460908
  10. 10

    Is submucosal fat injection effective in atrophic rhinitis? An experimental animal study.

    Balur MB, Koçak HE, Altınay S, et al.

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2017; (274(10)):3637-3642 doi:10.1007/s00405-017-4670-0.

    PMID: 28707085
  11. 11

    Olfaction in Primary Atrophic Rhinitis and Effect of Treatment.

    Mishra A, Mishra Shukla N, Verma V, Mishra SC

    OTO open 2020; (4(3)):2473974X20949503 doi:10.1177/2473974X20949503.

    PMID: 32885128
  12. 12

    Severe Secondary Atrophic Rhinitis with Extensive Osteomyelitis Following COVID-19-Associated Necrotizing Rhinitis: A Case Report and Microbiological Analysis.

    Danylevych A, Tsolko S, Tymechko I, et al.

    Reports (MDPI) 2025; (8(4)) doi:10.3390/reports8040237.

    PMID: 41283605
  13. 13

    From Commensal to Pathogen: Unveiling Klebsiella pneumoniae subsp. ozaenae as a Cause of Meningitis and a Literature Review.

    Cs P, P VD, Palukuru SR, Jakkam C

    Cureus 2025; (17(11)):e96255 doi:10.7759/cureus.96255.

    PMID: 41367467
  14. 14

    Role of Histopathology in Differentiating Primary Atrophic Rhinitis from Atrophic Stage of Rhinoscleroma.

    Nagalotimath US, Naveen K, Puranik RB, et al.

    Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 2017; (69(1)):62-66 doi:10.1007/s12070-017-1053-1.

    PMID: 28239581
  15. 15

    The evaluation of malignant mucosal melanoma of nasal cavity with a rare occasion.

    Kepekci AH, Kig C, Gundogan GI

    International journal of physiology, pathophysiology and pharmacology 2018; (10(4)):139-143.

    PMID: 30245777
  16. 16

    IgG4 Autoimmune Disease Masquerading As Oroantral Fistula.

    Schmidt P, Qasim A, Ali HR, et al.

    Cureus 2023; (15(7)):e42475 doi:10.7759/cureus.42475.

    PMID: 37637516
  17. 17

    Threshold and suprathreshold component analysis in olfactory dysfunction: a retrospective study.

    Brabahar BS, Kurien R, Panicker R, et al.

    The Journal of laryngology and otology 2024; (138(6)):647-651 doi:10.1017/S0022215123002268.

    PMID: 38058015

This page is for informational purposes only and does not constitute medical advice about atrophic rhinitis. Your ENT specialist should interpret endoscopy, scans, cultures, and any biopsy in the context of your symptoms and history.

Guide contents atrophic rhinitis
Research & Literature
03 The Biology of a Changing Nose 05 Daily Care and Medical Management