Primary atrophic rhinitis or ozena is a chronic nasal disease characterized by progressive atrophy of the nasal mucosa and underlying bone, accompanied by the formation of foul smelling, thick, dry crusts in the greatly enlarged nasal cavities. Although the incidence of ozena is greatly diminished in the western world, it is still encountered rarely and merits the attention of the ENT specialist. Hereditary, infectious, developmental, endocrine and nutritional factors have been implicated but the etiology of ozena still remains enigmatic. Numerous surgical and non-surgical methods have been advocated for treatment of ozena. We review our experience with 17 ozena patients in the past 20 years and discuss different modes of treatment. The relevant literature is reviewed.