• Clinical science

Rhinitis

Summary

Rhinitis usually refers to inflammation of the nasal mucosa as a result of a type 1 hypersensitivity reaction (allergic rhinitis) and/or upper respiratory tract infection (infectious rhinitis). Clinical manifestations of rhinitis include nasal congestion, sneezing, rhinorrhea, and post-nasal drip. Furthermore, patients with allergic rhinitis complain about itching eyes and exacerbation of symptoms in certain seasons or with exposure to various allergens (e.g., dust). Management of allergic rhinitis involves identifying and avoiding the causative allergen. Nasal decongestants such as oral antihistamines (e.g., cetirizine) and intranasal sympathomimetics (e.g., xylometazoline) are used for symptomatic relief. Intranasal glucocorticoids are also very effective in the management of allergic rhinitis but should be used judiciously. Certain rarer forms of rhinitis – such as vasomotor rhinitis – are not associated with an inflammatory process. Vasomotor rhinitis is caused by a number of autonomic and/or hormonal stimuli that increase blood flow to the nasal mucosa, resulting in nasal congestion and rhinorrhea. Treatment of vasomotor rhinitis primarily involves avoiding the causative stimulus. Because infectious rhinitis almost always simultaneously involves the sinuses (rhinosinusitis), it is discussed in the sinusitis learning card.

Classification

References:[1]

Allergic rhinitis

Intranasal sympathomimetics should not be used for more than three days because of the risk of rebound nasal congestion (rhinitis medicamentosa)!

References:[2][3][4][5]

Vasomotor rhinitis

  • Definition: Vasomotor rhinitis is a general term for rhinitis that is caused by an increase in blood flow to the nasal mucosa as a result of:
  • Etiology
  • Clinical features
  • Treatment:
    • Address the underlying cause of rhinitis (e.g., discontinue the offending drug)
    • Medical therapy
    • Surgical therapy
      • Resection of hypertrophic nasal turbinates in order to relieve nasal obstruction

References:[1][6][7][8]

Differential diagnoses

Other conditions that may present with nasal congestion include:

  • Nasal polyps
  • Deviated nasal septum
  • Adenoid hypertrophy (in case of children)
  • Foreign nasal body
    • Epidemiology: : mostly young children (2–5 years)
    • Etiology: : organic (e.g., food; items) or inorganic objects (e.g., pearls; , stones, small toys) are inserted into the nose
    • Clinical features
    • Diagnostics
      • Headlight or otoscope
      • Flexible fiberoptic endoscopy
    • Treatment: removal through positive pressure techniques; ; if this fails, extraction via endoscopy and anesthesia

References:[9][10]

The differential diagnoses listed here are not exhaustive.