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Chronic Rhinitis

Chronic rhinitis denotes a prolonged course of nasal mucous membrane inflammation and its main symptoms - rhinorrhea and nasal congestion. Because several forms of rhinitis are recognized (infectious, allergic, atrophic, etc.), various additional symptoms may be observed, which is why patient history, together with a thorough ear, nose and throat examination, is vital to make the diagnosis.


Presentation

The clinical presentation of rhinitis somewhat varies depending on the underlying cause, but all patients report nasal congestion and rhinorrhea in the initial stages of the disease. One of the most common subtypes, allergic rhinitis, can be further classified into seasonal, perennial, and occupational, each manifesting by nasal complaints, but also constitutional symptoms - malaise, fatigue, and headaches [1]. Persistent need for mouth breathing and sneezing may be encountered as well, while chronic symptoms often cause frequent rubbing of the nose and the appearance of an "allergic crease" across the nasal bridge due to persistent irritation [2]. Exposure to a specific allergen during a particular time of the year (tree pollens in the spring or grass pollens in the summer), an environmental irritant (tobacco, formaldehyde, hair spray, etc) or an indoor allergen (dust mites, molds) can induce typical symptoms and lead to their prolongation in the absence of a diagnosis and appropriate therapy [1] [3]. Allergic conjunctivitis, eczema, and even asthma may accompany rhinitis in such patients [1]. On the other hand, infectious pathogens (both bacterial and viral) can present with nasal obstruction, frequent and recurrent epistaxis and purulent rhinorrhea in the setting of a bacterial infection [4]. Atrophic rhinitis, another form of non-allergic inflammation of the nasal mucosa, can cause a chronic cough, excessive mucus production (known as the nasal drip), and dryness, while patients frequently complain of nasal crusting, as well as dense and thick secretions that induce the need to clear the throat [5]. Furthermore, it is not uncommon for patients to suffer from chronic inflammation of the nasal and sinus mucosa (known as chronic rhinosinusitis), in which symptoms last for more than 12 weeks [6]. Vasomotor rhinitis, characterized by an intermittent appearance of chronic watery rhinorrhea and sneezing, is also an important cause of chronic rhinitis, but its etiology remains to be determined [4].

Anosmia
  • Four of eight patients with anosmia subjectively improved whereas the other four patients felt unchanged.[ncbi.nlm.nih.gov]
  • Clinical features : Commonly seen in females and starts around puberty. Foul smell from the nose. Marked anosmia (merciful anosmia) Nasal obstruction Epistaxis when the crusts are removed. Nasal cavity full of greenish or greyish black dry crusts[slideshare.net]
  • Medicine Click here for Patient Education Rhinitis is inflammation of the nasal mucous membrane, with resultant nasal congestion, rhinorrhea, and variable associated symptoms depending on etiology (eg, itching, sneezing, watery or purulent rhinorrhea, anosmia[msdmanuals.com]
  • Eustachian tubes connect the middle ears to the back of the throat Chronic ear infection, known as otitis media Loss of smell or anosmia Asthma Obstructive sleep apnea Both types of rhinitis are associated with: Decreased production at work Increased[webmd.com]
Chronic Cough
  • Atrophic rhinitis, another form of non-allergic inflammation of the nasal mucosa, can cause a chronic cough, excessive mucus production (known as the nasal drip), and dryness, while patients frequently complain of nasal crusting, as well as dense and[symptoma.com]
  • Post Nasal Drip and Chronic Cough Post nasal drip can cause a chronic cough.[medicinenet.com]
Paroxysmal Sneeze
  • Symptoms : Paroxysmal sneezing. In the morning. Excessive rhinorrhoea.[slideshare.net]
Loud Snoring
  • The use of BR had no effect on sleep quality, arousal-index apnoea-hypopnoea-index or snoring loudness. Snoring frequency was significantly lowered by BR (173 /-29 snores x h(-l)), compared with placebo (258 /-34 snores x h(-1); p 0.016).[ncbi.nlm.nih.gov]
Excoriation
  • The membrane is pale, relaxed, and secretes an offensive, purulent material, which, drying, forms crusts or scabs, and, when removed, leaves an excoriated surface. In this form the sense of smell is destroyed. Symptoms .[henriettes-herb.com]

Workup

The diagnosis can often be made solely through obtaining a thorough patient history and performing a detailed physical examination, as the clinical presentation is highly specific for rhinitis [1] [2] [4]. Patients should be asked about the timing and onset of symptoms that may reveal seasonal or occupational factors that can provoke them, while the use of medications is important as well since drug-induced rhinitis is also described in the literature [1]. Angiotensin-converting enzyme (ACE) inhibitors, phentolamine, methyldopa, prazosin, beta blockers, oral contraceptives, chlorpromazine, decongestants and nonsteroidal anti-inflammatory drugs (NSAIDs) are all potential causes of medication-induced rhinitis [1]. A full ear, nose, and throat (ENT) exam (with a particular emphasis on anterior rhinoscopy and observation of discharge) can confirm the diagnosis. Pale, pink, or bluish swelling of the nasal mucosa and accompanying watery eye discharge and conjunctival swelling are highly suggestive of allergic rhinitis [2]. Conversely, purulent nasal secretion strongly points to a bacterial etiology, in which case cultivation of the smear may be recommended. Apart from clinical criteria, percutaneous and immunoglobulin E (IgE) testing for allergens are frequently employed in the setting of chronic rhinitis [1], while imaging studies, such as computed tomography (CT) and upper airway endoscopy, may be quite important if the diagnosis remains unresolved [3].

Lymphocytic Infiltrate
  • For the lymphocytic infiltrate, there was no difference between infected and not infected patients with allergic rhinitis (p 1.0).[ncbi.nlm.nih.gov]
  • For the lymphocytic infiltrate, there was no difference between infected and not infected patients with allergic rhinitis ( p 1.0).[scielo.br]

Treatment

  • RESULTS: Complete sets of pre-treatment and post-treatment surveys were obtained from 19 patients.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis : Disease persists for yearsTreatment :1. Medical : a. Nasal irrigation and removal of crusts. b. 25% glucose in glycerine. – Inhibits the growth of proteolytic organisms which are responsible for foul smell. c.[slideshare.net]
  • Narrow-angle glaucoma is a relative contra-indication to the use of ipratropium. 2 Prognosis and Additional Therapies Although no single agent is uniformly effective in controlling the many and varied symptoms of vasomotor rhinitis, available evidence[aafp.org]

Etiology

  • Conversely, purulent nasal secretion strongly points to a bacterial etiology, in which case cultivation of the smear may be recommended.[symptoma.com]
  • Abstract Children are not small adults, and although many features of chronic rhinitis in children are similar to those in adults, there are significant differences in etiologic factors, manner of presentation, and therapy.[ncbi.nlm.nih.gov]
  • Epidemiology Most common health problem in the United States Sites Unilateral or bilateral, nasal cavity or paranasal sinus Pathophysiology Associated with deviated septum or nasal polyps Ostial obstruction in osteomeatal compex causes anaerobic overgrowth Etiology[pathologyoutlines.com]

Epidemiology

  • The measure is a useful assessment method for epidemiological studies of occupational exposure risk.[ncbi.nlm.nih.gov]
  • […] also ulceration and infection extending into sinuses Essential features Thickened, hyalinized basement membrane (minimal criteria) directly beneath respiratory epithelium and around seromucinous glandular tubuli Terminology Rhinosinusitis, sinusitis Epidemiology[pathologyoutlines.com]
  • Two centres (Cape Town and Polokwane) participated in this study of the epidemiology of allergic rhinitis.[samj.org.za]
  • Schoenwetter WF: Allergic rhinitis: epidemiology and natural history. Allergy Asthma Proc 2000, 21 :1–6. PubMed CrossRef Google Scholar 13.[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • SUMMARY: Recent findings on the function of vitamin D may explain aspects of the pathophysiology of chronic rhinitis and CRS, and may help direct future treatment of these diseases.[ncbi.nlm.nih.gov]
  • The basic pathophysiology for both allergic and nonallergic causes is essentially the same.[pedsinreview.aappublications.org]

Prevention

  • Prevention The only prevention of chronic rhinitis is when allergens are identified, to avoid exposure to them, as well as to tobacco smoke or other pollutants which, in high exposure, may be responsible for the development of the disorder.[health.ccm.net]
  • This article was last reviewed on Monday, January 29, 2018 MORE A-Z Diabetes Prevention Programme With the right lifestyle changes, you may be able to prevent diabetes and even stop the progression of the disease.[healthhub.sg]
  • This makes it even more important to keep your allergies under control and to prevent rhinitis and sinusitis from occurring.[allergyasthmasinusctr.com]
  • RespiFacile fits inside your nostrils and prevents your nasal valve from collapsing while you breathe in. The improvement in breathing is immediate and marked.[respifacile.com]

References

Article

  1. Quillen DM, Feller DB. Diagnosing rhinitis: allergic vs. nonallergic. Am Fam Physician. 2006;73(9):1583-1590.
  2. Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg. 2015;152(1):S1-43.
  3. Tran NP, Vickery J, Blaiss MS. Management of Rhinitis: Allergic and Non-Allergic. Allergy Asthma Immunol Res. 2011;3(3):148-156.
  4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  5. Pinto JM, Jeswani S. Rhinitis in the geriatric population. Allergy Asthma Clin Immunol. 2010;6(1):10.
  6. Schroer B, Pien LC. Nonallergic rhinitis: common problem, chronic symptoms. Cleve Clin J Med. 2012;79(4):285-293.

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Last updated: 2019-07-11 21:42