Rhinitis

The rhinitis can be defined as inflammation of the nasal mucosa, caused by various agents and mechanisms. Clinically, it translates into a stuffy or stuffy nose, watery or mucous rhinorrhea, nasal itching, and sneezing attacks. These symptoms can occur in anyone as a response to natural aggressions such as smoke, strong odors, etc.

It is one of the most frequent syndromes in routine medical practice and, although it is considered a minor process, it affects a large number of people and leads to a decrease in the quality of life. The most common is seasonal allergic rhinitis, which affects 10% of the population.

We will distinguish different types of rhinitis depending on the agent that produces it:

• Allergic rhinitis: seasonal or perennial
• Infectious rhinitis: acute or chronic
• Non-allergic rhinitis: idiopathic, hormonal, drug-induced, atrophic

Causes of rhinitis

Allergic rhinitis

The agent that causes it is an allergen, that is, a substance that acts on contact with the nasal mucosa, triggering a hypersensitivity reaction, with significant local inflammation and increased mucous secretion. In the case of seasonal rhinitis, the allergen is pollen. In Spain, the pollens of grass, olive, cypress and banana stand out.

Perennial allergic rhinitis is one that occurs throughout the year, without presenting a clear seasonal predominance. The allergens that produce it can be very varied and often difficult to identify. The most common are substances that pets have on their skin, dust and mites.

Infectious rhinitis

It is mainly due to viruses, although on occasions there may be a secondary bacterial infection involving the paranasal sinuses. The viruses most frequently implicated are rhinoviruses, responsible for the common cold. This type of rhinitis can be acute or chronic.

Non-allergic rhinitis

It affects a heterogeneous group of people.

• Idiopathic, vasomotor, or cholinergic rhinitis is triggered by nonspecific stimuli (strong odors, changes in temperature).
• Hormonal rhinitis can appear during pregnancy and puberty and in some diseases such as acromegaly or hypothyroidism. Hormonal changes in postmenopausal women can also influence the appearance of rhinitis.
• Drug rhinitis results from the abuse for long periods of time of substances used for nasal decongestion.
• Primary atrophic rhinitis is usually associated with sinusitis and chronic headaches. It has been attributed to infection by different bacteria, although its mechanisms are not currently known. Secondary can happen after different situations, such as nasal surgery, nasal trauma or radiation.

Regardless of the initial causes, the mechanism by which the different types of rhinitis occur is common: the causative agent affects the nasal passages producing an inflammation of the mucosa and, as a consequence, an increase in mucous secretions from the nose.

In most cases, when the causative agent disappears, the inflammation disappears, but there are occasions in which it can persist and become chronic or lead, as a consequence, to sinusitis.

What symptoms appear?

The symptoms of the different types of rhinitis are also common, more or less intense depending on the virulence of the causative agent and the inflammatory response presented by the nasal mucosa.

• As a consequence of inflammation and increased nasal secretions, there is:
  nasal packing
• rhinorrhea
• sneezing
• cough, as a consequence of the subsequent drip of mucous secretions into the pharynx.

It is frequently accompanied by a headache or “feeling of dullness” in the head and plugging of both ears, as a result of the accumulation of mucus in the middle ear, which is caused by inflammation of the Eustachian tube, the tube that connects the middle ear with the upper part of the pharynx.

Diagnosis of rhinitis

The diagnosis of rhinitis is very simple and is based on the clinical picture and the patient’s history. The latter will allow us to identify the cause of rhinitis, since the patient usually starts symptoms whenever he or she suffers from exposure to the allergen (in the case of allergic rhinitis) or will refer to other symptoms, such as fever or general malaise, suggestive of Respiratory infection.

In persistent forms (chronic or perennial allergic rhinitis) we can perform an anterior and / or posterior rhinoscopy.

Rhinoscopy will allow us to explore the nasal passages and see the degree of inflammation of the mucosa and the existence or not of more important lesions (polyps or tumors) that could be producing rhinitis symptoms.

Posterior rhinoscopy is performed through the mouth, and allows to see the cavum, and the back of the nostrils. It is important to perform this test, since, although it is rare, there may be a neoplasm in this area that is responsible for the symptoms. In these cases, more sophisticated tests (such as a CT scan) will be necessary in order to determine the extent of the injury.

A routine examination of the ears and throat should always be done.

How is it treated?

Cases of acute rhinitis associated with a respiratory infection do not require special treatment, being sufficient with the administration of analgesics and antipyretics and, if there is a lot of nasal congestion, the application of decongestant sprays, not more than 2 or 3 days. It is also very useful to carry out nasal washes with physiological saline 2 or 3 times a day.

In allergic rhinitis, the treatment will consist, first of all, in avoiding contact with the allergen. This is not possible on many occasions (for example, in pollinosis), so it will be necessary to use antihistamines by mouth and the application of nasal corticosteroids, in the form of a spray.

Treatment of chronic or idiopathic rhinitis is more difficult and is usually reduced to the application of local corticosteroids in the most acute moments. In some cases, chronic rhinitis may be due to structural alterations (deviation of the septum, etc.) in which case surgery can be considered, taking into account that it is only useful to improve symptoms in those cases in which deviation of the septum it is very important, since, in the rest, it does not imply an improvement that justifies the risk posed by the intervention.

In allergic rhinitis, desensitization of the individual is useful, through the administration of vaccines based on allergen extracts, generally throughout the fall and winter, in the case of pollinosis.

In general, irritant substances in the nose should be avoided, mainly tobacco, since they help to perpetuate the inflammation of the nasal mucosa and, therefore, favor the appearance of chronic rhinitis.