Rhinitis Rhinitis refers to inflammation of the nasal mucosa. Common symptoms include nasal congestion, clear nasal discharge, sneezing, and nasal itching. Rhinitis is often caused by allergens, infections, environmental factors, etc.

Inflammation of the nasal mucosa caused by bacteria, viruses, allergens, etc.

Manifests as symptoms such as nasal congestion, itching, runny nose, and sneezing.

Allergic rhinitis has a certain genetic predisposition.

Acute rhinitis has a better prognosis, while chronic rhinitis often recurs.

Rhinitis is inflammation of the nasal mucosa caused by viruses, bacteria, allergens (such as pollen), various physical and chemical factors (such as irritating gases), and certain systemic diseases. It mainly presents as symptoms such as nasal congestion, itching, runny nose, and sneezing. There are many types of rhinitis, with allergic rhinitis being the most common.

Classification by Etiology

Allergic Rhinitis

Inflammatory response of the nasal mucosa caused by allergens such as dust mites, mold, pets, pollen, etc., with a certain genetic predisposition.

Non-Allergic Rhinitis

Inflammatory response of the nasal mucosa caused by viruses, bacteria, irritating odors, temperature changes, etc., including vasomotor rhinitis, atrophic rhinitis, hormonal rhinitis, gustatory rhinitis, drug-induced rhinitis, occupational rhinitis, and chronic non-allergic rhinitis.

Classification by Onset

Acute Rhinitis

Acute inflammatory condition of the nasal mucosa caused by various upper respiratory viruses, commonly known as "common cold" or "flu," with a certain degree of infectivity, occurring throughout the year.

Chronic Rhinitis

Chronic inflammatory disease of the nasal mucosa and submucosa, often without obvious pathogenic microbial infection, lasting for several months or longer, characterized by recurrent episodes.

Causes of Rhinitis

Acute Rhinitis

Caused by upper respiratory viral infections or bacterial infections, with over 100 known viruses capable of causing the condition, including common culprits such as rhinoviruses and adenoviruses.

Chronic Rhinitis

The exact cause of chronic rhinitis remains unclear. It is often due to repeated episodes of acute rhinitis or incomplete treatment, disturbances in the body's endocrine or immune systems, poor nasal ventilation leading to pathogen retention, chronic diseases, local medications, and long-term inhalation of dust and irritating gases, resulting in prolonged venous congestion or reflexive congestion of the nasal mucosa, thus triggering chronic rhinitis.

Other Types of Rhinitis

Allergic Rhinitis

Primarily caused by allergen stimuli such as dust mites, mold, pets, pollen, etc., leading to allergic inflammatory responses in the nasal mucosa, often associated with genetic factors.

Atrophic Rhinitis

Mainly caused by endocrine disorders, vitamin deficiencies, genetic factors, inappropriate nasal surgeries, infections, with a clear genetic predisposition.

Hormonal Rhinitis

Mainly caused by periodic hormonal changes in the body, such as significant nasal congestion during pregnancy.

Occupational Rhinitis

Often caused by exposure to specific substances in certain work environments, common substances include grains, wood dust, chemicals, and irritating gases.

Rhinitis can be triggered when the body's immune system is compromised due to exposure to cold, overwork, excessive smoking or drinking, nutritional deficiencies, and other illnesses.

Acute Rhinitis:

During the initial stages of viral infection, symptoms include dryness, burning, or itching inside the nose, sneezing, followed by nasal congestion, watery nasal discharge, reduced sense of smell, and nasal obstruction. Subsequent bacterial infections can cause the discharge to become mucous, purulent, or purulent.

Chronic Rhinitis:

The main symptoms are nasal congestion and increased nasal discharge, often accompanied by reduced sense of smell, nasal obstruction, discomfort in the nasal root, and headaches.

Other Types of Rhinitis:

Allergic Rhinitis: Main symptoms include nasal itching, sneezing, clear nasal discharge, nasal congestion, reduced sense of smell, and may be accompanied by itching and discomfort in the eyes or throat.

Atrophic Rhinitis: Main symptoms include nasal congestion, crusting in the nose, dryness, foul odor, and headaches.

Hormonal Rhinitis: Mainly characterized by nasal congestion, with symptoms periodically changing with hormone levels.

Occupational Rhinitis: Main symptoms include nasal congestion, runny nose, nasal itching, and sneezing.

Possible Associated Symptoms of Rhinitis:

In some cases, when the inflammation is severe, it can spread to affect the mucous membranes of the upper and lower respiratory tracts, leading to pharyngitis, otitis media, tracheitis, bronchitis, and pneumonia.

Seeking Medical Attention:

When patients experience symptoms such as nasal congestion, nasal itching, sneezing, and a runny nose, they should seek consultation at the otolaryngology department of a hospital. For suspected cases of allergic rhinitis that do not respond adequately to basic drug treatment, patients can be referred to an allergy department for further treatment.

Physical Examination:

Examine the nasal and upper respiratory tract for any structural abnormalities, and observe the condition of the mucous membranes in the nasal and other upper respiratory tract areas, to check for congestion, edema, secretions, etc.

Nasal Endoscopy:

Nasal endoscopy is used to examine the internal structures of the nasal cavity, nasopharynx, and even the sinuses through the narrow nasal cavity and nasal passages. It is used for patients with atypical symptoms or inadequate treatment response.

Skin Prick Test:

This test is used to identify specific skin reactions caused by allergens, and to determine whether they are related to clinical symptoms. It can differentiate between allergic rhinitis and non-allergic rhinitis.

Serological Tests for Allergic Reactions:

Immunoglobulin E (IgE) immunoassays are used to differentiate between allergic rhinitis and non-allergic rhinitis. This test is suitable for patients who cannot undergo skin prick tests, but it is more expensive and less sensitive in diagnosing allergic reactions caused by inhaled allergens compared to skin tests.

Nasal Cytology Examination:

Although this examination lacks specificity and sensitivity, some researchers still use it to help differentiate between allergic rhinitis and infectious rhinitis.

Objective Assessment of Nasal Ventilation Function:

Nasal resistance testing and nasal reflex testing are currently the most commonly used methods for objectively evaluating the nasal ventilation status. Assessing nasal ventilation is widely applicable in the auxiliary diagnosis of diseases, selection of treatment methods, and evaluation of treatment effects.

Imaging Examinations:

Nasal computed tomography (CT) and magnetic resonance imaging (MRI) are used to evaluate the anatomical structures of the nose and aid in differential diagnosis.

What diseases should rhinitis be distinguished from?

Acute and Chronic Sinusitis:

Caused by swelling of the sinus ostium mucosa or obstruction of the sinus ostium by nasal polyps, the symptoms are more severe than rhinitis. When nasal cavity inflammation affects the sinuses, purulent discharge, headaches, and sinus tenderness may be observed, and severe cases may even have systemic symptoms.

Influenza:

Also known as "flu," it is an acute respiratory infectious disease caused by influenza virus. Systemic symptoms such as high fever, chills, headaches, and generalized joint and muscle pain are prominent, while upper respiratory symptoms such as runny nose and sneezing are not significant.

Nasal Tumors and Lesions:

Patients with nasal tumors typically have unilateral nasal symptoms, while rhinitis symptoms are mostly bilateral. Nasal sinus CT and nasal sinus MRI can assist in differentiating these diseases.

Cerebrospinal Fluid Rhinorrhea:

Cerebrospinal fluid rhinorrhea can be caused by skull or nasal bone fractures, intracranial surgery, etc. Compared to rhinitis, it typically leads to unilateral or bilateral watery nasal secretions that are more noticeable when the head is lowered, without significant nasal congestion, sneezing, etc. Differential diagnosis is mainly conducted through endoscopy combined with imaging examinations.

Treatment

The primary treatment for rhinitis is medication. When symptoms do not improve with drug treatment, or in cases where the condition severely affects quality of life or is complicated by chronic rhinosinusitis or nasal polyps, surgical treatment may be considered.

How to Treat Acute Rhinitis?

Acute rhinitis, commonly known as "common cold" or "flu," is infectious and has no simple and effective treatment. Symptomatic and supportive treatment is mainly used, and antibiotics can be used in cases of bacterial infection. In addition, patients should drink plenty of water, have a light diet, ensure regular bowel movements, and get adequate rest.

Treatment for rhinitis includes several types of medications. It's important to note that there is no absolute "best," "fastest," or "most effective" medication, as individual responses may vary. In addition to common over-the-counter medications, it is essential to consult a doctor to select the most appropriate medication based on individual circumstances.

Nasal Cavity Irrigation

This involves using physiological saline nasal spray or nasal lavage to cleanse the nasal mucosa, reducing inflammation symptoms. However, individuals with extensive nasal trauma, severe sodium chloride metabolism disorders, or allergies should avoid this method.

Nasal Corticosteroids

These are locally applied nasal sprays containing corticosteroid components such as budesonide, fluticasone propionate, and mometasone furoate. They are sprayed onto the nasal mucosa to reduce nasal mucosal inflammatory reactions and promote the repair of damaged ciliated epithelium. However, adverse reactions such as pharyngitis, cough, bronchospasm, nasal irritation, and epistaxis should be noted.

Antihistamines

These medications have anti-allergic effects and are particularly suitable for patients experiencing sneezing and nasal itching. Common drugs in this category include levocabastine hydrochloride, azelastine, and loratadine. They are used for allergic rhinitis, but adverse reactions such as mucosal dryness and urinary retention should be considered.

Anticholinergic Drugs

For instance, ipratropium bromide has the ability to relax smooth bronchial muscles, reducing nasal secretions. However, adverse reactions such as nasal dryness, burning, irritation, congestion, headache, and dry mouth should be monitored.

Decongestants

Hydroxymetazoline, for example, can constrict blood vessels, alleviate symptoms, and reduce congestion. However, it does not have an effect on nasal itching, sneezing, or runny nose. It should be used for no more than a week, as prolonged use may lead to drug-induced rhinitis.

Leukotriene Receptor Antagonists

Montelukast sodium, for instance, has a preventive and anti-inflammatory effect on the mucosa. It is suitable for seasonal and perennial allergic rhinitis. However, potential adverse reactions such as allergic reactions, hallucinations, drowsiness, excitement, nausea, and diarrhea should be taken into account.

Surgical treatments for rhinitis are primarily considered when drug therapy is ineffective. Here are some surgical options:

Selective Nerve Ablation

This procedure involves the transection of the vidian nerve under nasal endoscopy. It is suitable for patients with allergic rhinitis or those with unclear responses to drug and immunotherapy.

Submucosal Resection of the Inferior Turbinates

This procedure involves the removal of submucosal soft tissue under nasal endoscopy. It is suitable for patients with non-allergic chronic hypertrophic rhinitis when there is thickening and hypertrophy of the inferior nasal turbinate bone or mucosa.

Lateral Nasal Wall Internal Mobilization and Fixation, Anterior Nares Closure, and Nasal Cavity Narrowing Surgery

These procedures are suitable for patients with atrophic rhinitis. They aim to reduce nasal cavity size, decrease nasal mucosal dryness, and minimize crust formation.

Preoperative examination should determine the presence of acute inflammation or secretions in the nasal cavity to establish the extent of resection and ensure nasal cavity cleanliness. Postoperatively, anti-infective therapy is necessary, and spicy foods should be avoided.

Endoscopic Sinus Surgery

This surgery is suitable for patients with rhinosinusitis or nasal polyps. It involves the excision of edematous mucosa and opening of the sinuses to clear diseased tissue and provide ventilation and drainage.

Currently, there is a lack of evidence regarding the efficacy and safety of traditional Chinese medicine in the treatment of rhinitis, and the use of herbal medicine is not recommended. Some patients with allergic rhinitis may choose acupuncture treatment to relieve nasal congestion, and subcutaneous embedding therapy may also be used in the treatment of allergic rhinitis.

Prognosis

The prognosis of rhinitis patients varies depending on the cause of the disease and the effectiveness of treatment. Acute rhinitis is self-limiting, with spontaneous improvement generally occurring within one week. Chronic rhinitis often recurs, and the treatment effectiveness varies from person to person. Allergic rhinitis, as an allergic reactive disease, requires long-term symptom control and management.

Acute Rhinitis

It can lead to various complications such as acute sinusitis, acute otitis media, acute pharyngitis, laryngitis, tracheitis, and bronchitis due to direct spread of infection or improper blowing of the nose.

Allergic Rhinitis

As an allergic reactive disease, it is often associated with concurrent bronchial asthma and secretory otitis media.

Atrophic Rhinitis

As the disease progresses, nasal collapse, nasal septal perforation, purulent sinusitis, dacryocystitis, and secondary nasal sinus mucous cysts may occur.

Other Types

Other types of rhinitis do not have significant complications.

Daily Care

Different types of rhinitis require different daily care methods. The follow-up time for chronic rhinitis and allergic rhinitis is generally 4-6 weeks, while the follow-up time for other types of rhinitis can be determined based on the recovery of symptoms.

Acute Rhinitis

Acute rhinitis caused by respiratory viral infections often resolves spontaneously, so the main focus is on symptomatic treatment and preventing complications. It is advisable to drink plenty of hot water, maintain a light diet, and get adequate rest.

Chronic Rhinitis

Eliminating the causative factors is crucial for chronic rhinitis. Active treatment of systemic diseases, regular physical exercise, boosting the body's immunity, cultivating good hygiene habits, and avoiding excessive fatigue are recommended.

Other Types of Rhinitis

For allergic rhinitis, it is important to control the allergen environment and reduce exposure to allergens. For patients allergic to dust mites, maintaining indoor humidity below 50%, using dust mite-proof encasings for mattresses and pillows, and washing bedding and wooden furniture with water above 55 degrees Celsius weekly are recommended.

For patients allergic to mold, it is important to avoid using carpets, promptly address moldy items, clean bathrooms and kitchens with water at 60 degrees Celsius, and regularly clean appliances such as air conditioners and refrigerators, which are prone to mold growth.

For patients allergic to pollen, reducing outdoor activities during pollen season, wearing pollen masks and sealed eyewear when going out, taking a shower before bedtime to remove pollen from the body, and avoiding hanging clothes outside during pollen season are recommended.

For patients allergic to pets, it is advisable to avoid keeping pets at home if possible. Pet owners should bathe their pets 1-2 times a week, frequently wash clothes and bedding, and minimize contact with pets. If contact occurs, hands should be washed afterward.

Acute Rhinitis

For acute rhinitis patients, it is important to drink plenty of hot water, maintain a light diet, and get adequate rest.

Chronic Rhinitis

For chronic rhinitis patients, it is important to engage in regular physical exercise, boost the body's immune system, cultivate good hygiene habits, and avoid excessive fatigue.

Other types of rhinitis

For allergic rhinitis patients, it is important to actively avoid allergens.

For atrophic rhinitis patients, it is important to improve nutrition, enhance personal hygiene, and supplement vitamins.

For occupational rhinitis patients, it is important to actively improve the work environment.

For steroid-induced rhinitis patients, it is important to strengthen pregnancy management.

Prevention of rhinitis:

Allergic Rhinitis

Appropriate measures can be taken to reduce allergens in both outdoor and indoor environments. Avoid outdoor activities, ventilate the home frequently, keep the household environment clean and tidy, and reduce exposure to dust mites. Avoid purchasing too many stuffed toys for children, avoid keeping pets at home, and preferably avoid carpeting children's rooms to prevent the breeding of bacterial dust mites.

Non-allergic Rhinitis

Avoid close contact with patients and minimize visits to public places.

Engage in regular physical exercise to enhance resistance.

Drink plenty of hot water, supplement vitamins, and get adequate rest.

Improve living and working environments, and avoid prolonged exposure to dust and irritating gases.

Take preventive Chinese herbal medicine such as Andrographis paniculata.

Pay attention to hormonal changes, which are important for preventing rhinitis.