Symptoms of Chronic Rhinitis II

Symptoms

1. Chronic Infectious Rhinitis Chronic infectious rhinitis caused by bacteria may occur when treatment for acute rhinitis is incomplete and inflammation repeatedly occurs or persists, or when rhinitis continues for a long time due to chronic inflammation of the paranasal sinuses or tonsillar tissue, or when rhinitis does not heal because the overall nutritional or immune status is poor.

Treatment is usually sufficient with appropriate antibiotic administration. If there are complications such as chronic hypertrophic rhinitis or stubborn chronic sinusitis, surgery may be considered, but in children, conservative treatment is generally performed rather than surgery.

Among chronic infectious rhinitis, rhinitis caused by tubercle bacilli or fungi does not respond well to treatment. Pathological findings show granulomas or granulomatous changes, and examination findings may reveal ulcers or necrosis in the nasal cavity, sometimes appearing in a tumor-like form. In such patients, tuberculosis, fungal infection, or a tumor should be differentiated through tissue biopsy and immunohistochemical testing.

2. Vasomotor Rhinitis Vasomotor rhinitis is not classified within the category of allergic rhinitis and can be defined as noninfectious, nonallergic chronic rhinitis with no clear cause such as anatomical abnormalities, infection, pregnancy, medication, or endocrine disorders. The diagnosis of vasomotor rhinitis is made by differentiating it from other types of rhinitis. Infectious rhinitis or sinusitis may also occur during the course of vasomotor rhinitis.

3. Nonallergic Rhinitis Associated with Eosinophilia Nonallergic rhinitis is classified into eosinophilic rhinitis and non-eosinophilic rhinitis depending on whether eosinophils are increased in nasal discharge. In non-eosinophilic rhinitis, runny nose is the main symptom, whereas in eosinophilic rhinitis, nasal congestion is the main symptom. Compared with non-eosinophilic rhinitis, eosinophilic rhinitis shows more pronounced mucosal thickening of the sinuses on radiologic examination and is characterized by frequent association with asthma or aspirin sensitivity.

In general, eosinophilic rhinitis shows a marked response to steroids, whereas non-eosinophilic rhinitis has no effect except with anticholinergic agents.

Some patients with chronic rhinitis have a significant increase in eosinophils on nasal smear examination, no history of atopic disease, and negative skin test results. Such cases are called eosinophilic nonallergic rhinitis. However, antihistamines or decongestants have no clear effect, and when steroids are used, symptoms improve and eosinophilic infiltration of the nasal mucosa also decreases.

4. Occupation- and Environment-Related Rhinitis Exposure to irritating dust, formaldehyde gas from plywood processing, toxic substances such as chemicals and paint, cleaning agents, perfumes, cosmetics, air pollution, cigarette smoke, and spray products, either temporarily or chronically, can cause nasal congestion. For treatment, avoiding the suspected irritant is most important, and when that is not feasible, ventilation, air filters, masks, and similar measures are used.

5. Hormonal Rhinitis ① Rhinitis During Pregnancy and Menstruation In women, endogenous progesterone rises sharply during the later stages of pregnancy and just before the start of menstruation. Progesterone causes vasodilation and congestion in the nasal cavity, resulting in nasal congestion. It is best to avoid medication if possible.

② Hypothyroidism In general, sympathetic nervous system function decreases and parasympathetic nervous system function becomes relatively prominent, inducing vasodilation in the nasal cavity and leading to symptoms of rhinitis. First, correct the thyroid hormone abnormality, then address any remaining pathological conditions in the nasal cavity.

6. Drug-Induced Rhinitis The condition of nasal congestion that can occur after the use of nasal mucosal constrictors or various systemic medications is collectively called drug-induced rhinitis. Drug-induced rhinitis occurs due to impaired autonomic regulation of the nasal blood vessels and mucosal preparation caused by the continuous use of medication, resulting in decreased vasoconstriction and increased vasodilation. With prolonged use of any topical decongestant, the rebound phenomenon described above may occur, making it difficult to stop using it.

So far, we have explained the symptoms of chronic rhinitis II. In the next installment, we will look at the symptoms of chronic rhinitis III.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal