Rhinitis is a common and often underestimated condition that affects millions of people worldwide. Characterized by inflammation of the nasal mucosa, rhinitis presents with symptoms such as nasal obstruction, discharge, sneezing, headaches, and postnasal drip. Despite being a benign condition, rhinitis significantly affects the quality of life due to persistent nasal congestion and associated facial discomfort.
The term “rhinitis” is derived from the Greek word rhinos (nose) and itis (inflammation), and it can be acute or chronic, allergic or non-allergic. Whether triggered by environmental allergens, infections, or irritants, understanding the pathophysiology, symptoms, and treatment of rhinitis is crucial for both clinicians and patients.
Clinical Features of Rhinitis (From the Visual Guide)
Let’s begin with a simplified list of clinical features derived from the diagram:
- Nasal Obstruction
- Nasal Discharge (Mucoid or Mucopurulent)
- Headache due to swollen turbinates
- Red Nasal Mucosa
- Swollen Turbinates
- Postnasal Discharge
Each of these signs points to underlying inflammation of the nasal mucosa and varies depending on the type and severity of rhinitis.
Types of Rhinitis
Rhinitis can be broadly classified into several types based on etiology. Understanding each type helps tailor treatment strategies.
1. Allergic Rhinitis
Caused by hypersensitivity to allergens such as pollen, dust mites, pet dander, or molds.
Characteristics:
- Sneezing, nasal congestion, clear nasal discharge
- Nasal itching
- Conjunctival symptoms (watery, itchy eyes)
- Seasonal (hay fever) or perennial
Pathophysiology:
An IgE-mediated immune response causes histamine release, leading to vasodilation, mucus secretion, and mucosal swelling.
2. Infectious Rhinitis
Also known as acute viral rhinitis or the common cold, this form is caused by rhinoviruses, adenoviruses, or coronaviruses.
Symptoms:
- Nasal congestion
- Thick mucopurulent discharge
- Headache and sore throat
- Low-grade fever
3. Non-Allergic Non-Infectious Rhinitis
These include a diverse group with similar symptoms but without allergen exposure or infection.
Subtypes:
- Vasomotor Rhinitis (triggered by cold air, perfume, smoke)
- Drug-induced Rhinitis (from nasal decongestants, beta-blockers)
- Hormonal Rhinitis (during pregnancy)
- Occupational Rhinitis (due to workplace irritants)
4. Atrophic Rhinitis
Characterized by thinning of the nasal mucosa, crusting, and foul odor.
Causes:
- Chronic infections
- Previous nasal surgeries
- Vitamin A deficiency
- Syphilis, leprosy
Causes of Rhinitis
| Type | Common Causes |
|---|---|
| Allergic Rhinitis | Pollen, dust mites, animal dander, molds, food allergens |
| Infectious Rhinitis | Rhinovirus, adenovirus, coronavirus |
| Vasomotor Rhinitis | Weather changes, stress, strong smells, temperature changes |
| Drug-induced Rhinitis | Overuse of nasal decongestants, antihypertensives |
| Hormonal Rhinitis | Pregnancy, puberty, hypothyroidism |
| Atrophic Rhinitis | Chronic infection, nasal surgery, nutritional deficiencies |
Detailed Clinical Features and Their Significance
1. Nasal Obstruction
This is one of the most distressing symptoms. It occurs due to:
- Mucosal swelling
- Vascular engorgement
- Turbinate hypertrophy
Impact: Difficulty in breathing, sleep disturbances, mouth breathing
2. Nasal Discharge (Mucoid or Mucopurulent)
- Mucoid: Clear and watery, seen in allergic rhinitis
- Mucopurulent: Yellow or greenish, suggests infection
Significance: Nature of discharge helps in differentiating types of rhinitis
3. Headache (Due to Swollen Turbinates)
- Caused by pressure build-up in sinuses and congested nasal passages
- Especially seen in infectious and allergic rhinitis
Clinical Relevance: May mimic migraine or sinusitis
4. Red Nasal Mucosa
- Indicates inflammation and increased vascularity
- Seen in all forms of rhinitis except atrophic rhinitis (which has pale mucosa)
5. Swollen Turbinates
Turbinates are responsible for humidifying and filtering inhaled air. In rhinitis:
- They become edematous due to inflammation
- Block airflow, contributing to congestion
6. Postnasal Drip
- Mucus dripping into the throat from the back of the nose
- Common in chronic rhinitis
- Causes throat clearing, irritation, and cough
Diagnosis of Rhinitis
Diagnosis is mostly clinical, but may include:
| Test | Purpose |
|---|---|
| Nasal Endoscopy | Direct visualization of turbinates and discharge |
| Allergy Testing (IgE) | Identify allergen-specific IgE |
| Nasal Cytology | Detect eosinophils (in allergic rhinitis) |
| CT PNS (Sinus Scan) | Rule out sinusitis in chronic rhinitis |
| Nasal Smear Culture | Identify pathogens in bacterial rhinitis |
Treatment and Management of Rhinitis
The treatment depends on the underlying cause and symptom severity.
General Measures
- Avoid known allergens and irritants
- Humidify indoor air
- Maintain nasal hygiene with saline rinses
Medical Management
| Medication | Function |
|---|---|
| Antihistamines (Cetirizine) | Relieve sneezing, runny nose in allergic rhinitis |
| Intranasal corticosteroids | Reduce inflammation and swelling |
| Decongestants (Oxymetazoline) | Temporary relief of nasal congestion |
| Leukotriene receptor antagonists | Useful in allergic rhinitis |
| Antibiotics | Only in case of secondary bacterial infection |
| Nasal saline irrigation | Clears mucus, allergens |
Allergen Immunotherapy (Desensitization)
Used in persistent allergic rhinitis:
- Administered as subcutaneous injections or sublingual drops
- Gradual exposure to allergens to reduce sensitivity
Surgical Management
Indicated in chronic rhinitis with anatomical obstruction:
- Turbinate reduction surgery
- Septoplasty (if deviated nasal septum is present)
- Polypectomy (if associated nasal polyps)
Complications of Untreated Rhinitis
- Chronic sinusitis
- Eustachian tube dysfunction and otitis media
- Nasal polyps
- Sleep disturbances (including obstructive sleep apnea)
- Impact on work/school productivity
Rhinitis in Children vs Adults
| Feature | Children | Adults |
|---|---|---|
| Common Cause | Allergens, infections | Allergens, irritants, medications |
| Symptoms | Sneezing, runny nose, nasal blockage | Postnasal drip, congestion, headache |
| Complications | Otitis media, sinusitis | Sinusitis, nasal polyps |
| Treatment | Antihistamines, nasal saline | Corticosteroids, immunotherapy |
Rhinitis vs Sinusitis: How to Differentiate?
| Feature | Rhinitis | Sinusitis |
|---|---|---|
| Duration | Usually less than 10 days | More than 10 days |
| Nasal Discharge | Clear or mucoid | Thick, yellow-green discharge |
| Facial Pain/Pressure | Rare | Common |
| Fever | Mild or absent | Common in acute bacterial sinusitis |
| Response to Antihistamines | Good | Minimal |
Frequently Asked Questions (FAQs)
What causes rhinitis?
Rhinitis can be caused by allergens, viral infections, irritants, hormonal changes, or medications.
Is rhinitis contagious?
Allergic rhinitis is not contagious. However, viral rhinitis (common cold) can spread through droplets.
Can rhinitis be cured permanently?
While there's no permanent cure, symptoms can be controlled with medications, lifestyle modifications, and immunotherapy.
How can I tell if I have allergic rhinitis?
Symptoms like sneezing, itchy eyes, clear runny nose, and seasonal occurrence suggest allergic rhinitis. Allergy tests can confirm the diagnosis.
What home remedies help relieve rhinitis symptoms?
- Steam inhalation
- Saline nasal sprays
- Warm compress for headache relief
- Ginger and honey (in cases of infectious rhinitis)
Can rhinitis affect sleep?
Yes. Nasal obstruction from rhinitis can cause snoring, mouth breathing, and even obstructive sleep apnea in chronic cases.
Is rhinitis linked to asthma?
Yes. Allergic rhinitis and asthma often coexist. They share common pathophysiology and are considered part of a spectrum called “united airway disease.”
