Knowing and treating chronic rhinitis

Rhinitis refers to an inflammatory disease of the nasal mucosa accompanied by one or more symptoms of a runny nose, sneezing, itching, and nasal congestion. It is a disease with a high prevalence of more than 10-20% worldwide, and the number of patients with rhinitis is increasing due to changes in the living environment, westernization of eating habits, and air pollution such as fine dust.

Rhinitis can be broadly divided into acute rhinitis, chronic rhinitis, and atrophic rhinitis according to clinical features. Acute rhinitis is an infectious rhinitis commonly referred to as a cold, and chronic rhinitis is largely divided into infectious and non-infectious depending on the cause. Causes of non-infectious chronic rhinitis include allergic rhinitis, anatomical abnormalities of nasal structures, autonomic nervous system imbalance, hormonal abnormalities, drugs, and emotional anxiety. As such, it is correct to view rhinitis as a group of diseases of a wide spectrum rather than a single disease, and if an accurate diagnosis and treatment are not made, serious side effects may occur due to taking the wrong drug.

Regardless of the cause, most chronic rhinitis patients show similar clinical features with only differences in the severity of symptoms. Nasal congestion is the main symptom, and the symptoms vary from left to right. In severe cases, both nostrils are blocked, making it difficult to breathe through the nose, so breathing through the mouth. A runny nose is also a common symptom, and most of it is a clear runny nose (watery rhinorrhea). However, when infected with bacteria, it may turn into a yellow-green snot (purulent rhinorrhea). Nasal secretions often run down the back of the throat, which is called postnasal drip. Chronic rhinitis can cause paroxysmal sneezing as the nasal mucosal nerve is exposed due to inflammation, and it can also cause loss of smell or loss of smell.

Since it is practically difficult to check the inflammatory response in the nose during actual treatment, diagnosis is usually made based on symptoms such as itching, sneezing, nasal discharge and nasal congestion and the results of nasal examination. When examining the nasal cavity of a patient with chronic rhinitis, watery or purulent discharge may be observed along with swelling of the nasal mucosa (swelling due to inflammation or tumor, etc.). If swelling of the nasal mucosa persists for a long time, it may not contract even with topical mucoconstrictors. Since rhinitis can be accompanied by various allergic diseases such as atopy, allergic reaction tests, nasal smear tests, and bacterial culture tests can be performed together.

Treatment methods vary depending on the cause, but if there is sinusitis (sinusitis) or tonsillitis other than rhinitis, they are treated first. In the case of allergic rhinitis, it is treated with avoidance therapy to avoid the causative antigen, drug therapy using antihistamines, topical steroids, antileukotrins, anticholinergic sprays, and immunotherapy. In the case of chronic hypertrophic rhinitis, topical nebulized steroids can be used for medical treatment, and surgical treatment includes turbinate (nose lathe) plastic surgery, turbinate resection, laser surgery, and radiofrequency surgery. Excessive surgical resection of the turbinate can cause worsening of symptoms, so it is important to receive appropriate surgical treatment according to an accurate diagnosis by an otolaryngologist. For vasomotor rhinitis, topical steroids or anticholinergic sprays are mainly used, and for drug rhinitis, the start of treatment is to prohibit the use of the drug.

The course of chronic rhinitis varies depending on the cause. If the cause is clear, treatment may improve it, but if it is not, it usually lasts a long time. If adequate treatment is not given to patients with chronic rhinitis, chronic inflammation may continue and irreversible thickening (swelling of the nasal mucosa) may occur in the nasal mucosa and turbinate. Occasionally, a giant inferior turbinate is observed, a condition called chronic hypertrophic rhinitis. Chronic hypertrophic rhinitis can occur when the inflammatory state of chronic rhinitis continues for a long time regardless of the cause. In addition, chronic rhinitis can cause complications such as lacrimal cystitis, conjunctivitis, otitis externa, otitis media, and laryngitis.

So, what are some ways to prevent rhinitis? As a general preventive measure, it is important to wash your hands thoroughly after going out to avoid catching a cold. Also, avoiding rhinitis-causing factors such as dust, sudden temperature changes, fatigue or stress, and cigarette smoke or soot can help prevent it. If the causative agent of allergic rhinitis has been identified through a skin test, it is important to be careful not to be exposed to the causative antigenic substance. Washing the nose with saline in the morning and evening can also help prevent it. Long-term use of topical mucoconstrictors should be avoided in the presence of rhinitis. It is difficult to prevent rhinitis, but a certain amount of prevention effort must be combined with treatment.