Rhinitis

Rhinitis is inflammation of the mucous membranes of the nose. Rhinitis often occurs with sinusitis.

Rhinitis is commonly caused by a viral infection or allergy. Older people, however, may develop rhinitis in response to aging itself (atrophic rhinitis), irritants and cold temperatures (vasomotor rhinitis), certain foods (gustatory rhinitis), certain drugs (drug-induced rhinitis), low levels of thyroid hormone (hypothyroidism), or fleshy outgrowths in the nose (nasal polyps).

The symptoms of rhinitis are about the same no matter what the cause; the most common symptom among older people is a runny nose. Other symptoms include the following:

• Nasal congestion
• Postnasal drip
• Coughing from postnasal drip, especially upon lying down
• Sneezing
• Itchiness in the nasal passages (itchiness can occur no matter what the cause but is especially common with allergies).

A diagnosis of rhinitis is based on the cause and duration of symptoms. The doctor may use a flexible viewing tube (endoscope) to examine the nasal passages, especially if polyps are suspected. Treatment often involves the use of general measures to help alleviate the symptoms of rhinitis, regardless of the cause. However, many causes can be treated specifically. For example, rhinitis caused by nasal polyps can be treated by surgically removing the polyps.

Viral rhinitis: Viral rhinitis is extremely common and is often the most bothersome feature of the common cold. No treatment is completely effective. Nonprescription decongestants taken by mouth in pill or liquid form (pseudoephedrine) or sprayed into the nose (phenylephrine or oxymetazoline) help control congestion. However, symptoms can worsen if decongestant nasal sprays are taken for more than 3 days and then abruptly stopped.

Antihistamines, either alone or combined with other drugs in a cold remedy, should not be taken. They are ineffective against viral rhinitis, and many older antihistamines, such as diphenhydramine and chlorpheniramine, can cause drowsiness, confusion, urinary retention, worsening of glaucoma, and loss of balance in older people.

Antibiotics are ineffective against viruses. Zinc lozenges are probably safe for older people, but their effectiveness is controversial. Receiving the influenza (flu) shot each year can help protect against the most severe viral rhinitis, which is rhinitis associated with the influenza virus.

Allergic rhinitis: Allergic rhinitis is caused by an allergic reaction to dust, molds, animals, foods, the pollens of grasses and trees, or other environmental triggers. Often, the person has a family history of allergies or asthma. Allergic rhinitis may cause itchy, watery eyes in addition to other symptoms. Blood tests or skin testing may help a doctor make the diagnosis.

Treatment involves avoiding substances that trigger the allergy, if possible. If avoidance is impossible, nasal sprays containing corticosteroids, antihistamines, or cromolyn are effective and safe for older people. Certain antihistamines taken by mouth are also effective and safe. Older antihistamines, such as diphenhydramine and chlorpheniramine, which are in most nonprescription products, can cause many side effects in older people. Newer antihistamines, such as fexofenadine, cetirizine, and loratadine, which cause fewer side effects, should be used instead. Leukotriene receptor blockers, such as montelukast, taken by mouth, are also moderately effective and safe. Allergy shots (immunotherapy) can make people less allergic by desensitizing them to the triggering substance. However, allergy shots are usually recommended only for people with severe symptoms that do not respond to drugs.

Atrophic rhinitis: Atrophic rhinitis occurs when the mucous membranes of the nasal passages thin (atrophy) and harden, causing the passages to widen and dry out and become more vulnerable to infection. The nasal bone can also become weakened and is more likely to break. The disorder affects older people worldwide but is growing less common in developing countries. Atrophic rhinitis may result from aging itself or from chronic infection, sinus surgery, radiation therapy, or unusual diseases, such as sarcoidosis.

Symptoms of burning or pain in the nose are common. So is congestion, which in severe cases is accompanied by thick, dry, offensive-smelling crusts in the nasal passages. Nosebleeds occur as well, and a person can lose the sense of smell. The disorder may be confused with sinusitis.

Treatment may involve several approaches. Salt water can be sprayed into the nose to keep the nasal passages moist. Topical antibiotics, such as bacitracin, may be applied directly inside the nose to kill bacteria. If the crusting becomes severe, other antibiotics, given by mouth or intravenously, may help. As a last resort, surgery can be performed to narrow the nasal passages, but severe nasal congestion may result.

Vasomotor rhinitis: Vasomotor rhinitis occurs when blood vessels in the nose widen (dilate) or narrow (constrict) in response to irritants such as perfumes or other odors, cigarette smoke, pollution, or cold, dry air. Avoiding irritants is the primary treatment. Warm humidified air, such as that from a vaporizer, may also help. Ipratropium nasal spray is effective but seems to relieve a runny nose more so than relieving congestion. Azelastine, an antihistamine nasal spray, also works because it dries out the mucus.

Gustatory rhinitis: Gustatory rhinitis may be a form of vasomotor rhinitis. Gustatory rhinitis is triggered by eating. Any type of food can trigger symptoms, although hot, spicy foods and alcohol have been reported to cause the most severe symptoms. Many cold foods can also be culprits. Treatment involves avoiding problematic foods and extremely hot or cold foods.

Drug-induced rhinitis: Drug-induced rhinitis is caused by a variety of drugs, including estrogen supplements; some antihypertensive drugs, such as angiotensin-converting enzyme (ACE) inhibitors and beta-blockers; antidepressants; aspirin; and some antianxiety drugs. Using decongestant nasal sprays for more than 3 days at a time can lead to rebound nasal congestion.

Treatment involves discontinuing the drug that causes symptoms. Withdrawal from long-term regular use of a decongestant nasal spray may need to be supervised by a doctor specializing in ear, nose, and throat disorders. Corticosteroid nasal sprays may also help ease symptoms as the body begins to rid itself of the offending drug.