Rhinitis and Rhinosinusitis

Rhinitis describes a condition with symptoms including runny nose, itchiness and sneezing

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The most usual causes of rhinitis are the common cold and allergies. 

When symptoms last less than six weeks, it is described as acute rhinitis. If symptoms persist for longer, it is known as chronic rhinitis and is usually caused by allergies, chronic infection and structural abnormalities such a deviated septum (in which the bone between the nostrils is off-centre).

Causes and Risk Factors

Acute rhinitis: this is usually brought about by common cold  or other infection.
Chronic rhinitis: can be subdivided into two main categories: allergic and non-allergic rhinitis.
o Allergic rhinitis (hay fever) occurs when the body’s immune system overacts to a perceived threat such as pollen, moulds, house dust mites, animal dander, chemicals and foods etc. Allergic rhinitis can be diagnosed by a skin test and/or blood test. 
o Non-allergic rhinitis has similar symptoms but does not involve an allergic reaction .
Other causes of chronic rhinitis are blockage in the nose, e.g. nasal polyps, enlarged adenoids and a deviated septum, that impede mucus drainage and restrict air flow.

Medications can cause rhinitis or worsen it in people with allergic rhinitis, as can the prolonged use of nasal decongestants. Some blood pressure medications such as beta blockers and vasodilators (that widen the blood vessels) can also cause rhinitis.

Hormonal changes in pregnancy can cause rhinitis in pregnancy, which will clear once the baby is delivered.

Signs and Symptoms of Rhinitis

The symptoms of non-allergic rhinitis may last for hours or for several days. Signs and symptoms of non-allergic rhinitis may include a blocked or stuffy nose, a runny nose or a postnasal drip.  

Allergic rhinitis may also have similar symptoms but is usually associated with sneezing and itchiness of the nose, eyes or throat.

Allergic Rhinitis in Children 

Allergic rhinitis is the most common chronic allergic disease in children and accounts for 50 percent of childhood rhinitis. It significantly affects the child’s quality of life, and may worsen asthma, ear infections, eczema and sinusitis.

They may also experience:
Noisy breathing
Snoring and sleep apnoea
Loss of sense of smell and taste
Disturbed night sleep with subsequent daytime tiredness
 

Rhinitis Treatment 

Avoidance of allergens is the best treatment, where possible, such as removing carpets and pets
Antihistamines provide good relief for mild to moderate symptoms. Newer antihistamines are long-acting and less likely to cause drowsiness 
Decongestants may also help to reduce nasal congestion
Corticosteroids in the form of nasal spray reduce the immune response and may be prescribed to reduce severe symptoms
Nasal polyps and enlarged adenoids can be removed and deviated septums can be corrected with surgery

How to Prevent Rhinitis 

It is important to be aware of the allergens that trigger your rhinitis and to avoid them as much as possible, though sometimes it may be difficult to pinpoint the trigger factors. However, there are ways to reduce your exposure to allergens and irritants such as:
Using air conditioning and an air purifier during the seasons when pollen levels are high
Keeping your house free of dust as much as possible using a vacuum cleaner
Bathing your pets regularly

Rhinosinusitis  

Rhinosinusitis (also known as sinusitis) is an inflammation of the nose and the nasal cavities around the nasal passages (sinuses). This causes congestion and excessive nasal discharge, resulting in a blocked nose.

Rhinosinusitis can be either infective or allergic in origin and the treatment of each is different.

Infective Rhinosinusitis 

This is caused by viruses and bacteria invading the upper airway passage.

1. Acute Viral Rhinosinusitis (Common Cold)

Initial symptoms include low-grade fever and sore throat, followed by a cough, congestion and runny nose with thick nasal discharge. These symptoms usually peak around day three and clear in less than 10 days without worsening.

Treatment for Viral Rhinosinusitis

Antibiotics are not recommended for the treatment of a common cold. Cough mixtures can be given to adults to control the cough caused by a common cold. Nasal or oral decongestants can be given up to three days to control the symptoms of congestion.

2. Acute Bacterial Rhinosinusitis

This is suspected when symptoms of a common cold persist or worsen after seven to 10 days. Bacterial sinusitis is diagnosed based on the onset of two or more of the following symptoms:
Blockage, congestion or stuffiness
Nasal discharge, almost pus-like
Facial pain, headache
Reduction/loss of sense of smell

Consult your doctor, who will refer you to an eye, nose and throat (ENT) specialist immediately if you experience any of the following symptoms:
Swelling around the eyes
Double or reduced vision
Severe headache
Stiff neck, vomiting, weakness or numbness

Treatment for Bacterial Rhinosinusitis
For mild cases, symptoms can be relieved using:
Decongestants (for not more than 10 days)
Nasal saline spray
Painkillers
Antihistamines (if one suffers from concurrent allergic rhinitis)

For moderate to severe cases, your doctor will advise a course of antibiotics and nasal steroid sprays.

3. Recurrent Acute Rhinosinusitis

This is suspected when three or more episodes of acute rhinosinusitis occur each year with symptom-free intervals between them. The treatment is the same as for acute rhinosinusitis. You should see an ENT specialist for further assessment.

4. Chronic Rhinosinusitis

This is suspected when symptoms of rhinosinusitis last for more than 12 weeks. It may also worsen as a result of dental disease, asthma or regular exposure to pollutants like cigarette smoke.

You should see an ENT specialist for further assessment such as nasal endoscopy, allergy testing and screening for weakened immunity. Some patients may need an endoscopic sinus surgery to clear the sinuses.

Infective Rhinosinusitis in Pregnancy 

The management of rhinosinusitis in pregnancy is the same as that for adults. Antibiotics are generally avoided during pregnancy.

Infective Rhinosinusitis in Children 

Children at higher risk include:
Those from  two to eight years old, when an immature immune system is common
Those with allergic rhinitis
Those with gastroesophageal reflux or nasopharyngeal reflux

As rhinosinusitis in children is commonly associated with middle ear infections which may affect hearing, speech and language development, it is crucial that you seek appropriate treatment for your child early, if needed.

Treatment for Infective Rhinosinusitis in Children 

Depending on your child’s age and condition, the doctor may prescribe one or a combination of the following to relieve symptoms:
Nasal steroid spray to help reduce swelling and blockage
Saline nasal drops to help decrease dryness
Nasal decongestants (not more than five days) to help relieve congestion



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