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Toronto Notes 2019 Rhinitis Rhinitis
Definition
• inflammationofthelining(mucosa)ofthenasalcavity
Otolaryngology OT23
Table 11. Classification of Rhinitis
Inflammatory
Perennial non-allergic Asthma, ASA sensitivity
Allergic Seasonal Perennial
Atrophic
Primary: Klebsiella ozena (especially in elderly)
Acquired: post-surgery if too much mucosa or turbinate has been resected
Infectious
Viral: e.g. rhinovirus, influenza, parainfluenza, etc. Bacterial: e.g. S. aureus
Fungal
Granulomatous: TB, syphilis, leprosy
Non-infectious Sarcoidosis GPA
Irritant Dust
Chemicals Pollution
Non-Inflammatory
Rhinitis medicamentosa Topical decongestants
Hormonal Pregnancy Estrogens Thyroid
Idiopathic vasomotor
Rhinitis medicamentosa: rebound congestion due to the overuse of intranasal vasoconstrictors; for prevention, use of these medications for only 5-7 d is recommended
Table 12. Nasal Discharge: Character and Associated Conditions
Character
Watery/mucoid Mucopurulent Serosanguinous Bloody
Associated Conditions
Allergic, viral, vasomotor, CSF leak (halo sign)
Bacterial, foreign body
Neoplasia
Trauma, neoplasia, bleeding disorder, HTN/vascular disease
Allergic Rhinitis (i.e. Hay Fever)
Definition
• rhinitischaracterizedbyanIgE-mediatedhypersensitivitytoforeignallergens • acute-and-seasonalorchronic-and-perennial
• perennialallergicrhinitisoftenconfusedwithrecurrentcolds
Etiology
• whenallergenscontacttherespiratorymucosa,specificIgEantibodyisproducedinsusceptiblehosts • concentrationofallergenintheambientaircorrelatesdirectlywiththerhinitissymptoms
Epidemiology
• ageatonsetusually<20yr
• morecommoninthosewithapersonalorfamilyhistoryofallergies/atopy
Clinical Features
• nasal:obstructionwithpruritus,sneezing
• clearrhinorrhea(containingincreasedeosinophils) • itchingofeyeswithtearing
• frontalheadacheandpressure
• mucosa: swollen, pale, “boggy”
• seasonal(summer,spring,earlyautumn)
■ pollensfromtrees
■ lasts several wk, disappears, and recurs the following year at same time • perennial
■ inhaled: house dust, wool, feathers, foods, tobacco, hair, mould
■ ingested: wheat, eggs, milk, nuts
■ occurs intermittently for years with no pattern or may be constantly present
Complications
• chronicsinusitis/polyps • serousotitismedia
Congestion reduces nasal airflow and allows the nose to repair itself (i.e. washes away the irritants). Treatment should focus on the initial insult rather than target this defense mechanism