RHINITIS

Definition: Inflammation involving mucosal lining of nasal cavity

-Secondary to exposure Skin-prick negative

to inhaled allergens 44 – 87 %
(aeroallergens)

-Type 1 hypersensitivity

-Other co-existing
conditions:
conjunctivitis, sinusitis =
rhinosinusitis, otitis
media

SYMPTOMS CLASSIFICATION – AIRA Classification

• Rhinorrhea, pruritus
• Nasal congestion
• Sneezing
• Itchy nose
• Lacrimation
• Post nasal drip
• Headache due to
congestion of
paranasal sinuses

SIGNS
NASAL SIGNS OCULAR SIGNS OTOLOGIC SIGNS
• Transverse nasal crease (black • Edema of lids • Retracted TM
line in dorsum of nose due to • Cobblestone appearance of
constant upward rubbing of conjunctiva (chronic
nose) inflammation -> tissue
• Pale and edematous nasal remodeling)
mucosa • Allergic shiners (congestion of
• Swollen turbinates small blood vessels beneath
 • Thin, watery or mucoid the skin)
discharge

PHARYNGEAL SIGNS LARYNGEAL SIGNS

• Granular pharyngitis • Hoarseness of voice due to edema of vocal cords
• Due to hyperplasia of
submucosal lymphoid tissue

INVESTIGATIONS
1. Complete blood count – eosinophilia
2. Nasal smear – eosinophilia
3. Skin tests – prick, scratch test, intradermal test
4. Radioallergen absorbent test (RAST) – measures specific IgE antibody concentration in blood

MANAGEMENTS
1. Avoidance of allergens
2. Pharmacological tx

Antihistamines Oral: Cetrizine, Desloratadine, Loratadine

Intranasal, ocular: Azelastine
Sympathomimetics Oral: Phenylephrine
** Vasoconstriction -> relieves nasal Topical (Aerosol): Phenylephrine,
congestion and edema Xylometazoline
** associated with rebound congestion =
Rhinitis Medicamentosa

Corticosteroids Oral
** Inhibit recruitment of inflammatory Topical: Beclomethasone, Budesonide,
cells -> Treat Rhinitis Medicamentosa Fluticasone

Anticholinergics Ipratropium Bromide

Leukotriene Receptor Antagonist Montelukast
Anti IgE Antibody Omalizumab

3. Immunotherapy (decrease formation of IgE, increase IgG)

 SINUSITIS
Definition: Inflammation of the paranasal sinuses
Commonly co-exists with rhinitis = rhinosinusitis

ACUTE RHINOSINUSITIS CHRONIC RHINOSINUSITIS

ARS is defined as worsening of symptoms after five
days or symptoms persist after 10 days and less
than 12 weeks.
CRS is defined as symptoms persisting for more
than 12 weeks.
To dx:
-Symptoms (mucopurulent drainage, nasal
obstruction, facial pain and decreased sense of
smell)
-CT scan (gold standard)
++ nasal endoscopy (increase accuracy)

SYMPTOMS
<5 DAYS: acute viral RS = common cold.
Acute bacterial rhinosinusitis (ABRS) is suggested when there are at least three symptoms/signs of:
1) Discolored discharge (with unilateral predominance) and purulent secretion in the nasal cavity
2) Severe local pain (with unilateral predominance)
3) Fever (>38°C)
4) Elevated erythrocyte sedimentation rate (ESR) /C-reactive protein
5) Deterioration of symptoms and signs

INVESTIGATIONS
1. Anterior rhinoscopy – mucosal edema, nasal inflammation, purulent nasal discharge, nasal
polyps
2. Nasal endoscopy – observe and tissue sampling
3. Nasal swab – C&S
4. Endoscopically-Directed Middle Meatal Culture (EDMMC) or Maxillary Sinus Taps
(MST)*bacterial culture for CRS

MANAGEMENT
1. Pharmacological
Antibiotics Amoxicillin
Corticosteroids Intranasal: Mometasone furoate
(acute: 14-21 days; chronic 16-52 weeks)
Oral *for chronic only 25mg/day for 2 weeks
Anti-histamines Oral: Cetrizine, Desloratadine, Loratadine
Intranasal, ocular: Azelastine
Decongestant Oxymetazoline
2. Nasal saline irrigation
3. Functional Endoscopic Sinus Surgery