Acute rhinitis leads to cough, mild fever, nasal congestion, runny nose, and sneezing.Manifestations of chronic rhinitis are similar to those of acute rhinitis, but in prolonged or severe cases, patients may also present with thick, foul-smelling, mucopurulent rhinorrhea, crusted mucus, and / or bleeding.
- Atrophic rhinitis leads to enlargement of the nasal cavities, crusting and malodorous bacterial colonization, nasal congestion, anosmia and epistaxis which can be relapsing and severe.
- Vasomotor rhinitis causes sneezing and watery rhinorrhea. The mucosa is turgid and varies from bright red to purple. The pathology is characterized by periods of remission and exacerbation.
The different forms of rhinitis are diagnosed clinically. No exams are required. Vasomotor rhinitis differs from specific viral or bacterial infections of the nose by the lack of purulent exudate and crusts. It differs from allergic rhinitis by the absence of an identifiable allergen.
- For viral rhinitis, decongestants, antihistamines, or both are used
For atrophic rhinitis, topical treatment with antibiotics, estrogen, and vitamins A and D.
Humidification of the environment and, sometimes, topical corticosteroids and oral pseudoephedrine are useful for vasomotor rhinitis
- Viral rhinitis can be treated symptomatically with decongestants (both topical vasoconstriction with a sympathomimetic amine, such as oxymetazoline every 8/12 h or 0.25% phenylephrine every 3/4 h for no more than 7 days, and sympathomimetic systemic amines, such as pseudoephedrine 30 mg orally every 4/6 h). Antihistamines (see table Nasal mast cell stabilizers for inhalation) may be useful, but those with anticholinergic effects dehydrate mucous membranes and therefore may increase irritation. (See also Common Cold.)
- Decongestants can also relieve symptoms of acute bacterial rhinitis and chronic rhinitis, while an underlying bacterial infection requires culture, pathogen identification, antibiotic sensitivity study, and appropriate antimicrobial treatment. If symptoms persist, biopsy may be needed to rule out cancer.
Treatment of atrophic rhinitis is directed at reducing scabs and eliminating odor with nasal irrigation, topical antibiotics (eg, bacitracin, mupirocin), topical or systemic estrogens, and vitamins A and D. Surgical reduction of the patency of the nasal cavities reduces the formation of crusts caused by the drying effect of the air flow on the atrophic mucosa.