Chronic Rhinosinusitis

Chronic rhinitis can be tough to deal with on a daily basis and, due to the long-lasting symptoms it can cause, is not always the easiest condition to alleviate. However, with the support of a rhinologist, it can be managed a lot more effectively. One of the most common questions patients with chronic rhinitis ask is: “Can the condition be cured?” In this article, join us as we look to answer this question and more, highlighting not only what causes rhinitis but also how it can be treated.

Sinusitis – What is it?

Sinusitis (also known as rhinosinusitis) is where the sinuses (air-filled tissues around the nose) are infected and is common after a cold or flu.

Symptoms of a sinus infection typically include:

• A fever or high temperature

• A blocked or runny nose

• A reduced sense of smell

• Green or yellow mucus from the nose

• Pain, swelling, or tenderness around the cheeks, eyes, or forehead

Some people may also experience headaches, toothache, bad breath, coughing, snoring, and nasal voice, but rhinosinusitis usually clears up by itself within a month.

Sinusitis and rhinitis are two common respiratory conditions that cause cold-like symptoms – but the two are not to be confused.

What is chronic rhinitis?

Chronic rhinitis refers to the persistent inflammation of the lining of your nasal passages. It is a long-lasting condition that can cause many symptoms that you might find hard to manage.

Acute rhinitis is similar to chronic rhinitis, but there are some major differences between the two. Acute rhinitis is short-term and normally lasts for only a couple of weeks. Chronic rhinitis, on the other hand, typically lasts for at least 12 weeks.

Acute rhinitis is also often caused by infections such as the common cold, whereas chronic rhinitis is usually brought on by specific triggers such as allergies, environmental factors, or hormonal changes.

Another important distinction between the two is that acute rhinitis usually clears up on its own or with the help of antibiotics. However, chronic rhinitis requires ongoing treatment and management.

Symptoms of chronic rhinitis

There are many symptoms of chronic rhinitis that impact your overall quality of life. These can include:

• Nasal congestion – a ‘stuffy’ or blocked nose is very common due to the inflammation of your blood vessels and tissues within the nose

• Rhinorrhoea – a runny nose which produces excess mucus

• Sneezing

• Itchiness within the nose, throat or ears

• Reduced or lost sense of smell

• Fatigue

• Coughing

• Postnasal drip

• Worsening of other health conditions such as asthma 

These symptoms are persistent in chronic rhinitis and can have an emotional impact as well as a physical one. Apart from the physical discomfort that these symptoms can bring, they can also disturb your sleep, impacting your social life and productivity.

Losing your sense of smell can decrease your sense of taste, making eating and drinking much more difficult. They can lead to other health conditions too, which can make daily life harder.

Therefore, seeking treatment for the symptoms of chronic rhinitis is essential.

Types of chronic rhinitis

There are four main types of chronic rhinitis — non-allergic, allergic, atrophic, and mixed.

Allergic rhinitis, or hay fever, occurs because of an allergic response to an allergen such as dust, pollen, or pet dander. When your body detects the allergen, your immune system overreacts and causes symptoms of rhinitis to occur.

Non-allergic rhinitis, on the other hand, is brought on when your body develops the same symptoms, but without being caused by an allergic response.

Mixed rhinitis is the most common type of chronic rhinitis and involves a combination of non-allergic and allergic rhinitis.

Atrophic rhinitis occurs inside the tissues of your nose when it atrophies (thins). Over time, the tissue becomes hard and when air flows through, your nostrils widen. This then causes your nasal passages to become too dry, leading to the development of the condition.

Chronic rhinosinusitis causes

Whether it be an allergic trigger, environmental factor or underlying health condition, there is often an underlying cause behind chronic rhinitis.

Inflammation can play a significant role in chronic rhinitis, for instance, developing in the lining of your nose and causing associated symptoms.

Allergic rhinitis is also often caused by allergens such as pollen, dust, mould, and pet dander. When these allergens in the air enter your body, they bind with something called immunoglobulin E (IgE) which causes your body to release histamine to defend against the allergen. This histamine release then leads to the symptoms associated with chronic rhinitis.

Non-allergic rhinitis doesn’t involve your immune system and is thought to develop when the blood vessels inside your nose begin to expand. This leads to congestion and swelling, as well as other rhinitis symptoms.

Non-allergic rhinitis can be caused by irritants such as:

• Detergent

• Perfumes

• Strong odours

• Pollution

• Smoke

• Dry weather conditions

• Upper respiratory infections, like the common cold

• Certain medications, such as beta blockers

• Hormonal changes

• Stress

• Structural abnormalities

• Other medical conditions such as asthma or chronic sinusitis

Chronic rhinitis diagnosis

The diagnostic process for chronic rhinitis encompasses many different assessments and tests to ensure an accurate diagnosis.

As a first step, your medical history will be taken into account. A rhinologist (a doctor who specialises in problems with your nose and sinuses) will sit down with you to discuss your symptoms in more detail, including when they started, how long they've lasted and any patterns that you have noticed.

Information about any past medical conditions, allergies, or family history will also be taken into account to help understand why chronic rhinitis has developed.

Your rhinologist will then perform a physical examination of your nasal passages and sinuses to check for signs of inflammation, congestion, and changes in your mucus. This part of the chronic rhinitis diagnosis is usually done with a computed tomography (CT) scan or nasal endoscopy (a thin tube with a camera attached inserted into your nasal passage).

If you are affected by postnasal drip, your throat may be checked. Similarly, your ears can be checked in case there is congestion or fluid accumulation.

To confirm if your chronic rhinitis is caused by allergens or not, allergy testing will also often be performed. This can either be via a skin prick test — where small amounts of allergens are introduced to the skin and any sensitivities or reactions are analysed — or an allergen-specific blood test where a sample is analysed for allergen-specific antibodies.

Chronic runny nose

Do you suffer from a chronic runny nose?

Anything that irritates the inside of the nose can cause rhinorrhoea (a runny nose), including infections like cold, flu, and sinusitis, as well as allergies.

However, the most common cause of a chronic runny nose is rhinitis.

When you breathe in through your nose, it warms the air and adds moisture before travelling into the lungs. Cold, dry air can irritate the lining in your nose – causing the nasal glands to produce excess mucus to keep the lining moist.

Notice how your nose runs when you cry?

Whether they are tears of joy, sadness, or from an irritant, they drain through the inner corner of your eyelids, through the nasolacrimal duct, and into your nasal cavities. This ultimately stimulates mucus production which naturally drips from your nose.

Irritants such as traffic fumes, strong odours, and cigarette smoke can trigger non-allergic rhinitis, resulting in a runny nose.

To learn more about the cause of a chronic runny nose and the part rhinitis has to play in it, get in touch with OneWelbeck.

Can chronic rhinitis be cured?

While chronic rhinitis is not always curable, it can be effectively managed with the right strategies.

There are a number of top tips and effective ways to cope with chronic rhinitis, including:

• Avoiding known allergens

• Avoiding irritants such as pollution

• Using an air purifier

• Staying hydrated

• Stopping smoking

• Nasal irrigation (rinsing your nasal passages out with a saline solution)

Understanding the underlying cause of your chronic rhinitis is crucial to ensuring you take the right approach when managing your symptoms.

Chronic rhinitis treatment

Treating chronic rhinitis will depend on the type you have. Using antihistamines, for example, won’t do anything against non-allergic rhinitis. Therefore, your treatment needs to be tailored to your exact needs.

Allergic chronic rhinitis is typically treated using antihistamines to suppress the histamine release or immunotherapies like allergy injections or tablets to desensitise your immune system to the allergen. Combining these with allergen avoidance tactics can make a big difference.

Other chronic rhinitis treatments include nasal corticosteroids and decongestants.

Nasal corticosteroids usually come in the form of nasal sprays and are used to reduce inflammation and alleviate congestion. Decongestants, both oral and nasal, can provide short-term relief from congestion.

ClariFix

ClariFix is an innovative treatment that we offer at OneWelbeck. ClariFix permanently reduces symptoms of chronic rhinitis with cryotherapy and is advised if other lines of treatment haven’t worked.

We perform ClariFix as an outpatient procedure and it is done by placing a small amount of liquid nitrogen into the back of your nose. The treatment takes around half an hour and you can return to regular activities right away.

To identify the right treatment for your needs, it’s important to consult with a rhinologist who can help understand your exact needs and identify which type of rhinitis you have.

Learn more about our chronic rhinitis treatments at OneWelbeck.