Nasal Disorders

Nasal Disorders2018-08-10T19:06:27+00:00

RHINITIS

VASOMETER RHINITIS/GUSTATORY RHINORRHEA

In vasomotor rhinitis, certain nonspecific stimuli, including changes in environment like temperature, humidity, barometric pressure or weather, airborne irritants such as odors and fumes, dietary factors, sexual arousal, exercise and emotional factors trigger rhinitis. There is still much to be learned about this, but it is thought that these non-allergic triggers cause dilation of the blood vessels in the lining of the nose, which results in swelling and drainage. Vasomotor rhinitis appears to be significantly more common in women than men, leading some researchers to believe that hormones play a role. In general, age of onset occurs after 20 years of age, in contrast to allergic rhinitis, which can be developed at any age. Individuals with vasomotor rhinitis typically experience symptoms year-round, though symptoms may be exacerbated in the spring and autumn when rapid weather changes are more common. An estimated 17 million United States citizens have vasomotor rhinitis. The antihistamine azelastine, applied as a nasal spray, may be effective for vasomotor rhinitis.

RHINORRHEA (RUNNY NOSE)

NON-ALLERGIC RHINITIS

Nonallergic rhinitis refers to rhinitis that is not due to an allergy. The diagnosis is made upon excluding allergic causes. It is an umbrella term of rhinitis of multiple causes, such as occupational (chemical), smoking, gustatory, hormonal, senile (rhinitis of the elderly), atrophic, medication-induced, local allergic rhinitis, non-allergic rhinitis with eosinophilia syndrome and idiopathic, non-infectious perennial allergic rhinitis or non-infectious non-allergic rhinitis. Non-allergic rhinitis can co-exist with allergic rhinitis, and is referred to as “mixed rhinitis.”

Drinking alcohol may cause rhinitis as well as worsen asthma. In these cases, alcohol-induced rhinitis may be of the mixed rhinitis type. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), particularly those that inhibit cyclooxygenase 1 (COX1), can worsen rhinitis and asthma symptoms in individuals with a history of either one of these diseases. These exacerbations most often appear due to NSAID hypersensitivity reactions rather than NSAID-induced allergic reactions.

Steroids such as fluticasone propionate or budesonide in nostril spray form may be used for symptomatic treatment. The antihistamine cyproheptadine is also effective, probably due to its antiserotonergic effects.

UPPER RESPIRATORY INFECTIONS

Upper respiratory infections (URIs) are among the most common reasons people seek medical attention and are the leading reason why people miss school or work. URIs are most commonly caused by viruses and can occur year-round, although most frequently in the cold or rainy months. The symptoms of a viral URI typically include nasal congestion, sneezing, and a runny nose with clear mucus. A sore or scratchy throat, hoarse voice, ear fullness, headache, and low-grade fever may also be present. Similar symptoms may be caused by influenza virus infection (also called “the flu”), but this usually causes more severe symptoms such as high fever, malaise, and aching muscles. The typical viral URI lasts approximately 7 to 10 days. Often, the first 2 to 3 days are marked by nasal congestion and stuffiness, followed by several days of sniffling and a runny nose. If a URI lasts longer than 10 days without improving it is important to seek medical attention to rule out a more serious condition. Prolonged or worsening symptoms may indicate the presence of bacterial sinusitis, acute otitis media or bacterial pharyngitis, among other conditions. Treatment of a viral URI typically involves reducing the burden of symptoms while allowing the infection to run its natural course. Contact your physician for treatments and diagnosis backed by medical research.

SNORING AND SLEEP APNEA

Snoring is generally considered the noisy breathing caused by vibrations of the upper airway during sleep. In contrast to snoring (noisy but otherwise normal pattern of breathing), sleep apnea is thought of as a disturbance of this pattern with interruptions and pauses in breathing. After a pause in breathing, there is often a gasp prior to the next breath.

Regular snoring is not considered a serious health risk. Snoring has not been proven to cause other medical conditions, and it is generally thought of as more of a nuisance to sleep partners. In contrast, obstructive sleep apnea (OSA) causes both short and long-term consequences to the patient’s health. Signs of OSA include daytime sleepiness, restless sleep, periods of silence during sleep followed by gasps for breath, morning headaches, mood changes, and the tendency to fall asleep during the day while in the sitting-up position. Health risks include more than just the decrease in oxygen levels at night during the apnea episodes.

They also include:

  • Increased risk of cardiovascular disease
  • Increase in blood pressure
  • Increase chances of stroke, diabetes, depression
  • Increase in weight (obesity)
  • Increase chances of congestive heart failure

The first line treatment for both snoring and sleep apnea rely mainly on lifestyle changes. These include:

  • Weight loss (dieting and exercise)
  • Avoiding alcohol and other sedatives (muscle relaxants, etc), especially prior to sleeping
  • Avoid sleeping on your back (side or stomach positions are better)
  • Some people even sew a tennis ball into the back of a T-shirt to prevent themselves from rolling onto their back at night
  • Some may try oral appliances or nasal dilator strips with variable results

NASAL CONGESTION

Nasal congestion has a variety of causes, and is usually attributed to either a structural anatomic blockage or swelling of the nasal tissue. Both problems can narrow the nasal cavity and give a sensation of “nasal congestion.” The following is a list of potential causes of nasal congestion:

  • Allergies
  • Viral infection
  • Environmental irritants
  • Enlarged turbinates (anatomical structures inside the nasal cavity)
  • Deviated nasal septum
  • Chronic sinusitis
  • Nasal polyps
  • Benign and cancerous tumors

Treatment of nasal congestion typically begins with medical therapy along with conservative treatments such as avoiding known allergens and using nasal saline irrigations.

EPISTAXIS (NOSE BLEEDS)

Epistaxis is defined as bleeding from the nostril, nasal cavity, or nasopharynx. Nosebleeds are due to the bursting of a blood vessel within the nose. This may be spontaneous or caused by trauma. While nosebleeds are rarely life threatening and usually stop on their own, approximately 60% of the population will be affected by epistaxis at some point in time, with 6% requiring professional medical attention. The causes of nosebleeds are typically unknown, but they may also result from trauma, medication use, tumors, or nasal/sinus surgery. There is no single definitive treatment for the management of nosebleeds and many factors including severity of the bleeding, use of anticoagulants, and other medical conditions can play a role in which treatment is utilized.