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Rhinitis and Sinusitis

Almost everyone knows what it feels like to have a runny, stuffed-up nose at times. Often these symptoms are accompanied by a headache in the area around the eyes, nose and temples. People with allergies are especially prone to these symptoms. They are signs of rhinitis and sinusitis, two very common medical problems. It is estimated that up to 40 million American adults and children have one or both of these conditions.

Although not life-threatening, rhinitis and sinusitis can make you miserable. At their worst, they can keep you from functioning normally, and may lead to life-threatening complications. Fortunately, there are things you can do to prevent these problems. And effective treatments exist when these symptoms do arise. If you have allergies, you are more likely to develop rhinitis or sinusitis than are persons without allergies. This makes it even more important to keep your allergies under control and to prevent rhinitis and sinusitis from occurring.

What Is Rhinitis?

The word rhinitis means simply "inflammation of the nose." The nose normally produces a fluid called mucus. This fluid is normally thin and clear. It helps to keep dust, debris and allergens out of the lungs. Mucus traps particles like dust and pollen as well as bacteria and viruses.

Normally, mucus drains down the back of the throat, but you're not aware of it due to its relatively small amount and thin consistency. But when the nose becomes irritated, it may produce more mucus, which becomes thick and pale yellow. The mucus may begin to flow from the front of the nose as well as the back. Substances in the mucus may irritate the back of the throat and cause coughing. This increased mucus draining down the throat is called postnasal drip.

What Causes Rhinitis?

Rhinitis may be caused by irritants or allergens (substances that provoke an allergic response). In response to these substances, the cells of the body release histamine and other chemical mediators. These are the substances that cause the symptoms of allergic rhinitis—sneezing, runny nose, and itching, watery eyes.

In many people, rhinitis is a temporary condition that clears up on its own after a few days. In others, especially those with allergies, rhinitis is a chronic problem—one that is nearly always present or that recurs often. Rhinitis is often classified into several types:

Allergic rhinitis. Rhinitis caused by an allergic reaction may be either seasonal—occurring only at certain times of the year—or perennial—occurring year round. Seasonal allergic rhinitis is sometimes called "hay fever." It is an allergic reaction to pollen from trees and grasses. Ragweed pollen is another frequent culprit causing hay fever. This type of rhinitis occurs mainly in the spring and fall, when these pollens from trees, grasses and weeds are in the air.

Perennial allergic rhinitis is caused by allergies to substances that are present year round. The chief causes of this type of rhinitis are allergies to dust mites, mold, animal dander and cockroach debris.

Nonallergic rhinitis. Sometimes perennial rhinitis is not caused by allergic triggers. It may be caused by overuse of topical nose sprays, hormonal changes, structural abnormalities of the nose (such as septal deviation), and occasionally by medications. Often, the cause of this type of rhinitis is not well understood, but it is commonly present in patients with asthma. Its symptoms are similar to those produced by allergy.

Infectious rhinitis. Perhaps the most common form of rhinitis, infectious rhinitis is also known as the common cold. It is caused by infection with a cold virus that takes up residence in the mucous membranes of the nose and sinus cavities.

It can be hard to tell the difference between allergies and the common cold. There are more than a hundred strains of cold viruses. Each tends to become widespread at certain times of the year, which is why you may mistake a cold for a seasonal allergy.

How is Rhinitis Treated?

Most cases of rhinitis go away once the source of irritation is gone. In the meantime, decongestants can help to relieve a stuffy nose. Be very careful, however, with the use of over-the-counter decongestant nasal sprays. Overuse of these products can actually make your stuffy nose worse. If used chronically and then stopped, after the effects of these products wear off, the tissue inside the nose and sinuses tends to become swollen. This can prompt you to use more of the medication, after which these tissues swell even more. A vicious cycle can begin if you keep using the product. As your body adjusts to the chronic medication, you need more of the medication more often to relieve the side effects. At first you may get relief, but in the long run the symptoms are worse. You then try to relieve the symptoms with more medication, which in turn worsens the side effects, and so on. All the while the underlying cause of your stuffy nose is not being treated.

Perhaps the most widely used type of medication used to control the symptoms of rhinitis are the antihistamines. These medications counteract the affects of histamine, the naturally occurring chemical that causes allergy symptoms. The chief side effect of antihistamines is drowsiness. A number of new antihistamines have been developed that do not cause drowsiness in most people. These medications are available with a doctor's prescription. Cromolyn nose spray, available over the counter, may be helpful for allergic rhinitis and causes essentially no side effects. The most effective medications for allergic rhinitis are the prescription corticosteroid nose sprays that reduce allergic inflammation, usually without causing systemic side effects.

What Is Sinusitis?

Sinusitis is an infection or inflammation of the sinuses. A sinus is simply a hollow space. There are many sinuses in the body, including four pairs inside the skull. These are called the paranasal sinuses. They serve to lighten the skull and give resonance to the voice.

The paranasal sinuses are lined with the same kind of tissue that lines the inside of the nose. The same things that can cause swelling in the nose—such as allergies or infection—can also affect the sinuses. When the tissue inside the sinuses becomes inflamed, mucus discharge is increased. Over time, air trapped inside the swollen sinuses can create painful pressure inside the head. This is what is known as a "sinus headache."

What Causes Sinusitis?

Most cases of sinusitis are caused by infection with a virus. If the sinuses remain blocked for a long time, though, a secondary infection may result. This secondary infection is caused by bacteria that are normally present within the respiratory tract. These bacteria multiply and cause a sinus infection when they are unable to drain out of the blocked sinuses.

When a sinus infection results from blocked sinuses, you can experience symptoms ranging from: drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat; nasal obstruction or congestion; tenderness and swelling around the eyes, cheeks, nose and forehead; and/or a reduced sense of smell and taste. This resulting sinusitis can be classified into two types:

Acute sinusitis. This temporary inflammation of the sinuses is known as acute sinusitis. During acute sinusitis the mucous membranes of your nose, sinuses and throat become inflamed, possibly from a pre-existing cold or allergies. Swelling obstructs the sinus openings and prevents normal mucus drainage, causing mucus and pressure to build up. 

Chronic sinusitis. When symptoms become more frequent or persistent, sinus infections may cause chronic sinus inflammation and symptoms. If you have more than three sinus infections in a year or experience symptoms for longer than 12 weeks you could have chronic sinusitis. More than 50 percent of persons with moderate to severe asthma also have chronic sinusitis.

How is Sinusitis Treated?

The first step in treating sinusitis is to unblock the nasal passages. This allows proper drainage of the sinuses, which helps flush out a bacterial infection. If a bacterial infection is present, your doctor will carefully select an appropriate antibiotic to combat it. Following are a few common treatment options prescribed to patients with sinusitis:

Nasal steroids. Sprays are helpful for many people to decrease inflammation, but can often lead to damage of the nasal lining.

Antibiotics. A long course of antibiotics often recommended by physicians to help fight congestion.

Oral steroids. Although prescribed for severe chronic sinusitis, it should be noted that oral steroids (such as prednisone) are powerful medicines with significant side effects, and these medicines typically are only prescribed when other medicines have failed.

In order to help alleviate some of the symptoms associated with sinusitis doctors also suggest nasal lavage with warm salt water or breathing in hot steam through the nose for 10 to 15 minutes, 3 to 4 times a day to make you feel more comfortable.

In certain cases some patients may also be candidates for sinus surgery which includes conventional sinus surgery, known as functional endoscopic sinus surgery (FESS), or a less-invasive option that uses a balloon catheter, called “balloon sinuplasty,” to open up blocked sinus passageways, restoring normal sinus drainage. These treatment options are recommended for patients with chronic sinusitis symptoms that will not go away with antibiotics or medication.

How Can I Prevent Rhinitis and Sinusitis?

The best course for preventing rhinitis and sinusitis is to keep your nasal passages as free and clear as possible. This is particularly important if you have allergies.

If you have chronic rhinitis and tend to get repeated bouts of sinusitis, your doctor may prescribe a steroid nasal spray. Taken every day, this medication will help to keep the nasal and sinus passages from becoming inflamed.

To the extent possible, avoid exposure to the things that trigger your allergies. Keep cigarette smoke out of your home and avoid it in other places as much as possible.

Most important, keep your doctor informed of your symptoms. Together you can devise a plan of action to take before a minor case of rhinitis or sinusitis turns into a bigger health problem.

 

SOURCE: This information should not substitute for seeking responsible, professional medical care. First created 1995; fully updated 1998; most recently updated 2005.
© Asthma and Allergy Foundation of America (AAFA)
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