Rhinitis

Question 1

What is rhinitis?

Answer 1

Inflammation of the lining (mucosa) of the nose

Question 2

What is the clinical definition of rhinitis?

Answer 2

symptoms of runny nose, sneezing and nasal blockage.

Question 3

What are the 3 classifications of Rhinitis?

Answer 3

Non-allergic including rhinitis medicamentosa
Infective
Allergic

Question 4

non-allergic pathogenesis

Answer 4

Occupational - low molecular weight compounds
Drug misuse - cocaine
Hormonal changes - pregnancy and menopause
Idiopathic - cold or dry air
Age
other - food, emotional
Medicines - aspirin, NSAIDs, beta-blockers, antidepressants, oral contraceptives

Question 5

What are the causes of Rhinitis Medicamentosa?

Answer 5

Chronic overuse of topic decongestants such as xylometazoline (Otrovine products) or oxymetazoline

Question 6

What are the symptoms of Rhinitis medicamentosa

Answer 6

nasal hypersensitivity, mucosal swelling, rebound nasal congestion

Question 7

Management of Rhinitis medicamentosa

Answer 7

Withdraw vasoconstrictor nose drops
use topical corticosteroid
patient education

Question 8

infective rhinitis - acute examples

Answer 8

common cold (viral), influenza, erysipelas

Question 9

Acute rhinitis - duration and management

Answer 9

Duration 5-10 days

Management - self limiting

Question 10

infective rhinitis - chronic examples

Answer 10

TB, Leprosy

Bacterial - streptococcal, pneumococcal and staphylococcal

Question 11

Infective rhinitis - additional symptoms and management

Answer 11

crust formation, foul odour.

Management - nasal swab and culture. Suitable antibiotic

Question 12

What is allergic rhinitis?

Answer 12

Symptomatic disorder of the nose resulting from an IgE-mediated immunological reaction following exposure to allergen.

Question 13

Allergic Rhinitis Classification - Seasonal Pollinosis or Hay-Fever

Answer 13

Symptoms peaking during the months of spring and summer when pollen levels are their highest

Question 14

Allergic Rhinitis Classification - Perennial Rhinitis

Answer 14

Similar to hay fever but substances which cause allergic reaction present all year round.

Question 15

Inflammatory Process - Immediate Rhinitis Symptoms

Answer 15

Histamines, leukotrienes, prostaglandins, bradykinin and platelet activating factors
- Itch, sneezing, rhinorrhoea, nasal congestion

Question 16

Inflammatory Process - Chronic rhinitis symptoms

Answer 16

Eosinophils

- Nasal blockage, loss of sense of smell, nasal hyper reactivity

Question 17

How many L of air does the nose filter, warm and humidify per day?

Answer 17

10,000

Question 18

What part of the nervous system are nasal passages regulated by?

Answer 18

Sympathomimetic nervous system

Question 19

Particle size - allergic rhinitis

Answer 19

greater than 10 microns caught in the nose, less than 2 microns in the lungs

Question 20

Where do wind borne pollens come from 20-30 microns

Answer 20

Spring - trees, hazel and birch

Summer - grasses, flowers, weeds

Question 21

Fungal spores 2-5 microns got to lungs

Answer 21

house dust mites - perennial AR

Question 22

Symptoms of hay fever

Answer 22

• sneezing
• coughing
• runny or blocked nose
• itchy red or watery eyes
• loss of smell
• pain around the temples and forehead
• headache
• earache
• feeling tired

Question 23

Diagnosis tests for rhinitis

Answer 23

• take full patient history
• examination
• skin prick test
• blood eosinophils
• nasal smear

Question 24

Differential Diagnosis

Answer 24

• timing of rhinitis
• family history - eczema, asthma, urticarial, rhinitis
• living conditions - bedding, carpets, age of house, dampness
• Medications
• Diet

Question 25

Managing rhinitis?

Answer 25

• Allergen avoidance
• Pharmacotherapy
• Immunotherapy
• Surgery
• Patient education

Question 26

Pharmacotherapy

Answer 26

• Oral antihistamines
• Nasal corticosteroids
• Sodium cromoglicate eye drops
• Short term nasal decongestant
• intranasal ipratropium
• Leukotriene receptor antagonists
• oral corticosteroids