| Treatment
of chronic rhinitis and post-nasal drip depends on the underlying
condition causing the problem. A complete history and examination
is done to determine if the problem is caused by either an
impairment in the normal production of mucus or in its normal
clearance from the nose. Treatment options consists of one
of more of the following:
Avoidance of Allergens: An allergy is an exaggerated
"normal body" inflammatory response to an outside
substance. These substances that cause allergies are called
allergens, and typically include pollen, mold, animal dander,
house dust, and even some foods. The best treatment is avoidance
of these allergens, but in many cases this may be impossible.
Some helpful suggestions include:
Use a pollen mask when mowing the grass or
cleaning the house; install an air purifier or at least change
the air filters monthly; use cotton or synthetic materials
such as Dacron in pillows and bedding; enclose mattress in
plastic; consider using a humidifier; keep windows closed
during high pollen times; eliminate house plants; and bathe
frequently or even give away dander producing pets.
Avoidance of Nasal Irritants: Nasal irritants
usually don't lead to the typical immune response seen with
classical allergies, but nevertheless they can mimic or make
allergies worse. Examples of these irritants include cigarette
smoke, perfume, aerosol sprays, smoke, and smog & car
exhaust.
Wash the Nose and Sinuses with Salt Water:
Nasal irrigation's utilizing a buffered hypertonic saline
solution helps to reduce swollen and congested nasal and sinus
tissues. In addition, it washes out thickened nasal secretions,
irritants (smog, pollens, etc.), bacteria, and crusts from
the nose and sinuses. Non-prescription nasal sprays (Ocean
spray, Ayr, Nasal) can be used frequently, and are very convenient.
Nasal irrigation can be done several times
per day, and is frequently performed with a syringe or a Water
Pik device (the attachment is purchased separately). The irrigating
solution can be made by adding 2-3 heaping teaspoons of salt
to one pint of water. It is best to use Morton Coarse Kosher
Salt or Springfield plain salt because table salt may have
unwanted additives. To this solution, add 1 teaspoon of baking
soda. Store at room temperature, and always mix solution before
each use. If the solution stings, use less salt. In the beginning,
or for children, it is best to start with a weaker salt mixture.
It is not unusual to initially have a mild burning sensation
the first few times you irrigate.
While irrigating the nose, it is best to stand
over the sink and irrigate each side of your nose. Aim the
stream toward the back of your head, not at the top of your
head. For young children, the salt water can be put into a
small spray container which can be squirted many times into
each side of the nose.
Treatment of Infection: The most common nasal
infection is a viral infection known as "a cold".
The virus causes swelling of the nasal membranes and the production
of thick clear mucus. Symptoms usually last several days.
If "a cold" goes on for many days and is associated
with yellow or green drainage, it has may become secondarily
infected by a bacteria. Sinus blockage can lead to acute or
chronic sinusitis which can be characterized by nasal congestion,
thick mucus, and facial pain. Prompt and aggressive treatment
of infection with antibiotics, along with supplemental medications,
or in some cases surgery, help to re-establishment the normal
drainage pathways.
Allergy Medications & Treatments: Histamines
are naturally occurring chemicals released in response to
an exposure to an allergen, and they are responsible for the
congestion, sneezing, and runny nose typical of an allergic
reaction. Antihistamines are drugs that block the histamine
reaction.
These medications work best when given prior
to exposure. Antihistamines can be divided into two groups:
1) Sedating (Benadryl, ChlorTrimetron, Tavist), 2) Non- Sedating
(Claritin, Hismanal). Sedating antihistamines should be avoided
in those patients who need to drive or use dangerous equipment.
Non-sedating antihistamines can have serious drug interactions.
Decongestants: These drugs temporarily reduce
swelling of sinus and nasal tissues leading to an improvement
of breathing and a decrease in obstruction. They may also
stimulate the heart and raise the blood pressure and should
therefore be avoided by patients who have high blood pressure,
heart irregularity, glaucoma, thyroid problems, or difficulty
in urination. The most common decongestant is pseudoephedrine
(Sudafed).
Combinations: These drugs are made up of one
or more anti-allergy medications. They are usually a combination
of an antihistamine and a decongestant. Other common combinations
include mucus thinning agents, anti-cough agents, aspirin,
Advil, or tylenol. They help to simplify dosing and often
will work either together for even more benefit or have side-effects
that cancel each other out.
Allergy Shots (Immunotherapy): Allergy shots
interfere with the allergic response. After identification
of an allergen, small amounts of it is given back to the sensitive
patient. Overtime the patient will develop blocking antibodies
to the allergen, and they become less sensitive.
Steroids: These drugs (prednisone, medrol,
hydrocortisone) are highly effective in allergic patients,
however there is a potential for serious side effects when
used over time. They are best used for the short term management
of allergic problems, and must always be monitored by a physician.
Steroid nasal sprays: (Vancenase, Beconase,
Flonase, Nasacort, Rhinocort) They reduce allergic or inflammatory
inflammation, but do not have the side-effects of oral (systemic)
steroids.
Nasalcrom: This spray helps to stabilize allergy
cells (mast cells) by preventing release of allergy mediators,
like histamine.
Decongestant sprays: (Afrin, Neosynpherine)
They quickly reduce swelling of nasal tissues by shrinking
the blood vessels. They will improve breathing and drainage
over the short term, unfortunately if they are used for more
than a few days they can become highly addictive (rhinitis
metamentosa). Long term use can lead to serious damage.
Antihistamine sprays: It works like oral antihistamines
but applied topically to the nasal membranes (Astelin).
Atrovent: It helps to control nasal drainage
mediated by neural pathways. It will not treat an allergy,
but it does decrease nasal drainage.
Mucus Thinning Agents: Mucus thinning agents
are utilized to make secretions more thin and less sticky.
They help to prevent pooling of secretions in the back of
the nose and throat where they often cause choking. The thinner
secretions pass more easily. Guaifenesin (Humibid, Fenesin)
and organic Iodine (Organidin) are commonly used formulations.
If a rash develops or there is swelling of the salivary glands
they should be discontinued. Inadequate fluid intake will
also thicken secretions. Increasing the amount of water consumed,
and eliminating caffeine from the diet and the use of diuretics
are also helpful.
Reflux Medications: Antacids (Maalox, Mylanta)
help to neutralize acid contents, whereas other medications
(Tagamet, Pepcid, Prilosec) decrease stomach acid production.
Non-pharmacological treatments include avoiding late evening
meals and snacks and the elimination of alcohol and caffeine.
Elevating the head of the bed may help to decrease reflux
during sleep.
Surgery: Structural problems with the nose
and sinuses may ultimately require surgical correction. Obviously
this should be done only after more conservative measures
have been tried. Surgery is not a replacement for good allergy
control and treatment. Septal deviation, septal spurs, septal
perforation, enlargement of the turbinates, and nasal/sinus
polyps can lead to pooling of or overproduction of secretions,
blockage of the normal pathways leading to chronic sinusitis,
and chronic irritation.
Terminology
Acute Rhinitis: Inflammation of the nose that
occurs for only a few days. Typically this is caused by a
virus ("a cold"); if it goes on beyond a week then
it is probably bacterial.
Allergens: Normally harmless substances which
cause an exaggerated allergic reaction (inflammatory response)
in sensitive people.
Allergic Rhinitis: Medical term for hay fever,
a condition due to allergy that mimics a chronic cold. (Hay
fever is a misnomer since hay is not a usual cause of this
problem and there is no fever. Many substances cause the allergic
symptoms in hay fever. Allergic rhinitis is the correct term
for this allergic reaction. (Rhinitis means "irritation
of the nose" and is a derivative of Rhino, meaning "nose.")
Symptoms include nasal congestion, a clear runny nose, sneezing,
nose and eye itching, and tearing eyes. Post-nasal dripping
of clear mucus frequently causes a cough. Loss of smell is
common and loss of taste occurs occasionally. Nose bleeding
may occur if the condition is severe. Eye itching, redness,
and tearing frequently accompany the nasal symptoms.
Chronic Rhinitis: inflammation of the nose
that goes on for weeks to months which is different from "a
cold", and may be caused by allergy, nasal irritants,
structural, or physiological problems.
Hay Fever: A seasonal allergy to airborne
particles characterized by runny/itchy nose and eyes, sneezing,
itchy throat, excess mucus, and nasal congestion. It is a
misnomer because it is not caused by hay and it does not produce
a fever.
Non-Allergic Rhinitis: Inflammatory condition
of the nose without an obvious allergy cause.
Post Nasal Drip: Mucous accumulation in the
back of the nose and throat leading to or giving the sensation
of mucus dripping downward from the back of the nose.
Summer Cold: Similar to hay fever. Also a
misnomer because it is not caused by a virus.
Vasomotor Rhinitis: Similar to non-allergic
rhinitis, thought to be mediated by an abnormal neuronal control
of the blood vessels supplying the nose.
Chronic Rhinitis & Post-Nasal Drip At A Glance
* The nose functions to warm, clean, and
humidify air as well as playing a role in the sensations of
smell and taste.
* Rhinitis (inflammation of the nose) may or may not be caused
by allergies.
* Certain conditions alter the production, character, and
clearance of nasal secretions.
* Treatment of chronic rhinitis and post-nasal drip depends
on the underlying cause.
Seriousness
of Allergy Rhinitis | Perennial
Allergic Rhinitis |
Relieving
Toddler Nasal Congestion |
Non-Allergic
Rhinitis| Causes
of Allergic rhinitis| Treatment
of Allergic rhinitis|
History
of Allergic rhinitis| Abnormal
production of nasal secretions|
Allergic
Rhinitis in Children|
How
can chronic rhinitis and post-nasal drip be treated?|
What
are rhinitis and post-nasal drip? |
