Rhinitis

BSC NURSING III YEAR

1. RHINITIS Mr. Manikandan.T , RN., RM., M.Sc (N)., D.C.A .,( Ph.D ) Assistant Professor, Dept. of Medical Surgical Nursing, VMCON, Puducherry .

2. Definition Inflammation of the nasal mucosa. Rhinitis is a group of disorders characterized by inflammation and irritation of the mucous membranes of the nose.

3. Classification A. Acute rhinitis a. Non-allergic: 1. Infective: • Viral: Common cold ( coryza or flu), rhinitis associated with influenza or other viral infections. • Bacterial: Usually occurs as a secondary infection following unresolved viral rhinitis. 2. Non-infective: • Vasomotor rhinitis. • Rhinitis due to chemical irritation.

4. b. Allergic e.g. Hay fever.

5. B. Chronic rhinitis: a. Non-allergic: 1. Non-specific: • Chronic catarrhal rhinitis. • Chronic hypertrophic rhinitis. • Chronic atrophic rhinitis. • Rhinitis medicamentosa (drug-induced rhinitis). 2. Specific: • Scleroma . • Rare types: Syphilis, tuberculosis, lupus and, leprosy. b. Allergic: Perennial allergic rhinitis.

6. CAUSES – Rhinovirus. – Droplet infection. – reaction of the body’s  immune system  to an environmental trigger. The most common environmental triggers include dust, molds, pollens, grasses, trees, and animals. Both  seasonal allergies  and  year-round allergies  can cause allergic rhinitis.

7. Cont., changes in temperature or humidity; use of over-the-counter (OTC) and prescribed nasal decongestants; foreign body. Allergic rhinitis may occur with exposure to allergens such as foods ( eg , peanuts, walnuts, brazil nuts, wheat, shellfish, soy, cow’s milk, and eggs) medications ( eg , penicillin, sulfa medications, aspirin The most common cause of nonallergic rhinitis is the common cold. Drug-induced rhinitis may occur with antihypertensive agents, such as angiotensin -converting enzyme (ACE) inhibitors and beta-blockers; “ statins ,” antidepressants; aspirin, antianxiety medications.

8. • Dust mite feces • Dog dander • Cat dander • Cockroach droppings

9. Clinical features 1. Stage of invasion (few hours): Sneezing, burning sensation in the nasopharynx , nasal obstruction, and headache, Pruritis of nose 2. Stage of secretion (few days): Low grade fever, malaise, arthralgia, nasal obstruction, and profuse watery rhinorrhea . 3. Stage of resolution: Resolution within 5-7 days is the natural course of an uncomplicated disease. Symptoms lasting beyond 7 days, or worsening instead of improving suggest that secondary bacterial infection is being established.

10. Treatment 1. Supportive treatment: bed rest, analgesics, nasal decongestants (local i.e. drops and systemic), and occasionally steam inhalations. 2. Antibiotics should be reserved for treatment of secondary bacterial infections.

11. Symptom relief. Antihistamines and corticosteroid nasal sprays may be useful.Brompheniramine /pseudoephedrine (Dimetapp) is an example of combination antihistamine/decongestant medications Cromolyn ( NasalCrom ), a mast cell stabilizer that inhibits the release of histamine and other chemicals, is also used in the treatment of rhinitis

12. Use of saline nasal spray can act as a mild decongestant and can liquefy mucus to prevent crusting. Two inhalations of intranasal ipratropium ( Atrovent ) can be administered in each nostril two to three times per day for symptomatic relief of rhinorrhea . intranasal corticosteroids may be used for severe congestion, and ophthalmic agents ( cromolyn ophthalmic solution 4%) may be used to relieve irritation, itching, and redness of the eyes. Newer allergy treatments include leukotriene modifiers ( eg , montelukast [ Singulair ], zafirlukast [ Accolate ], zileuton [ Zyflo ])