Rhinitis Untreated-Secondary Issues
By Iftikhar Hussain, MD
Rhinitis is defined as inflammation of the membranes lining the nose, and is characterized by nasal congestion, runny nose, sneezing, itching and postnasal drainage. Associated fatigue, headache and cognitive impairment may significantly compromise activities of daily living.
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You’re sneezing, your nose is runny and itchy, but you have learned that a packet of tissues, some over-the-counter allergy medication and avoiding socialization takes care of the problem temporarily.
However, you could have a condition known as rhinitis. Left untreated, rhinitis can lead to bigger medical problems.
Here is the dictionary definition of rhinitis:
Rhinitis is defined as inflammation of the membranes lining the nose, and is characterized by nasal congestion, runny nose, sneezing, itching and postnasal drainage. Associated fatigue, headache and cognitive impairment may significantly compromise activities of daily living.
It is clear from the above definition that rhinitis is more than a locally bothersome issue. And, it can lead to the following problems.
- Ear and sinus infections
Asthma, allergic rhinitis, and atopic dermatitis have a significant impact in terms of treatment costs and quality of life. Patients with atopic diseases also have a high incidence of co-morbidities, such as otitis media and sinusitis. These conditions are secondary to obstruction of the eustachian tube and sinus ostia by inflamed mucosa.
- Effect on sleep and quality of life
Nasal obstruction from rhinitis causes sleep disturbance and consequently daytime fatigue and excessive drowsiness. A double blind, placebo-controlled, crossover study showed that patients who were treated with nasal corticosteroid had significant improvement in daytime fatigue, drowsiness, and quality of sleep. Untreated rhinitis is also associated with loss of smell and taste, sleep apnea, snoring, and increased frequency of asthma.
- Effect on cognition and learning
Rhinitis impairs cognitive functioning that can be further impaired by first-generation antihistamines. Studies have shown that children with allergic rhinitis are more likely to exhibit shyness, depression, anxiety, and fearfulness than their peers. Sleep disturbances may have a significant negative effect on school performance and self-esteem.
- Orthodontic problems
Chronic nasal obstruction in children can cause excessive mouth breathing resulting in increased facial length, high arched palate, and dental malocclusions. The literature indicates that upper-airway compromise can especially affect the narrow-faced child. Removing the nasal obstruction can reverse some of these changes. Much of the concern for nasal obstruction and abnormal dentofacial growth has centered on adeno-tonsillar hypertrophy. Allergic rhinitis and choanal atresia also should also be considered.
- Incidence of asthma and control of asthma
Allergic rhinitis needs to be recognized and treated. Appropriate management may also prevent the development of asthma or improve the outcome of co-existing asthma. Atopic diseases of childhood consist of the triad of asthma, allergic rhinitis, and atopic dermatitis. All share a common pathogenesis, being mediated by IgE, and are frequently presented together in the same individual and family.
Early diagnosis and aggressive management of these disorders seem to offer the possibility of altering their natural history. Although the temporal relationship between the onset of rhinitis and asthma has been close in several studies conducted in children and adults, the results of a prospective longitudinal study of 694 college freshmen with rhinitis shows that the risk of asthma remains even much later. Students with rhinitis but no evidence of asthma in 1961 were three times more likely (10.5%) to develop asthma during the ensuing 23 years than individuals without earlier rhinitis (3.6%).
Two other observations suggest a link between upper and lower airway disorders. First, the occurrence of bronchial hyperreactivity after nasal provocation in rhinitis patients who have no evidence of asthma and second asthma may improve when rhinitis is treated. Although rhinitis is risk factor for asthma, it has not been possible to predict which rhinitis patients will develop asthma.
Several studies have examined whether bronchial hyperreactivity after nasal provocation by allergen or bronchial methacholine challenge predict asthma in rhinitis patients. The results are inconclusive. The beneficial effects on asthma of treatment for rhinitis are well documented.
A three-part approach to management, which includes allergen avoidance, immunotherapy, and pharmacologic treatment in this order can reduce the progression of the inflammatory process and improve the patient’s quality of life.
