Rhinitis

Rhinitis Treatment & Surgical Procedures

What is Rhinitis?

Rhinitis is a nasal condition that leads to nasal congestion, nasal obstruction, runny nose, itchy nose and sneezing, and post-nasal drip. This condition or reaction generally occurs as a result of inflammation that occurs in and around the sinuses and nasal cavities. However, symptoms can also affect the eyes, ears, and throat.

What Causes Rhinitis?

There are many different types of rhinitis, and each type can be caused by different things. However, the two primary types of rhinitis are allergic and nonallergic rhinitis.

Allergic rhinitis is caused by an immune response to allergens in the air that trigger the release of histamine. Histamines are then what cause such symptoms as itching, swelling, and fluid buildup.

Common causes of allergic rhinitis include:

  • Pollen
  • Dust mites
  • Mold
  • Animal dander
  • Fumes and odors
  • Smoke
  • Certain foods and spices
  • Changes in the weather or environment

Nonallergic rhinitis can be similar to allergic rhinitis, but it is generally not caused by allergens or an allergic reaction. However, there can still be some overlap in the things that trigger nonallergic rhinitis and allergic rhinitis.

Common causes of nonallergic rhinitis can include:

  • Infections
  • Medications
  • Eating or drinking certain foods
  • Environmental irritants
  • Weather changes
  • Hormonal changes
  • Sleep patterns and behavior
  • Exposure to fumes, odors, and smoke
  • Stress
  • Nasal structural problems
  • Extensive sinus surgery

There are also some things that can increase a person’s chance of developing rhinitis, such as:

  • Daily exposure to irritants
  • Being over the age of 20
  • Female hormones
  • Prolonged use of decongestant drops or sprays
  • Occupational exposure to certain chemicals and fumes
  • Chronic health problems, such as diabetes, hypothyroidism, and chronic fatigue syndrome

If rhinitis has settled into your daily routine and over-the-counter fixes aren't doing the job, chat with us to find an ENT near you who can dig into the cause and build a treatment plan that actually works.

What are the Symptoms of Rhinitis?

The symptoms of rhinitis can vary depending on the specific type of rhinitis you are suffering from, however, there is also often overlap in symptoms. As such, it can sometimes be difficult to determine if you have allergic rhinitis or nonallergic rhinitis without first consulting with your doctor.

The primary symptom of rhinitis is nasal congestion. If you constantly feel stuffed up and like you need to blow your nose, you may have rhinitis. This is especially true if nothing comes out when you blow your nose, as rhinitis isn’t due to mucus buildup, but is the result of inflammation and swollen nasal passages.

Overall, some of the many symptoms of rhinitis, both allergic rhinitis and nonallergic rhinitis, can include:

  • Runny nose
  • Nasal congestion or stuffy nose
  • Sneezing
  • Itchy nose, eyes, ears, and throat
  • Postnasal drip
  • Coughing
  • Headaches
  • Nosebleeds
  • Clear drainage from the nose
  • Ear infections
  • Snoring
  • Bluish discoloration under the eyes
  • Fatigue
  • Mouth breathing

What Are the Different Types of Rhinitis?

Doctors primarily categorize rhinitis in one of two ways; allergic rhinitis, and nonallergic rhinitis. However, within the category of nonallergic rhinitis, there can be several other different types of nonallergic rhinitis.

Allergic Rhinitis

Allergic rhinitis is considered the most common type of rhinitis. It is an immunoglobulin E (IgE) inflammatory response triggered by different things in the environment. Most often, seasonal allergies and even year-round allergies are the cause of allergic rhinitis.

Allergic rhinitis can be intermittent or persistent. Intermittent allergic rhinitis generally lasts less than four days a week and for less than four weeks in total. Persistent allergic rhinitis will most often cause symptoms for more than four days a week or last more than four weeks at a time.

Nonallergic Rhinitis

Nonallergic rhinitis is not the result of an immune response. However, it can still be triggered by similar conditions as allergic rhinitis, such as weather, smoke, and odors. This type of rhinitis is also much less common, and only represents around 25% of all rhinitis cases.

There are a few different types of nonallergic rhinitis, all of which are heterogeneous and typically unrelated to one another.

  • Acute Viral Rhinitis: This type of rhinitis is caused by a variety of viruses. But the most common cause is the common cold. The most common symptoms of acute viral rhinitis include sneezing, runny nose, congestion, cough, postnasal drip, and even a low-grade fever.
  • Chronic Rhinitis: This type is an extension of rhinitis caused by a viral infection or inflammation, but it can also occur in some cases with diseases such as syphilis, tuberculosis, and histoplasmosis. Most cases of chronic rhinitis cause nasal obstruction, and in severe cases, it can lead to nosebleeds, crusting, and pus-filled discharge.
  • Atrophic Rhinitis: This is a specific form of chronic rhinitis that occurs when the mucous membrane in the nasal cavity thins. When this happens, the nasal passages dilate and dry out. Atrophic rhinitis often occurs in the elderly as well as those who have had sinus surgeries that have removed too much tissue.
  • Vasomotor Rhinitis: This is another form of chronic rhinitis that resembles allergic rhinitis. With vasomotor rhinitis, the nose reacts strongly to allergens and irritants even when allergies are not present. People with this type of rhinitis often have swollen mucous membranes and inflammation of the sinuses.
  • Rhinitis Medicamentosa: This form of nonallergic rhinitis occurs with rebound congestion that typically occurs as the result of the overuse of decongestant nasal sprays and drops. In this case, rhinitis is treated by discontinuing the use of the drug that is causing the problem.

Treatments for Rhinitis

Before rhinitis is treated, your doctor will attempt to diagnose the specific type of rhinitis you are suffering from, as different types can react differently to different treatment options. Overall, various treatment options for the different types of rhinitis may include:

  • Saline nasal sprays
  • Corticosteroid nasal sprays
  • Anticholinergic nasal sprays
  • Antihistamines, both sprays and oral medications
  • Decongestants
  • Allergic immunotherapy
  • Botulinum toxin
  • Mast cell stabilizers

Your doctor may also recommend lifestyle changes to avoid the triggers causing your specific type of rhinitis. Understandably, it might not be possible to avoid all triggers, but there are things you may be able to do to limit your exposure. These can include:

  • Keeping windows closed when pollen counts are high
  • Using an air purifier in your home
  • Wearing a mask when outdoors performing yard work
  • Frequently changing your heating and air conditioning filters
  • Frequently washing your bedding with hot water
  • Using a vacuum with a HEPA filter
  • Avoiding pets or bathing and grooming pets frequently
  • Avoiding exposure to smoke
  • Taking showers after being outdoors

Surgery for Rhinitis

If medications and lifestyle changes do not work, surgery may be necessary. If you continue to suffer from rhinitis, an ear, nose, and throat (ENT) doctor can evaluate your case and determine if surgery is needed and which procedure is best.

Traditionally, many ENT doctors relied on an invasive, time-consuming procedure known as vidian neurectomy for treating symptoms of rhinitis. However, medicine has come a long way, and now there are other, less invasive options. Two of the most common surgical procedures now for rhinitis are ClariFix and RhinAer.

Both of these methods utilize the thought process behind the vidian neurectomy procedure, which is to knock out the overactive nerve function. But these newer methods allow for more targeted treatment of the nerve branches, which avoids the need for cutting, drilling, or general anesthesia.

ClariFix for Rhinitis

ClariFix uses a nasal probe to apply cryotherapy to the desired inflamed area. Before the treatment, a local anesthetic is applied to numb the area, and then the doctor inserts a tiny camera along with the ClariFix probe to apply cold therapy to the nerve causing the problems.

The procedure takes only a few minutes, and you will feel minimal discomfort, such as slight pressure and a cooling sensation that can extend to the molars. This procedure is considered safe and effective and provides lasting relief for 4 out of 5 patients with a low chance of side effects.

Recovery after ClariFix takes about 1-2 days, during which you may experience some mild discomfort and congestion. Results should then be noticeable within 2 to 6 weeks.

RhinAer for Rhinitis

The RhinAer procedure is similar to ClariFix, except that it uses heat instead of cryotherapy. Your doctor will first apply an anesthetic and then insert a camera as well as the stylus-like RhinAer device through the nose. They will then apply heat to the nerve areas causing the issue using low-temp, non-ablative radiofrequency energy.

Similar to ClariFix, there is minimal discomfort during and after the procedure and recovery time is minimal. Clinical studies have shown the procedure to be effective in 96% of patients, with symptoms improving within three to six months.

Talk to Your Doctor About Your Options for Rhinitis

The treatment that is best for you will depend on your individual situation. Some people can effectively treat their rhinitis with medication and lifestyle changes, while others need surgery.

If surgery is necessary, RhinAer and ClariFix are currently two of the most effective treatment options if you want minimally invasive surgery. And if one of these procedures does not work, you can try the other one. They cannot be performed at the same time, but you can have a ClariFix treatment after recovering from a RhinAer treatment, and vice versa.

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