1) Disease Description (Causes and Symptoms)
- Definition summary: Chronic rhinitis is chronic inflammation of the nasal mucosa. The main symptoms include nasal congestion, persistent or recurrent runny nose, sneezing, itching, postnasal drip (secretions flowing down the back of the throat), and impaired sense of smell.
- Causes and pathophysiology
- Allergic: Repeated or persistent inflammation of the nasal mucosa caused by an IgE-mediated immune response to allergens (dust mites, pollen, animal hair, etc.).
- Nonallergic: Autonomic nervous system imbalance, hormonal changes (pregnancy, thyroid abnormalities, etc.), medications (such as long-term use of topical vasoconstrictors), environmental irritants (tobacco smoke, pollutants), structural abnormalities (deviated nasal septum, turbinate hypertrophy), and, rarely, chronic infections.
- Pathophysiology: Mucosal edema, vasodilation, and increased mucus secretion → impaired airflow and accumulation of secretions → postnasal drip, reduced sense of smell, and other symptoms.
- Main symptoms
- Persistent or intermittent runny nose (clear or cloudy), chronic nasal congestion (bilateral or unilateral), recurrent sneezing, nasal or throat itching, postnasal drip and coughing, reduced or lost sense of smell, and nighttime breathing problems (mouth breathing and reduced sleep quality).
2) Treatment Methods and Precautions
- Medication therapy (standard)
- Topical nasal corticosteroids (first-line treatment): Most effective for suppressing inflammation. Although systemic adverse effects are limited even with long-term use, local adverse effects such as nosebleeds and dryness may occur.
- Antihistamines (oral or nasal): Help relieve sneezing, itching, and runny nose. Less-sedating second-generation drugs are recommended.
- Combination nasal antihistamine/anti-inflammatory products: Effective for symptom control.
- Oral/topical decongestants (mucosal vasoconstrictors): Short-term use (several days) is recommended. Long-term use carries a risk of causing rebound rhinitis (rhinitis medicamentosa).
- Leukotriene inhibitors (e.g., montelukast): May be considered in cases such as asthma accompanied by allergic rhinitis.
- Antibiotics: Used only when chronic bacterial rhinitis/sinusitis is present and bacterial infection is suspected.
- Nonmedication treatment
- Saline nasal irrigation: Helps remove mucus and allergens and moisturize the mucosa.
- Avoidance therapy (allergic): Avoid identified allergens (mites, pets, pollen, etc.) and improve the residential environment.
- Immunotherapy (subcutaneous or sublingual): Effective in reducing long-term symptoms in allergic rhinitis when the causative allergen has been identified. The decision should consider the indications and risks (such as anaphylaxis).
- Procedures/Surgery
- Persistent nasal congestion/turbinate hypertrophy that does not respond to medication: Turbinate reduction (partial resection, electrocautery, laser, etc.), turbinoplasty, and, if necessary, septoplasty (correction of the deviation).
- Rarely, nerve block (non-systemic nerve block) or surgery related to the nasal mucosa may be considered.
- Precautions / Contraindications and Prevention of Complications
- Follow the prescribed instructions for nasal corticosteroids (follow the dose and frequency and receive instruction on the spraying technique).
- Nasal decongestant sprays are recommended for short-term use (5–10 days) — long-term use carries a risk of dependence and rebound rhinitis.
- A general evaluation, including cardiovascular and asthma status, is necessary before starting immunotherapy.
- Seek medical attention immediately if symptoms worsen (difficulty breathing, severe facial pain, high fever, persistent nosebleeds, etc.).
- Possible complications: Chronic sinusitis, otitis media, conjunctivitis, laryngopharyngitis, sleep disturbance (daytime sleepiness), worsening of olfactory dysfunction, and others.
3) Outpatient Visit Checklist (Items to Prepare and Points to Confirm)
- Items to prepare
- List of medications currently being taken (including prescription drugs, over-the-counter drugs, and nasal sprays), along with the time and dose of administration
- Copies or summaries of results from previous evaluations (allergy tests, nasal endoscopy, CT, etc.)
- Surgical history (including nasal surgery) and records of responses to previous treatments
- Symptom diary (when symptoms began, the times of day when they are most severe, triggers, and effects on daily life and sleep)
- Suspected allergy factors (pets, occupation, exposure to household dust, and whether symptoms worsen seasonally)
- Photos (inside the nose or the external shape of the nose, if a structural abnormality is suspected as the cause of nasal congestion)
- If you are using a nasal spray, bring the product with you (so the doctor can check your spraying technique)
- Information to tell the doctor in advance during an outpatient visit
- Suddenly worsened symptoms (fever, purulent discharge, severe facial pain), difficulty breathing, or severe bleeding
- Whether you are pregnant or breastfeeding, respiratory or cardiovascular disease, and whether you have coexisting asthma
4) Examples of General Questions to Ask the Doctor
- What are the expected adverse effects of this medication (e.g., a nasal corticosteroid)? Is it safe to use long term?
- How can you confirm whether my symptoms are allergic or nonallergic? Will I need additional tests?
- How quickly should my symptoms improve with treatment? How likely are they to recur?
- What should I change in my lifestyle (home environment, pets, occupational exposures)?
- What measures are needed to reduce the effects on my sleep or daily life?
5) Examples of Disease-Specific Questions
- What tests do you recommend to determine with certainty whether the cause of my nasal congestion and runny nose is allergic (such as a skin-prick test or specific IgE blood test)?
- If there is no improvement with medication, what are the criteria for considering surgery (turbinate reduction or septoplasty)? What benefits and risks can be expected after surgery?