OVERVIEW

What is chronic rhinitis?

Chronic rhinitis is a chronic inflammatory disease of the nasal mucosa characterized by varying degrees of nasal congestion and viscous nasal discharge, with symptoms lasting for more than 3 months and recurring episodes^[1].

Many factors can contribute to chronic rhinitis, such as viruses, bacteria, various physical and chemical agents (pollen, willow catkins, dust, etc.), and even some systemic diseases (endocrine disorders, vitamin deficiencies, etc.)^[1].

Chronic rhinitis can be treated with medication or surgery, but it cannot be completely cured. The goal of treatment is to manage the condition, improve the patient's quality of life, and minimize its impact on daily activities.

Is chronic rhinitis common?

Chronic rhinitis is a common condition, affecting approximately 40% of the population^[2].

What are the types of chronic rhinitis?

Traditionally, chronic rhinitis was classified into chronic simple rhinitis and chronic hypertrophic rhinitis based on pathological types and clinical manifestations.

However, this classification does not reflect the role of causative factors in disease onset. Currently, it is divided into allergic rhinitis (i.e., hay fever) and non-allergic rhinitis based on the presence of allergic factors^[1].

SYMPTOMS

What are the common manifestations of chronic rhinitis?

The main symptoms include nasal congestion, runny nose, dizziness, headache, etc. Among these, nasal congestion is one of the most prominent symptoms for such patients.

• Nasal congestion: The severity varies depending on the condition, and it may be intermittent or persistent. It can also manifest as unilateral, bilateral, or alternating nasal congestion.
• Abnormal nasal discharge: Increased nasal discharge, which may appear as clear and easy to expel. Some may experience thick mucus that is difficult to expel despite being less in quantity.
• Olfactory dysfunction: Primarily manifests as reduced sense of smell.
• Other symptoms: Nasal itching, sneezing, nasal voice, dizziness, headache, dry and sore throat, tinnitus, ear fullness, etc.

What adverse effects can chronic rhinitis cause?

Chronic rhinitis may lead to complications such as reduced sense of smell, nosebleeds, nasal voice, headache, dizziness, dry and sore throat, tinnitus, and ear fullness.

Long-term chronic rhinitis can cause sleep disturbances, and poor sleep quality may result in daytime fatigue and reduced mental alertness.

Can chronic rhinitis turn into cancer?

There is currently no evidence suggesting that chronic rhinitis can develop into cancer.

What are the main hazards of chronic rhinitis?

Chronic rhinitis causes physical discomfort due to symptoms like nasal congestion, runny nose, and reduced sense of smell, affecting work, study, and social interactions. The inflammation can also impact the respiratory and digestive systems connected to the nasal cavity, leading to throat discomfort, coughing, sticky phlegm, nausea, and other symptoms.

Additionally, nasal inflammation may trigger eye and ear symptoms, and prolonged otitis media can even impair hearing. Nasal congestion can worsen snoring and sleep hypoxia, potentially contributing to cardiovascular diseases and memory decline. In children, long-term mouth breathing and sleep hypoxia may also lead to intellectual and facial developmental issues.

Therefore, chronic rhinitis should be treated promptly and properly.

CAUSES

What are the common causes of chronic rhinitis?

• Allergic factors: Mainly environmental factors, such as dust irritation, inhalation of harmful chemical gases, and drastic changes in temperature and humidity^[1-3].
• Non-allergic factors: Including local and systemic factors^[1-3].
• Local factors: Such as prolonged or recurrent acute rhinitis, anatomical abnormalities of the nasal cavity and sinuses, mutual irritation from infections in adjacent areas, and improper nasal medication use.
• Systemic factors: Such as viral or bacterial infections, malnutrition, systemic chronic diseases (e.g., diabetes, anemia), and endocrine disorders.

Does chronic rhinitis develop from acute rhinitis?

Recurrent or improperly treated acute rhinitis may progress to chronic rhinitis, but other systemic, local, or environmental factors can also contribute to its onset.

Who is more prone to chronic rhinitis?

• People in poor environments: Those exposed to dust, harmful gases, or frequent changes in temperature and humidity, such as workers in cement plants, flour mills, chemical factories, or construction sites.
• Older individuals: The decline in nasal tissue function in the elderly increases the risk of the disease.
• People with nasal conditions: Such as prolonged or recurrent acute rhinitis, anatomical abnormalities of the nasal cavity or sinuses, or mutual irritation from infections in adjacent areas, which elevate the risk.
• People with systemic diseases: Those with immune dysfunction, malnutrition, endocrine disorders, diabetes, or anemia are more susceptible to chronic rhinitis.

Is chronic rhinitis contagious?

No, it is not contagious.

Chronic rhinitis is generally considered a non-infectious disease and therefore not contagious. However, if it is complicated by a bacterial infection, it may have some degree of contagiousness^[1].

Is chronic rhinitis hereditary?

Chronic rhinitis has a certain hereditary tendency, but since it is a common and frequently occurring disease heavily influenced by environmental factors, genetics is not the most critical factor in its onset^[1].

DIAGNOSIS

What tests are needed to diagnose chronic rhinitis?

• External nose examination: First, check externally for any nasal deformities or changes in nasal shape. In severe cases, the nasal bridge may appear widened.
• Nasal cavity examination: If chronic rhinitis is suspected, the doctor will first perform a nasal cavity examination, usually using an anterior rhinoscope in the clinic. This is very convenient and almost painless. During the examination, nasal drops may be needed to observe the nasal mucosa's reaction. Patients with this condition may show significant edema in the nasal mucosa.
• Nasal endoscopy: Additionally, patients with severe nasal congestion, reduced sense of smell, tinnitus, or ear fullness may require nasal endoscopy to rule out other conditions such as nasal or nasopharyngeal tumors.
• Other tests: Sometimes, nasal resistance tests are needed to determine the degree and nature of nasal congestion.

Why is nasal endoscopy needed for chronic rhinitis? What precautions should be taken for this examination?

Nasal endoscopy is a very intuitive and relatively minimally invasive examination. Severe nasal congestion, reduced sense of smell, tinnitus, or ear fullness can be evaluated through nasal endoscopy to exclude other conditions such as nasal or nasopharyngeal tumors.

Before the endoscopy, the nasal cavity needs to be topically anesthetized. Therefore, patients with a history of hypertension or allergies to local anesthetics like lidocaine should inform the doctor in advance.

Additionally, since the examination may cause minor trauma to the nasal mucosa and lead to bleeding, patients taking anticoagulants such as aspirin should carefully consider whether to undergo this test.

What is the difference between chronic rhinitis and chronic sinusitis?

Chronic rhinitis involves chronic inflammation of the nasal mucosa, while chronic sinusitis involves inflammation of the sinuses.

Because the nasal mucosa and sinus mucosa are continuous, inflammation can affect both areas. Therefore, chronic rhinitis often coexists with chronic sinusitis, collectively referred to as chronic rhinosinusitis.

TREATMENT

Which department should I visit for chronic rhinitis?

Otolaryngology (ENT) or Otorhinolaryngology.

Can chronic rhinitis heal on its own? Does it require treatment?

Once chronic rhinitis develops, it is difficult to resolve on its own. Prompt treatment at a reputable hospital is recommended.

What are the treatment options for chronic rhinitis?

Etiological treatment: Identify systemic, local, or environmental factors and treat accordingly. For example, if the patient has diabetes or immune dysfunction, the primary condition should be addressed first. If environmental factors are involved, maintaining a comfortable environment—free of dust, harmful gases, and with appropriate temperature and humidity—is advised^[1-3].
Adjuvant therapy: Such as nasal irrigation.
Nasal irrigation is a safe adjunctive treatment for chronic rhinitis, effectively improving symptoms and quality of life.
Treatment duration: Can be long-term, adjusted based on symptom improvement, or used for routine nasal cleaning^[1-3].
Nasal irrigation involves using a device to deliver saline or other solutions (e.g., isotonic or hypertonic saline, sometimes with added glucocorticoids) into the nasal cavity to relieve symptoms^[1-3].

Topical medication:

Chronic simple rhinitis is typically managed non-surgically with intranasal glucocorticoid sprays (e.g., Rhinocort, Nasonex, Flonase), which reduce inflammation and edema. These are first-line treatments^[1-3].

For infections, decongestants like oxymetazoline may be used to shrink blood vessels and alleviate symptoms.

Surgery: Considered if medications fail or structural abnormalities (e.g., hypertrophic inferior turbinates) are present. Chronic hypertrophic rhinitis often requires surgical intervention^[1-3].

What medications are used for chronic rhinitis? How long is treatment needed? Any precautions?

Chronic rhinitis medications are primarily topical, including intranasal glucocorticoids and decongestants.

1. Intranasal glucocorticoids:

   • First-line treatment; safe for long-term use. Examples: Rhinocort, Nasonex, Flonase^[3].
   • Treatment duration: ~6 months^[3].
   • Administer by spraying away from the nasal septum (right hand for left nostril, left hand for right).
   • Caution in children under 3; Nasonex is preferred for those over 3.

2. Antihistamines:

   • E.g., loratadine, for allergic rhinitis to relieve sneezing/itching^[1].
   • Avoid if operating machinery/driving^[1].

3. Nasal decongestants:

   • E.g., oxymetazoline or ephedrine; rapid symptom relief but limit use to ≤7 days to avoid rebound rhinitis.
   • Beware unregulated "herbal" nasal drops containing hidden decongestants.

When is surgery needed for chronic rhinitis?

• Chronic hypertrophic rhinitis;
• Persistent nasal obstruction unresponsive to medication;
• Structural abnormalities or complications.

Are there post-surgical complications?

Properly indicated surgeries are generally safe. Over-treatment or improper techniques may cause dryness, obstruction, or headaches.

Does chronic rhinitis require regular follow-ups?

Routine follow-ups are unnecessary unless symptoms worsen (e.g., colored discharge, smell loss, ear issues).

Can chronic rhinitis be cured?

No cure exists, but treatment aims to control symptoms and maintain quality of life.

Is recurrence common? Why?

Yes. Persistent mucosal inflammation and anatomical vulnerabilities make relapse likely with immunity drops or environmental changes.

DIET & LIFESTYLE

What should chronic rhinitis patients pay attention to in their diet?

Patients with chronic rhinitis should avoid overly hot, spicy, or other irritating foods in their diet, as these can cause blood vessel dilation and increased gland secretion, thereby worsening symptoms such as nasal congestion and runny nose^[4].

What should chronic rhinitis patients pay attention to in daily life?

• Avoid excessive fatigue and repeated colds, and focus on improving the body's resistance;
• If suffering from conditions like diabetes, hypothyroidism, or anemia, actively treat the underlying diseases;
• Improve living and working environments to avoid inhaling dust and harmful gases, and minimize drastic changes in temperature and humidity;
• Learn proper nose-blowing techniques—avoid excessive force and blowing both nostrils simultaneously^[4];
• Strictly follow medication guidelines and learn how to use nasal drops correctly^[4].

Does chronic rhinitis affect normal life, study, and work?

Chronic rhinitis can have a certain degree of impact on daily life, study, and work because:

• It may cause dizziness and headaches, affecting concentration;
• Nasal congestion and mouth breathing can lead to snoring, dry throat, and sore throat;
• Frequent nose-blowing, postnasal drip, throat-clearing, and nasal speech can affect social interactions to some extent;
• Symptoms of chronic rhinitis are closely related to psychological factors. If subjective symptoms are significantly worse than objective findings, attention should be paid, and psychological counseling sought if necessary.

PREVENTION

Can chronic rhinitis be prevented? How to prevent it?

Yes.

• Acute rhinitis should be treated promptly to achieve a cure and avoid progression to chronic rhinitis;
• Avoid excessive fatigue, enhance immunity, and prevent recurrent upper respiratory infections;
• Improve nutritional status and actively treat systemic chronic diseases or underlying conditions;
• Improve living and working environments, avoid tobacco and alcohol irritation, and prevent exposure to dust or sudden changes in temperature and humidity.