OVERVIEW

What is rhinitis?

Rhinitis refers to an inflammatory reaction occurring in the nasal mucosa. It is a relatively common condition, primarily characterized by nasal itching, congestion, sneezing, and runny nose^[1].

Based on the speed of onset and duration of the condition, rhinitis can be classified into acute rhinitis and chronic rhinitis^[1]. There are many causes of rhinitis, such as viral or bacterial infections, allergies, medications, or exposure to irritants.

Rhinitis is mainly treated with medication. Different types of rhinitis vary in diagnosis, treatment, and prognosis.

What are the types of rhinitis?

According to the speed of onset and duration, rhinitis can be divided into acute and chronic types. Common chronic rhinitis includes allergic rhinitis (commonly known as hay fever), atrophic rhinitis, and drug-induced rhinitis^[1].

• Acute rhinitis: Caused by viral infections, often followed by secondary bacterial infections. It can occur year-round but is more common in winter.
• Allergic rhinitis (hay fever): A chronic inflammatory reaction of the nasal mucosa triggered by allergens (e.g., pollen, dust mites). Symptoms usually resolve after removing the allergen. It often coexists with bronchial asthma.
• Atrophic rhinitis: Caused by long-term irritation leading to atrophy of the nasal mucosa. In severe cases, the underlying nasal turbinates and bones may also atrophy.
• Drug-induced rhinitis: Caused by excessive long-term use of nasal decongestants, antidepressants, or antihypertensive drugs. Symptoms typically improve after discontinuing the medication.

Is rhinitis common?

Very common. Most people have experienced acute rhinitis, which is essentially what we commonly refer to as a "cold"—a viral infection causing nasal itching, congestion, sneezing, and runny nose^[2].

In the general population, the prevalence of allergic rhinitis is 10%–25%^[1], meaning 10 to 25 out of 100 people have allergic rhinitis.

Which department should I visit for rhinitis?

Otolaryngology (ENT).

SYMPTOMS

What are the symptoms and manifestations of rhinitis?

The symptoms of rhinitis mainly manifest as nasal discomfort, often including nasal itching, congestion, runny nose, and sneezing. Additionally, depending on the type of rhinitis, symptoms may also appear in other areas.

• Acute rhinitis: Most cases present with nasal dryness, a burning sensation, fatigue, headache, or fever. Initially, nasal discharge is watery, but if a bacterial infection occurs later, it may become thick or even purulent. Tinnitus or hearing loss may also occur.
• Allergic rhinitis: Symptoms include nasal congestion, itching, clear watery nasal discharge, and repeated sneezing (ranging from a few to dozens of times), usually triggered immediately after exposure to allergens.
• Atrophic rhinitis: Reduced sense of smell, along with symptoms such as nosebleeds, nasal dryness, discomfort, headache, and dizziness due to atrophy of the nasal mucosa. In severe cases, a foul odor may be noticeable when exhaling.
• Rhinitis medicamentosa: Mainly characterized by nasal congestion, which often worsens at night or when sitting still. Nasal secretions may be present, accompanied by dryness, discomfort, or a burning sensation.

Why does rhinitis cause ear fullness?

The back of the nasal cavity connects to the ear via the Eustachian tube. Normally, this tube opens to balance air pressure on both sides of the eardrum.

During a rhinitis flare-up, swelling of the nasal mucosa and increased nasal secretions can block the Eustachian tube opening or even cause inflammation, preventing the tube from opening properly. This disrupts air pressure balance on both sides of the eardrum, leading to ear fullness.

Why does rhinitis cause watery eyes?

During an allergic rhinitis episode, concurrent conjunctivitis may occur, causing eye itching and tearing.

This happens because the nasolacrimal duct connects the eyes to the nasal cavity. Normally, tears drain through this duct into the nose. However, inflammation-induced mucosal swelling can block the duct, forcing tears to overflow from the eyes.

Why does rhinitis cause headaches or dizziness?

• Swelling of the nasal mucosa during a rhinitis flare-up can compress nerve endings, triggering headaches.
• Nasal congestion may lead to brain hypoxia, also causing headaches or dizziness.
• In atrophic rhinitis, excessive nasal cavity enlargement reduces its ability to warm and humidify air. Dry, cold air irritating the mucosa can also cause headaches.

Why does rhinitis cause a reduced sense of smell?

Key reasons include:

• Nasal mucosa swelling obstructs airflow, preventing odor particles from reaching the olfactory area.
• Atrophy of the nasal mucosa may damage connected olfactory nerves in certain nasal regions.
• Chronic nasal congestion deprives olfactory nerves of prolonged odor stimulation, leading to "disuse atrophy."

What severe complications can rhinitis cause?

Chronic rhinitis symptoms like nasal congestion, runny nose, and sneezing can disrupt daily life and social interactions. Nasal obstruction may worsen snoring and sleep hypoxia. In children, long-term mouth breathing due to congestion may impair intellectual and facial development. Persistent inflammation can also affect the ears and eyes, leading to otitis media or dacryocystitis. Allergic rhinitis often coexists with bronchial asthma^[1].

Can rhinitis develop into cancer?

No evidence currently links rhinitis to malignancy, so concerns are generally unwarranted. However, since tumor causes remain unclear and chronic inflammation may be a factor, a complete dismissal of any association is unwise.

Notably, some nasal/sinus malignancies mimic rhinitis symptoms, requiring medical evaluation for accurate diagnosis. Timely consultation is advised.

CAUSES

What are the common causes of rhinitis?

There are various types of rhinitis, and the causes differ depending on the type^[1]:

• Acute rhinitis: Occurs when the body's resistance declines due to factors like alcohol/tobacco exposure, chronic illnesses, nasal diseases, or endocrine disorders, allowing viruses to invade the nasal mucosa and trigger inflammation.
• Allergic rhinitis: Triggered by exposure to allergens (e.g., pollen, dust mites, animal dander, mold). The immune system mistakenly identifies these allergens as harmful invaders, leading to symptoms like sneezing and watery nasal discharge to expel them. Often coexists with asthma or eczema due to shared allergic mechanisms.
• Atrophic rhinitis: Results from prolonged mucosal atrophy caused by chronic irritation, such as harmful dust/air exposure,脓性 secretions from chronic sinusitis, or excessive/inappropriate nasal surgeries damaging the mucosa.
• Drug-induced rhinitis: Caused by long-term use of medications (e.g., nasal decongestants, antidepressants, antihypertensives) that impair mucosal function and disrupt vascular regulation.

Who is prone to rhinitis?

• Individuals with weakened immunity or chronic nasal conditions;
• Those with a family/personal history of allergies or allergic rhinitis;
• People exposed long-term to dust, irritant gases, or chemicals at work;
• Overusers of nasal decongestants, antidepressants, or antihypertensives.

Is rhinitis hereditary?

Most types are not genetic, but allergic rhinitis has a hereditary tendency. Patients with allergic rhinitis often have concurrent asthma, and family history of allergies increases risk^[3].

Is rhinitis contagious?

Chronic rhinitis is not contagious. However, acute rhinitis caused by cold viruses can spread (the virus, not the rhinitis itself). Minimize contact with infected individuals and wash hands frequently to prevent transmission.

DIAGNOSIS

What tests are needed to diagnose rhinitis?

If symptoms related to rhinitis appear, the doctor may recommend the following tests to confirm whether rhinitis is present or to determine the type of rhinitis:

• Nasal endoscopy: Includes anterior rhinoscopy and nasal endoscopy to examine the nasal cavity, nasal mucosa, and nasal secretions. Different types of rhinitis present differently on nasal endoscopy. For example, allergic rhinitis may show pale, edematous nasal mucosa, or sometimes congestion or a bluish tint.
• Blood test: Primarily checks for abnormalities in blood cell counts to assess the possibility of infection and aid in diagnosis.
• Imaging tests: CT scans or X-rays are used to examine nasal structure abnormalities and rule out other conditions, assisting in diagnosis.
• Allergen testing: Not all cases of rhinitis require this test. It is usually considered when allergic rhinitis is suspected.

What is the difference between rhinitis and sinusitis?

Despite the similar names, they affect different anatomical locations:

Think of the nasal cavity as a "living room," while the sinuses are like smaller "rooms" connected to it. Rhinitis refers to inflammation in the "living room" (nasal cavity), whereas sinusitis involves inflammation in the "rooms" (sinuses). The two conditions can influence each other, but their treatments differ. Doctors will differentiate them based on the specific affected area.

TREATMENT

Can Rhinitis Be Completely Cured?

Acute rhinitis can generally be cured, but it may recur if you catch a cold again.

Chronic rhinitis usually has a longer course and is difficult to completely cure, often recurring. However, with active and effective treatment, the frequency of episodes can be reduced, and symptoms during flare-ups can be alleviated^[4].

How Is Rhinitis Treated?

Rhinitis is primarily treated with medication, though severe cases may require surgery under a doctor's recommendation.

Medications for rhinitis fall into two categories: systemic drugs, which work throughout the body to reduce inflammation, swelling, promote mucus discharge, and combat allergies; and localized nasal treatments, such as nasal sprays or drops. Common medications include^[1,4]:

• Nasal corticosteroids: e.g., budesonide nasal spray, which reduces nasal mucosal swelling and inhibits blood vessel dilation, effectively relieving symptoms like nasal congestion, runny nose, and sneezing. This is the first-line treatment for rhinitis.
• Antihistamines: e.g., azelastine hydrochloride nasal spray, which works quickly to relieve itching and sneezing but is less effective for nasal congestion. Side effects may include bitter taste, throat irritation, headache, and drowsiness.
• Nasal decongestants: e.g., oxymetazoline spray, which quickly reduces nasal mucosal swelling and congestion. However, prolonged use (beyond one week) is not recommended, as it may lead to "medication-induced rhinitis."

All medications should be used under a doctor's supervision to avoid misuse.

Additionally, nasal irrigation may help clean the nasal cavity and remove crusts and odors. Some patients with allergic rhinitis may benefit from immunotherapy.

What Is Immunotherapy for Allergic Rhinitis?

Allergic diseases occur when the body overreacts to certain environmental stimuli. Immunotherapy involves gradually exposing the body to increasing doses of the allergen to desensitize it, reducing or eliminating the allergic response^[5].

However, immunotherapy is time-consuming (typically taking 3–6 months to show effects, with a full course lasting 3 years) and costly (ranging from thousands to tens of thousands). Not all patients respond well, so careful consideration is advised.

What Are the Methods of Immunotherapy for Allergic Rhinitis?

Current methods include injections and sublingual drops.

Do Anti-Allergy Medications for Rhinitis Cause Drowsiness?

Anti-allergy drugs vary in type. Older antihistamines, such as chlorpheniramine, are more likely to cause drowsiness.

Modern antihistamines have reduced sedative effects and are often taken at bedtime. Other types of anti-allergy medications typically do not cause drowsiness and may even enhance symptom relief when combined with antihistamines.

What Nasal Sprays or Drops Are Used for Rhinitis? What Should Be Noted?

There are three main types of nasal sprays/drops for rhinitis^[1,4]:

• Decongestants: e.g., oxymetazoline spray. These over-the-counter drugs provide quick relief for nasal congestion but should not be used for more than a week to avoid "medication-induced rhinitis."
• Corticosteroids: e.g., budesonide nasal spray.
• Antihistamines: e.g., azelastine hydrochloride nasal spray.

The latter two are usually prescription drugs and, when used as directed, are not habit-forming. However, decongestants (the first type) are easily misused without medical guidance, leading to worsened symptoms.

Do Corticosteroid Nasal Sprays Have Side Effects?

All medications have side effects, but the benefits of treatment should not be overlooked due to fear of them. Nasal sprays deliver minimal doses, primarily affecting nasal mucosa, and generally cause no significant side effects when used as prescribed.

Is Surgery Necessary for Rhinitis?

Surgery may be considered for patients with long-term, treatment-resistant rhinitis that severely impacts quality of life.

However, outcomes vary due to complex factors like environment and psychology. Consultation with a specialist is recommended.

How Is Rhinitis Surgery Performed?

Common procedures include radiofrequency ablation or partial turbinate resection for hypertrophic rhinitis with severe obstruction. Atrophic rhinitis may require nasal cavity narrowing via filling or medialization.

Is Rhinitis Surgery Minimally Invasive?

Most rhinitis surgeries are endoscopic, performed through the nostrils without external incisions or scars. However, some procedures involve larger internal wounds that may require nasal packing for 1–2 days to control bleeding.

Can Rhinitis-Induced Loss of Smell Be Treated?

It depends.

Smell loss due to nasal congestion may improve with restored airflow. However, if the olfactory nerve is damaged, recovery is unlikely even after congestion is resolved.

DIET & LIFESTYLE

What dietary precautions should patients with rhinitis take?

Patients with allergic rhinitis should avoid allergenic foods in their daily diet, but there are no other specific dietary restrictions. It is recommended to maintain a balanced and nutritious diet to help boost immunity.

What lifestyle precautions should patients with rhinitis take?

• Avoid factors that trigger or worsen rhinitis, including allergens, smoke, dust, alcohol, irritating gases, etc.
• Regular nasal irrigation is recommended.
• Avoid excessively cold or dry environments to reduce irritation to the nasal mucosa. Wear a mask when going out in winter and use a humidifier indoors.

How should patients with rhinitis perform nasal irrigation?

• Some hospitals have electric nasal irrigators, and patients can undergo nasal irrigation at the hospital.
• Purchase a simple manual irrigator for home use. There are various models of nasal irrigators, and specific usage instructions can be obtained from sales personnel. Add the corresponding saline solution to the irrigator with warm water for rinsing, or use only saline solution. Suitable for adults and children willing to undergo nasal irrigation, can be used at home or in school dormitories, 1–2 times a day.
• Small spray-type nasal irrigation bottles. The pre-mixed solution can be sprayed into the nostrils a few times, but the bottle cannot be reused after emptying. Convenient for carrying around and can be used multiple times a day. The gentle spray pressure makes it suitable for children who are unwilling to use nasal irrigators.

PREVENTION

How to prevent rhinitis?

• Avoid exposure to known allergens or irritants, wear a mask when going out;
• Exercise regularly, maintain a regular schedule, balance work and rest to prevent colds;
• Stay away from dusty and polluted environments, keep living spaces clean and well-ventilated; avoid smoking and alcohol;
• Actively treat related conditions such as diabetes, endocrine disorders, sinusitis, and nasal polyps.