September 7, 2012

Not all nasal symptoms of nasal congestion, drainage and obstruction are caused by inflammatory conditions of the nose. Noninflammatory nasal conditions are best classified as rhinopathy, while inflammatory nasal conditions are called rhinitis.

Hyper-Reflexive Rhinopathy

Hyper-reflexive rhinopathy (HR) is a relatively common condition of the nasal lining. The fundamental cause is an excess of input from the parasympathetic nervous system; this leads to excessive production of nasal secretions and to a lesser extent nasal congestion. HR is commonly called vasomotor rhinitis (VMR), but this terminology is incorrect, since the cause is not inflammatory as the name “VMR” suggests. HR is a common cause of non-specific complaints of post-nasal drip, especially in older adults. Symptoms of HR may also occur in association with eating in a condition known as gustatory rhinopathy. Before the diagnosis of HR is given, it is important to exclude other potential causes of the nasal symptoms; thus, patients will usually undergo nasal endoscopy, CT scan, and sometimes allergy testing.

Rhinitis Medicamentosa

Rhinitis medicamentosa (RM) refers to the development of rebound nasal congestion in association with chronic use of topical nasal decongestants. This nasal congestion is quite profound — RM patients often report that they have no nasal airflow whatsoever. At presentation, RM patients will report that they started using topical nasal decongestants occasionally, but that over time, they required more and more topical nasal decongestant for less and less effect. In essence, they are addicted to the topical nasal decongestants.

Endocrinal Rhinopathy

Endocrinal rhinopathy is the nasal manifestation of an underlying abnormality of the endocrine system. Hypothyroidism can lead to a reduction of activity of the sympathetic nervous system, and the resultant excess of parasympathetic nervous system activity can lead to congestion and rhinorrhea. The labile blood sugar levels in diabetes can lead to edema of nasal lining. High levels of estrogen, caused by pregnancy and oral contraceptives, can lead to isolated nasal congestion.

Atrophic Rhinitis

Atrophic rhinitis is caused by mucosal atrophy, which leads to nasal crusting and even pain. Klebsiella ozenae and aggressive nasal surgery have been implicated as causes. Septal perforation may develop in advanced cases.

Toxin and Irritants

Toxin and irritants (including air pollution, tobacco smoke, and industrial chemicals) may have a direct effect on the nasal lining and produce nasal symptoms.

Drug-Induced Rhinopathy

Drug-induced rhinopathy may be produced by certain prescription medications. For instance, older blood pressure drugs (such as reserpine, prazosin, and others) may produce nasal symptoms.

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