UNDERSTANDING

RHINITIS

Rhinitis is an incredibly common condition, affecting more than 20 million adults andmore than 7 million children in the United States each year. Rhinitis means inflammationof the nose and is characterized by symptoms resulting from inflammation of the nasalmucous membrane. Rhinitis is frequently confused with sinusitis (inflammation of thesinus spaces), and most people who think they have sinusitis are really suffering fromchronic rhinitis.

Nasal congestionDifficult breathing Sneezing Runny nose Post-nasal drainage Itchy nose Headaches

Rhinitis features inflammation and swelling of the mucous membranes, a moist tissuethat lines the nasal cavity. The purpose of this membrane is to trap dust, pollen,bacteria, viruses and other particles in a thin fluid called mucus. Tiny hairs called ciliamove the particles down the throat. This keeps the air that goes into your lungs cleanand free of debris. When this membrane becomes irritated, it can cause reactions such as thickenedmucus, swelling, stuffy nose, difficulty breathing, sneezing and headaches. Whilerhinitis usually isn’t serious, its symptoms can negatively impact sleeping, exercising,and other daily activities. Rhinitis can be acute or chronic. Acute rhinitis is temporary, lasting a few days in mostpeople. In others, chronic rhinitis can last weeks or months, and often recurs.

What is Rhinitis?

Symptoms

Description

Most commonly, rhinitis is caused by an allergen. An allergen is a substance that aperson’s immune system recognizes as foreign or dangerous. As a result, the immunesystem reacts by making a type of antibody (a protein intended to neutralize the foreignsubstance) called Immunoglobulin E (IgE) to defend against the allergen. This reactionleads to the release of inflammatory chemicals such as histamine. When an allergen is thecause, it is called allergic rhinitis. Allergic rhinitis can be seasonal or perennial. Seasonal allergic rhinitis is caused by anallergen that appears at a certain time of the year, such as tree pollen in the spring, grasspollen in the summer, and weed pollen and mold spores in the fall. Perennial allergicrhinitis can exist year-round from exposure to certain foods and medicines, pets andother animals, and dust mites in carpeting and upholstery.

Southwest Florida is in a tropical climate zone. While allergens here do have seasonalvariation, the growing season is 12 months long, making perennial symptoms much morecommon than in more northern climate zones.

ALLERGIC RHINITIS

Pollen

Dust

Mites

Mold and fungal spores

Animal proteins and dander

Drugs and medicines

Certain foods

Insect venom

C o m m o n A l l e r g e n s

Chemicals

Certain beverages

When you visit Florida Gulf Coast ENTwith suspected rhinitis, your physician willask you about your symptoms, includingwhen they began, the severity, frequency, known triggers, and progression. Yourphysician will want to know whattreatments you’ve tried and if they’vebeen successful, and will ask about yourmedical history and any prior allergytesting, lab testing or imaging. Your physician will examine the inside ofyour nose to evaluate the color of yournasal membrane, the amount, color andconsistency of mucus, and look forswelling and any abnormalities that couldbe causing or contributing to yoursymptoms, such as a deviated septum ornasal polyps. Your physician may performa nasal endoscopy, which uses a smallcamera and light to visualize the sinusopenings and the back of the nose all theway to the nasopharynx and throat.

Depending on what is seen in the physicalexam, additional tests may be performed,such as allergy tests, pulmonary functiontests, lab testing, x-rays or CAT scans.Florida Gulf Coast ENT can perform anumber of these diagnostic tests in theoffice for your convenience. Once a diagnosis of rhinitis is made, yourphysician will develop a personalizedtreatment plan to help you reduce oreliminate known causes and triggers andcontrol your symptoms with avoidancemeasures, environmental control,medications, immunotherapy or surgery.

Treatment of allergic rhinitis is based onthe type and severity of symptoms, inaddition to a person’s age, other medicalconditions, daily medications, and overallhealth. A personalized treatment plan isrequired to manage allergy problems, aseach individual experiences their allergysymptoms differently. Your physician atFlorida Gulf Coast ENT can help youdetermine appropriate treatment.

ALLERGIC RHINITISEvaluation of Rhinitis at Florida Gulf Coast ENT

Treatment of Allergic Rhinitis

Allergy testing with counseling andavoidance of the substances that triggerthe allergies.

Nasal irrigation flushes saline (a saltwatersolution) through your nasal cavity toremove allergens and excess mucus, andto moisten the mucous membranes. Thiscan be done with a squeeze bottle or witha number of different irrigation devicesfound at your local pharmacy.

Antihistamines reduce or block histamine,the major inflammatory chemical yourbody produces in reaction to an allergen.These medications can help with itchiness,runny nose, and sneezing, but are lesseffective at easing congestion.Antihistamines are available as tablets,capsules, liquids, nasal sprays, andeyedrops. They are available in bothprescription and over-the-counter (OTC)formulas.

Nasal corticosteroid sprays reduce nasalinflammation and swelling and excessmucus, making it easier to breathe. Theyalso ease congestion, runny nose, sneezing,and itching. They are available in bothprescription and over-the-counter (OTC)formulas.

Decongestants reduce congestion byshrinking swollen blood vessels and nasaltissue. They don’t ease sneezing or itchingsymptoms. Decongestants are available astablets, liquids, nasal drops, and nasalsprays. They are available in prescriptionand over-the-counter (OTC) formulas.Some are available without a prescriptionbut must be obtained from behind thepharmacy counter. Decongestants canhave adverse effects on blood pressure andheart function. They should be used withcaution or under doctor supervision.

Initial Treatments forAllergic Rhinitis

Medications don't improve symptoms inMedications don't improve symptoms inevery individual. Some people requireevery individual. Some people requiredaily medications or multipledaily medications or multiplemedications to control their symptoms.medications to control their symptoms.In these cases, it's better to control theIn these cases, it's better to control thesymptoms by stopping the allergicsymptoms by stopping the allergicreaction from occurring. There arereaction from occurring. There aretherapies that will change the immunetherapies that will change the immunesystem and make a person less allergic.system and make a person less allergic.

Allergy immunotherapy Allergy immunotherapy uses injectionsuses injectionsor sublingual (under the tongue) drops toor sublingual (under the tongue) drops toexpose a person to small, increasingexpose a person to small, increasingdoses of a known allergen. Over time, thisdoses of a known allergen. Over time, thisreduces the IgE antibodies while buildingreduces the IgE antibodies while building“blocking antibodies” that eliminate“blocking antibodies” that eliminateallergens from the body, helping toallergens from the body, helping todevelop tolerance to the allergen. Thisdevelop tolerance to the allergen. Thismakes the person less allergic andmakes the person less allergic andreduces or eliminates symptoms.reduces or eliminates symptoms.

Overuse of decongestant nasal drops orOveruse of decongestant nasal drops orsprays can cause even more severe nasalsprays can cause even more severe nasalcongestion when the decongestantcongestion when the decongestantwears off, called rebound congestion.wears off, called rebound congestion.Talk to your physician at Florida GulfTalk to your physician at Florida GulfCoast ENT about proper usage ofCoast ENT about proper usage ofdecongestants.decongestants.

Allergy immunotherapy is the best long-term alternative for chronic allergic rhinitissymptoms. There are no procedures that will cure allergies, but some can reduce specificallergic rhinitis symptoms, including improved breathing and decreased sense ofcongestion. The procedures may reduce sense of ear fullness and pressure, facialpressure, and may reduce nasal drainage. The options include both surgical and lessinvasive in-office procedures.

ALLERGIC RHINITIS

C o m m o n A l l e r g e n s

Procedural Options for Allergic Rhinitis

Inferior Turbinoplasty

Nasal obstruction is commonly caused byenlargement of structures in the nosecalled the turbinates. Most people havenever heard of the turbinates, but almosteverybody has complained about theirturbinates numerous times in their life.These structures are full of glandulartissue that can expand like a grape orshrink like a raisin. A very successful andminimally invasive procedure, called aturbinoplasty, removes the glandulartissue from the turbinate, reducing itssize, prohibiting further growth, andreducing obstruction in the nasal cavity. The procedure is over 90% successful atimproving breathing and nasalcongestion, is well-tolerated andperformed easily in the office, and has fewrestrictions or risks following theprocedure.

Intranasal Ablations

Intranasal ablation procedures work onspecific areas of swelling in the nasalcavity to improve the openness of thenasal cavities and sinuses. Ablationsdecrease the glandular tissue that causesnasal obstruction, congestion, anddrainage. Ablations to some of the nasalnerves can decrease the stimulation ofthe glands to produce mucus, reducingnasal drainage. This works especially wellin individuals who frequently feel thinwatery drainage running out of theirnose, a condition frequently worsened byeating. Some of the most commonablation procedures are known as theRhinaer and Clarifix procedures. Thephysicians at Florida Gulf Coast ENT haveaccess to multiple ablation devices thatcan treat each individual’s needs.

Balloon Sinuplasty

While typically performed specifically forchronic sinusitis, balloon sinuplasty canbenefit patients with chronic rhinitis whoare prone to more frequent nasalinfections. Balloon sinuplasty opens thesinus drainage tracts to allow for betterdrainage and equalization of pressure. Itcan be performed safely and easily in theoffice with minimal post-procedurerestrictions or risks.

Rhinoplasty

Typically a cosmetic procedure, someexternal and cosmetic nasal defects cansignificantly affect nasal breathing.Florida Gulf Coast ENT has physicianswho specialize in rhinoplasty for bothfunctional and cosmetic reasons.

Septoplasty

The nasal septum (the cartilage and bone in the middle of the nose that should divide thenose into two equal halves) is one of the most common reasons for chronic nasalobstruction. As we age, and in response to specific nasal or facial trauma, this cartilageand bone begins to shift away from the center, narrowing the breathing passages. Septoplasty surgery can provide significant improvement in nasal breathing and reducethe number of sinus infections in certain individuals. It is typically performed at a surgerycenter or hospital under general anesthesia. However, some deviations can be improvedwith in-office procedures. In-office balloon assisted septoplasty is becoming a morecommon procedure. It's currently not covered by insurance, but is a less invasive optionthat can be performed in the office to improve nasal breathing.

C o m m o n A l l e r g e n s

Chronic inflammation of theChronic inflammation of thenasal mucous membrane cannasal mucous membrane cancause nasal polyps, sinusitis, orcause nasal polyps, sinusitis, ormiddle ear infections. Talk tomiddle ear infections. Talk toyour physician aboutyour physician aboutcontrolling your symptoms tocontrolling your symptoms tohelp prevent thesehelp prevent thesecomplications.complications.

NON-ALLERGIC RHINITIS

Non-allergic rhinitis is caused by something other than an allergic reaction. A diagnosisof non-allergic rhinitis is made after an allergic cause is ruled out. Even if you do haveallergies, non-allergic rhinitis can develop from other causes, including:

Nasal blockagesBacterial infections and virusesCertain medications Certain foods and beverages, including alcohol Odors or irritants in the airWeather or temperature changesAgingHormonal changes or pregnancyInflammation or irritation in the nose unrelated to allergyOther health conditions

Treatment of Non-Allergic RhinitisYour physician at Florida Gulf Coast ENT can help rule out allergic rhinitis and helpdetermine the cause for non-allergic rhinitis. If a cause can be determined, that triggershould be avoided as much as possible, or treated appropriately if it's another medicalcondition such as an infection. Often, the cause of non-allergic rhinitis can’t bedetermined, but your physician can help you control the symptoms. While there are fewermedication options for treating non-allergic rhinitis, there are some office procedures thatmay help to alleviate the symptoms. The physicians at Florida Gulf Coast ENT have accessto all available technologies that might improve breathing and drainage in those whosuffer from non-allergic rhinitis.

Non-allergic rhinitis doesn't typically cause itchy nose, eyes or throat.Non-allergic rhinitis doesn't typically cause itchy nose, eyes or throat.

If non-allergic rhinitis is caused by a viral or bacterial infection,If non-allergic rhinitis is caused by a viral or bacterial infection,fever may be present.fever may be present.

AsthmaSinusitisConjunctivitisDermatitisEustachian tube dysfunctionNasal polypsSleep disturbance

RELATED CONDITIONS

There are many other conditions that feature symptoms similar to those of rhinitis. Theseconditions may or may not exist concurrently with rhinitis. It’s important to talk to yourphysician at Florida Gulf Coast ENT about your symptoms to determine the particularcondition and treatment.

We proudly offer exceptional compassionate service thatincludes a full spectrum of adult and pediatric diagnostic,therapeutic and surgical services for problems involvinghearing, sinus and throat.

Our TeamSamuel L. Hill, III, MD, FACS, FAAOAPatrick M. Reidy, MDLeela Lavasani, MD, FACSPrice Sonkarley, MD, FACS

(239) 514-2225

floridagulfcoastent.com

floridagulfcoastearnosethroat

gulfcoastsinus

Shanai Hill, AU.D., CCC-ACynthia Drobiazgiewicz, AU.D., CCC-ANicole Diehl, AU.D., CCC-A, FAAA