Otorhinolaryngology (ENT)
Diseases of the Nose and Rhinitis
Nasal disease for MBBS ENT: allergic and vasomotor rhinitis, rhinitis medicamentosa, atrophic rhinitis, deviated septum and nasal obstruction, mapped to NMC codes EN3 and EN4.
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Diseases of the Nose and Rhinitis
Nasal disease for MBBS ENT: allergic and vasomotor rhinitis, rhinitis medicamentosa, atrophic rhinitis, deviated septum and nasal obstruction, mapped to NMC codes EN3 and EN4.
This chapter covers inflammatory and structural disorders of the nose. It focuses on allergic and non-allergic rhinitis and their management, rhinitis medicamentosa, atrophic rhinitis, septal deviation and nasal obstruction, and links these conditions to the sinus disease that often follows.
High-yield: Diseases of the Nose and Rhinitis
- Allergic rhinitis is an IgE-mediated response causing sneezing, watery discharge, nasal itching and congestion, often with allergic conjunctivitis.
- The classic signs of allergic rhinitis include pale boggy turbinates, an allergic salute and a transverse nasal crease.
- Allergic rhinitis is managed with allergen avoidance, intranasal steroids and antihistamines, with immunotherapy for selected cases.
- Vasomotor (non-allergic) rhinitis gives nasal blockage and rhinorrhoea without allergy and is triggered by temperature change, odours or spicy food.
- Rhinitis medicamentosa is rebound nasal congestion caused by prolonged use of topical decongestant sprays.
- Atrophic rhinitis (ozaena) causes a wide nasal cavity, foul crusting and paradoxically a blocked feeling despite roomy passages.
- A deviated nasal septum can cause unilateral obstruction and predispose to recurrent sinusitis; septoplasty corrects a symptomatic deviation.
- The turbinates humidify and warm inspired air; turbinate hypertrophy is a common cause of nasal blockage.
- Foreign bodies in the nose typically present in children with unilateral foul nasal discharge.
- Intranasal corticosteroids are the most effective single treatment for moderate to severe allergic rhinitis.
- Nasal obstruction should always prompt a search for a mass or polyp, especially if it is unilateral and persistent.
- Choanal atresia is a congenital blockage at the back of the nose; bilateral atresia causes cyclical cyanosis relieved by crying in a newborn.
- The nasal cycle is the normal alternating congestion of the two sides of the nose over a few hours.
- Rhinosinusitis often follows untreated allergic or infective rhinitis when sinus drainage is obstructed.
Types of rhinitis
- **Allergic rhinitis:** IgE-mediated. Sneezing, watery rhinorrhoea, itching, pale boggy turbinates. Intranasal steroids.
- **Vasomotor rhinitis:** Non-allergic. Blockage and rhinorrhoea from temperature, odours, spicy food.
- **Rhinitis medicamentosa:** Rebound congestion from overused topical decongestants.
- **Atrophic rhinitis (ozaena):** Wide cavity, foul crusting, blocked feeling despite roomy passages.
NMC competencies in this chapter
- **EN3.2:** Aetiology, features and management of diseases of the nose
- **EN4.22:** Allergic rhinitis: features and management
- **EN4.23:** Non-allergic and vasomotor rhinitis
- **EN4.24:** Atrophic rhinitis and rhinitis medicamentosa
- **EN4.27:** Deviated nasal septum and its management
- **EN4.28:** Nasal obstruction: causes and evaluation
- **EN4.29:** Nasal masses and other nasal conditions
Frequently Asked Questions
How is allergic rhinitis treated?
With allergen avoidance, intranasal corticosteroids and oral or intranasal antihistamines. Intranasal steroids are the most effective single treatment, and immunotherapy is reserved for selected patients.
What is rhinitis medicamentosa?
It is rebound nasal congestion caused by prolonged use of topical decongestant sprays. The treatment is to stop the spray, which often requires a course of intranasal steroids.
Why is unilateral nasal discharge in a child important?
Persistent unilateral foul nasal discharge in a child strongly suggests a nasal foreign body, which needs examination and removal.
When is septoplasty needed?
A deviated nasal septum is corrected by septoplasty when it causes troublesome nasal obstruction or contributes to recurrent sinusitis that does not respond to medical treatment.
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