Rhinitis

I've been nt feeling well for d past couples of weeks.. mainly coz my long lost friend - rhinitis came back to visit me.. it has been v "good" friend wit me since.. secondary 2?.. 9 years back.. *sweat* i was super well with them back in glasgow.. once i step back to msia/ spore, it's getting worse fr day to day.. well, i guess & "nose" is just a good "pollution indicator".. usually, after awhile, it shall recover by itself.. bt, my nose block is getting worse.. made me so sick! additional symptoms: cough at night, eye redness (infection?)

went google for it & fr NHS direct:
Rhinitis - non allergic
Introduction
Rhinitis is a condition where the inside of your nose swells, or becomes inflamed. This can cause cold-like symptoms, such as sneezing, itchiness, and a blocked, or runny, nose. One of the most common causes of rhinitis is an allergic reaction to something, such as pollen. This type of rhinitis is known as allergic rhinitis.

Types of non-allergic rhinitis
There are several different types of rhinitis that do not involve an allergic reaction. These types of rhinitis are known as non-allergic rhinitis.

Viral/ infectious rhinitis - caused by an infection, such as the common cold.
Vasomotor rhinitis - the blood vessels in the nose are over-sensitive, and certain environmental triggers, such as cold weather, or smoke, can cause them to expand and fill your nose with mucus.
Atrophic rhinitis - this is a form of rhinitis where the membranes inside the nose thin (atrophies) and harden. This causes the nasal passages to widen and dry out. Foul smelling crusts form inside the nose and you may lose your sense of smell. Atrophic rhinitis can occur as a complication of nose surgery, or as a result of infection.
Rhinitis medicamentosa - this form of rhinitis often occurs due to over-use of nasal decongestants.

Non-allergic rhinitis can also sometimes be caused by eating spicy food, or as a side-effect of certain medications, such as aspirin, or beta-blockers. It can also occur as a result of imbalances in the hormonal system caused by pregnancy, puberty, or an over-active thyroid gland.

General symptoms
Viral rhinitis, vasomotor rhinitis and rhinitis medicamentosa all have similar symptoms. These can include:
- sneezing
- a runny nose
- a blocked nose
- nasal pressure and pain

Atrophic rhinitis
- nasal crusting
- a foul or unpleasant smelling odour (produced by the crust)
- a nose bleed may occur if you try to remove the crusts, which may lead to a loss of the sense of smell (anosmia)

Causes
Viral rhinitis
Virus attacks the lining of the nose and throat, causing them to become inflamed. As the linings of the nose and throat become inflamed, they begin to produce more mucus, resulting in a runny nose and sneezing.

Vasomotor rhinitis
The blood vessels inside the nose help to control the flow of mucus by expanding and contracting.

For unknown reasons, people with vasomotor rhinitis have very sensitive nasal blood vessels, and environmental triggers can make the blood vessels expand, leading to congestion and an excess of mucus. Common triggers include:
- chemical irritants, such as smoke, perfumes, or paint fumes,
- changes in the weather, such as a drop in temperature,
- alcohol,
- spicy food
- stress.

Atrophic rhinitis
Inside the nose, there are three ridges of bone that are covered by a layer of tissue. These layers of tissue are known as turbinate tissue. Atrophic rhinitis sometimes occurs if the turbinate tissue becomes damaged.

Turbinate tissue can be damaged by infection, although in the UK, this is very rare. This is because the bacteria, known as klebsiella ozenae, which are usually responsible for atrophic rhinitis, are mainly found in India, China and Egypt.

More commonly, turbinate tissue is damaged, or removed, during surgery. Surgically removing turbinate tissue may be necessary if it is obstructing your air flow.

Turbinate tissue plays an important role in the effective functioning of your nose.
* help keep the inside of your nose moist,
* protect against bacteria,
* help to regulate the air pressure of the oxygen that we breathe in, and
* contain many important nerve endings that are used to transmit information, such as your sense of smell, to the brain.

If your nose loses a certain amount of turbinate tissue, it becomes dry, crusty and prone to infection. The amount of turbinate tissue that can be lost before atrophic rhinitis develops will differ from person to person. Some people have lost a large amount of turbinate tissue and never developed the condition, while others have only had a small reduction and it has triggered the condition.

People with atrophic rhinitis will also experience a shortness of breath because the turbinates are no longer regulating air pressure, and the lungs have to work harder to receive air. Many people also lose their sense of smell (anosmia).

Rhinitis medicamentosa
caused by the over-use of nasal decongestant sprays. (The condition can also occur as a complication of cocaine abuse.)

Nasal decongestants work by reducing the swelling of the blood vessels in your nose.

However, if decongestant sprays are used for more than 5-7 days at a time, the sprays can cause the nasal linings to swell up again, even when the cold, or allergy, that originally caused the problem has passed.

If you use more decongestants in an attempt to reduce the swelling, it is likely to make the problem worse. This is sometimes known as 'rebound congestion'.

Some people find that they get locked into a cycle of overuse and dependence - much like a drug addiction.

Diagnosis
Viral rhinitis
presence of typical cold symptoms.

Vasomotor rhinitis
Diagnosing can be difficult because it shares many of the same symptoms as allergic rhinitis. There are no specific tests for the condition.

Instead, diagnosis is normally made through a process known as 'diagnosis of exclusion'. GP will check all the other possible causes of rhinitis, such as allergens like pollen or animal fur. As part of this process, you may undergo some allergy tests.

There are several different tests that can be carried out which are listed below.

* Skin prick test - this is usually the first test to be carried out when trying to determine whether allergens are causing your rhinitis. The allergens are placed onto the skin of your arm and introduced into the skin by pricking the skin with a short pin. If there is a positive reaction, your skin will become itchy, red, and swollen.
* Blood test - this is used to measure the amount of Immunoglobulin E (IgE) antibody in your blood which has been produced by your immune system in response to a suspected allergen.
* Patch test - this test is often used to find the allergen causing eczema, or contact dermatitis. A small amount of the suspected allergen is added to special metal discs which are taped to your skin, usually for 48 hours, to see how it reacts. This test is usually carried out in hospital, in the dermatology (skin) department.

If the tests show that you are not experiencing any allergic reactions, a diagnosis of vasomotor rhinitis can be made.

Atrophic rhinitis
Diagnosed after checking for the characteristic symptoms, such as nasal crusting, widening of the nasal passages, an associated offensive odour, and a loss of smell.

A computer topography (CT) scan - involves using a machine that takes a series of X-rays to build up a detailed picture of the inside of your body. It may be used to confirm the diagnosis by looking for changes in your nasal cavities.

Rhinitis medicamentosa
Diagnosis the condition by asking you about your past use of nasal decongestant sprays.

Treatment
Viral rhinitis
Medical treatment for viral, or infectious, rhinitis is often not required because the infection that causes it normally passes within 14 days.

Decongestants may help to relieve the symptoms of congestion, and blocked nose, but it is important to follow the manufacturer's instructions. Overusing decongestants could make your congestion worse and lead to rhinitis medicamentosa. If you are taking a type of antidepressant called a monoamine oxidase inhibitor (MAOI), you should not use nasal decongestants.

Vasomotor rhinitis
Once the diagnosis of vasomotor rhinitis has been made, it is important to recognise any potential environmental triggers and, if possible, avoid them.

Symptoms can normally be relieved through the use of a nasal spray containing corticosteroids. Corticosteroids work by helping reduce inflammation and congestion.

If your condition still does not respond to treatment, there are several alternative methods that can be tried. These are outlined below.

* Antihistamine nasal sprays - while antihistamines are typically used to treat allergic conditions, they can also help reduce the inflammation caused by vasomotor rhinitis.
* Anticholinergics nasal sprays - anticholinergics help enlarge the airways making breathing easier. They also reduce the amount of mucus that your body produces, and are therefore helpful in treating the symptoms of a runny nose.
* Sodium cromoglicate - this medicine reduces inflammation and the production of mucus. It is normally taken by using an inhaler.

Atrophic rhinitis
The most common treatment for atrophic rhinitis is nasal irrigation. This involves using a syringe to fill the nasal cavities with a saline solution (a mix of salts and water). This helps reduce crusting and dryness.

Antibiotics can also be used to treat any infection, and reduce, or remove, the offensive odour.

There are several surgical treatments that can be used to treat atrophic rhinitis. These are listed below.
* Young's operation - this involves surgically closing the affected nasal cavity to allow it to heal without becoming infected. After a period of time, normally around nine months, the cavity is then reopened.
* Nasal narrowing operation - this procedure aims to narrow the affected nasal cavity by using grafted bone, or cartilage, or, sometimes, artificial materials, such as Teflon, or silicon. Narrowing the cavity leads to a reduction of the levels of crusting, and can also improve airflow within the nose.

Rhinitis medicamentosa
The best way to treat rhinitis medicamentosa is to stop using nasal decongestant sprays. However, many people find it difficult to stop using the sprays, particularly if they have been using them for some time.

Several methods that can help to ease the withdrawal process are listed below.
* Stop using the spray in your 'good', or least congested, nostril. Then after seven days, your 'good' nostril should open up, at which point you stop using the spray in your other nostril.
* The older types of antihistamine, that cause drowsiness, can help you sleep, and reduce night-time congestion. Do not drive, or operate heavy machinery, when taking these sorts of antihistamines.
* You can naturally lubricate your nose using a saline solution delivered by a small rubber ear syringe. To make the solution, mix half a teaspoon of salt in 220ml (8 oz) of lukewarm water.

In more severe cases of rhinitis medicamentosa, a short course of corticosteroid tablets (oral corticosteroids) may be prescribed.

Complications
Nasal polyps
Fleshy swellings that grow on the lining of your nose, or sinuses (the small, air-filled cavities above and behind your nose). They are the result of inflammation of the membranes of the nose, and are sometimes caused by rhinitis.

A nasal polyp will be shaped like a teardrop when it is growing, and look like a peeled grape attached by a narrow stalk, when it is fully grown. Nasal polyps may be yellowish, grey, or pink, in colour, and they can vary greatly in size. They can either grow singly, or in clusters, and they usually affect both nostrils.

If they grow large enough, or if they grow in clusters, nasal polyps can interfere with your breathing. They can also reduce your sense of smell by blocking the flow of air to the sensitive areas in the roof of your nose that control smell. They can also block the holes in your sinuses (small, air-filled cavities inside the cheekbones and forehead), through which air flows through and mucus drains out. If your sinuses become blocked, it can lead to sinusitis.

Smaller polyps can be shrunk using corticosteroids nasal sprays so that they do not cause any obstructions in your nasal cavities. Large polyps may need to be removed using surgery.

Sinusitis
A common complication of rhinitis is sinusitis. Sinusitis is an inflammation, or infection, of your sinuses. Usually, if your sinuses become filled with mucus, the fluid is normally drains away. However, if the fluid cannot drain away, for example as the result of a blockage, it can become infected with bacteria.

Sinusitis is a common problem for those with rhinitis because an excess of mucus, or nasal polyps, can stop the sinuses from draining properly.

Common symptoms of sinusitis:
* Pain and tenderness of the infected sinus - you may experience a throbbing pain in your sinuses (which is worse when you move your head), and toothache, or pain in your jaw, when you eat.
* A blocked or runny nose - your nose may produce a greenish, or yellowish coloured mucus. If your nose becomes blocked with mucus, any pain and tenderness in the affected area may become worse.
* High temperature.

The symptoms of sinusitis can be relieved by using over-the-counter (OTC) painkillers, such as paracetamol, ibuprofen or aspirin. These will relieve a headache, high temperature, and any pain, or tenderness that you may have around the infected area.

Children under 16 years of age should not take aspirin. Ibuprofen is not recommended for asthmatics, or those who have, or have had in the past, stomach conditions, such as ulcers. Speak to you GP if you are not sure about this.

Antibiotics may be recommended if you develop a secondary infection in your sinuses. If sinusitis remains a long-term problem (chronic sinusitis) you may require surgery to improve the drainage of your sinuses.