Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

1304 Rhinitis

Triggered by exposure to allergen (dust, animal dander,

molds, grasses, trees, etc.)

Seasonal component, but perennial symptoms can occur as

well

Pale white or bluish discoloration of nasal and specifically

turbinate mucosa Mucosa typically boggy or edematous

Erythematous mucosa can also be seen

Nonallergic (vasomotor) Rhinitis

Nasal congestion that may occur suddenly with changes in

temperature, humidity, or with smoke or chemical exposure

(e.g. perfume).

Associated with pregnancy or pre-menstrual time frame

May be postural with nasal congestion on dependent side

or both sides

Nasal congestion and clear rhinorrhea with food ingestion

(gustatory rhinitis)

Boggy edematous mucosa

May appear similar to allergic rhinitis with pale or bluish

discoloration of turbinate mucosa

Erythematous mucosa can also be seen

tests

■Allergic testing (skin or RAST) can reveal allergens to be avoided and

desensitization therapy can proceed in selected cases

■CT scan of the sinuses (coronal CT with bone window 3 mm cuts) to

rule out concomitant sinusitis

■Rarely, biopsy is rare needed for diagnosis of an underlying illness

(e.g. Wegener’s, sarcoid, lymphoma)

■Blood testing for systemic causes such as hypothyroidism, Wegener,

sarcoid

■Some use smear of nasal secretions to look for eosinophils (NARES

syndrome)

differential diagnosis

■Sinusitis/nasal polyposis with associated rhinitis

■Acute viral upper respiratory infection for acute rhinitis

■Normal nasal cycle where some patients notice congestion which

alternates sides

■Deviated septum causing nasal obstruction

■Systemic processes such as Wegener granulomatosis, sarcoidosis

■Tumor or mass causing nasal obstruction

■Adenoid hypertrophy causing nasal obstruction and nasal drainage

■Foreign body