Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:20

Rhinitis 1305

management

■Nonallergic and allergic rhinitis are treated similarly

➣Avoidance of trigger in allergic or nonallergic rhinitis is suggested

➣Control or recognition of an identified underlying mechanism

such as sinusitis, systemic disorders such as hypothyroidism, or

conditions such as pregnancy)

■Topical and systemic medications are chosen by history (ie antihis-

timines for allergy) or are given empirically for a 2–4 week period

and continued as indicated. Use of any medication or treatment in

pregnancy should be carefully considered in consultation with the

patient and obstetrician

specific therapy

Treatment Options

■Medications

➣Use of topical nasal steroid sprays are often first measure used

➣Systemic antihistamines (Non-sedating are commonly used first)

➣Systemic decongestants such as pseudoephedrine

➣Systemic steroids are rarely, but sometimes used

➣Topical nasal cromolyn for allergic rhinitis

➣Topical ipratropium bromide 0.03% 30 minutes prior to meals

for gustatory rhinitis

➣Topical nasal saline spray can be effective for symptom relief

➣Treatments are typically empiric and proceed with alternatives

after a 2–4 week trial

■Surgery

➣Surgical treatment of the inferior turbinates is often used.

Choices for treatment are multiple and may involve partial or

submucosal resection of the turbinates or size reduction by

mucosal cartery or radiofrequency ablation. Correction of a devi-

ated septum may offer relief as well and is often done in conjunc-

tion with treatment of the turbinates.

Side Effects

■Topical nasal steroid sprays

➣Nasal bleeding, ulceration or rarely perforation of the nasal sep-

tum

■Systemic effects such as glaucoma, cataracts and adrenal suppres-

sion should be considered, but do not appear to be as significant as

in pulmonary use

■The risks and benefits of the specific surgical procedures should

be carefully reviewed with the patient and may be specific to the