ear, nose, and throat disorders
Nonallergic Rhinitis
Treatment of Nonallergic Rhinitis
For viral rhinitis, decongestants, antihistamines, or both For atrophic rhinitis, topical treatment with antibiotics, estrogens, andvitamin Aand D For vasomotor rhinitis, humidification and sometimes topical corticosteroids and oralpseudoephedrine Viral rhinitismay be treated symptomatically with decongestants (either topical vasoconstriction with a sympathomimetic amine, such asoxymetazolineevery 8 to 12 hours orphenylephrine0.25% every 3 to 4 hours for not more than 3 days, or systemic sympathomimetic amines, such aspseudoephedrine30 mg orally every 4 to 6 hours). Intranasaloxymetazolineshould not be used for more than 3 days to avoid rebound nasal mucosal congestion. Antihistamines may be helpful in the treatment of viral rhinitis, but those with anticholinergic properties dry mucous membranes and therefore may increase irritation. (See also Common Cold .) Intranasal mast cell stabilizers (eg, cromolyn) and Treatment ofatrophic rhinitisis directed at reducing the crusting and eliminating the odor with nasal irrigation, topical antibiotics (eg,mupirocin), topical or systemic estrogens, and vitamins A and D. Occluding or reducing the patency of the nasal cavities surgically decreases the crusting caused by the drying effect of air flowing over the atrophic mucous membrane. Treatment ofvasomotor rhinitisis by trial and error and is not always satisfactory. Patients benefit from humidified air, which may be provided by a humidified central heating system or a vaporizer in the workroom or bedroom. Topical corticosteroids (eg,mometasone2 sprays twice a day) and nasal antihistamines can be of some benefit. Systemic sympathomimetic amines (eg, for adults,pseudoephedrine30 mg orally every 4 to 6 hours as needed) relieve symptoms but are not recommended for long-term use because they thicken the mucus and may cause tachycardia and nervousness. Topical vasoconstrictors are avoided because they cause the vasculature of the nasal mucous membrane to lose its sensitivity to other vasoconstrictive stimuli—eg, the humidity and temperature of inspired air. Rebound congestion can result after 3 days of continuous use; chronic use and dependence is known as rhinitis medicamentosa. 