Chronic rhinitis is a problem for one in ten people and is characterised by a constantly dripping nose, sneezing and a blocked feeling in the nasal passages. However, the information that one writer gives strongly suggests that the problem is non-allergic rhinitis. In this case, a runny nose results from the nasal lining becoming overly sensitive to a range of irritants such as stress, pollution, spicy food and perfume amongst others. There may be some hormonal factors involved — menopause, pregnancy and the use of oral contraceptives can encourage rhinitis. Some medications such as ACE inhibitors and beta-blockers used to treat high blood pressure, and certain medicines used for erectile dysfunction and depression can also have an impact. Mechanisms controlling the flow of blood to the lining of the nasal passages may also be over-sensitive, leading to spontaneous streaming.
There are various treatments for chronic rhinitis. Over-the-counter nasal decongestant sprays can be helpful but should be used cautiously as they can cause a rebound effect. Similarly, corticosteroid nasal sprays can cause problems if used long-term, leading to atrophy of the nasal lining, which in turn causes excessive dryness and discomfort (atrophic rhinitis). Surgery can be controversial, and medication may be a better option. Azelastine, taken twice a day, can be particularly effective as it has an anti-inflammatory effect that reduces the inflammation of the nasal lining.
Hip replacement is under discussion here because the reader has a low platelet count, and the question is whether or not to have a hip replacement operation. Platelets stick together to form a plug to seal a wound, but with thrombocytopenia that can drop to 20,000, causing symptoms such as multiple tiny bruises, bleeding gums or nosebleeds. Surgery to remove the spleen may be an option, but in this case, eltrombopag (a daily pill) has proved to be effective. The writer says that although the operation can create a bearing surface for the replacement hip joint, which will inevitably have a small disruptive effect on the bone marrow where platelets are made, it will not have any effect on the remainder of the bone marrow throughout the skeleton or impair platelet production significantly. The advice, therefore, is to go ahead with the operation because it is safe and effective in relieving chronic pain and restoring mobility.
One aspect of rhinitis not touched on here is rhinitis medicamentosa, a condition caused by overusing nasal decongestants for a long time. Initially, the person may experience immediate relief from their nasal congestion. Over time, however, the overuse of nasal decongestants can make the symptoms of congestion worse. Rhinitis medicamentosa is a common condition seen in patients who have used excessive medicines to treat nasal congestion.
Although the article is brief, it gives a good overview of one type of chronic rhinitis that is not caused by allergies and is helpful in recommending medication as well as warning against nasal decongestants. The same article could be improved by providing more information about rhinitis medicamentosa and the importance of avoiding excessive use of medicine to treat nasal congestion.
