Rhinitis MCQs

Nasal cycle of rhythmic congestion and decongestion is seen in all normal individuals. The duration of this cycle varies every 2.5 to 4 hours . This occurs because of the autonomic nerve supply of the nose. Nasal mucosa has rich blood supply. Sympathetic stimulation causes vasoconstriction and shrinkage of mucosa, while parasympathetic stimulation causes vasodilation and engorgement. Autonomic system is unstable in cases of vasomotor rhinitis . So the rhythmic congestion and decongestion is disturbed. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no 162, 198

Allergic rhinitis presents with watery nasal discharge. Not epistaxis. Causes of epistaxis include- Local causes like trauma (nose picking, intranasal surgery), infections, foreign bodies, high altitude, DNS Adenoids, juvenile angiofibroma, tumors of nose and paranasal sinuses Systemic causes like disorders of blood, liver, kidney, cardiovascular system, general infections, vicarious menstruation. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no – 194, 205, 206

The pollen is the most common allergens to cause seasonal allergic rhinitis . Allergic rhinitis is type I allergic reaction which is IgE mediated . A] Early phase is due to release of histamine from mast cells. B] Delayed phase is due to leukotrienes and prostaglandins. Sodium Cromoglycate is a mast cell stabilizer and hence helpful in its treatment. The most common allergen for perennial allergic rhinitis is house dust mite . Ipratropium bromide is an anticholinergic agent which is helpful in reducing the nasal discharge. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no – 194, 197

Behcet syndrome (ulcers in oral cavity, genital ulcers and uveitis) is not associated with polyp formation. Various diseases associated with ethmoidal nasal polypi include - Chronic rhinosinusitis due to chronic inflammation. Non-allergic rhinitis with eosinophilia syndrome ( NARES ) is a form of chronic rhinitis associated with polypi. Asthma Aspirin intolerance Cystic fibrosis - due to abnormal mucus. Allergic fungal sinusitis Kartagener syndrome - Bronchiectasis sinusitis, polyposis situs inversus and ciliary dyskinesis Young syndrome - Sinopulmonary disease, nasal polypi and azoospermia. Churg–Strauss syndrome - Asthma, fever, eosinophilia, sinusitis , polyposis vasculitis and granuloma. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8th Edition, pg. no –201

This is a case of Rhinitis medicamentosa . Caused due to prolonged use of topical nasal decongestants (α 2 -adrenergic agonists- xylometazoline, oxymetazoline). These drugs typically cause vasoconstriction. But in case of prolonged usage, they cause rebound congestion and rhinitis due to reflex vasodilation. Edema and redness of mucosa along with hypertrophy of turbinate may occur. Treatment - Stop using these nasal decongestant drops Short course of steroid nasal spray Turbinectomy – required in some cases if turbinates are hypertrophied. Reference – Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra ,8 th Edition, pg. no 199