A sleep clinician’s guide to runny noses: evaluation and management of chronic rhinosinusitis to improve sleep apnea care in adults
- S-Med
- Aug 21
- 1 min read
Rhinosinusitis and its component conditions, rhinitis and sinusitis, can be either allergic or nonallergic. Allergic rhinitis affects 10–20% of adults in North America After repeated exposures to an allergen, atopic individuals will produce an allergen-specific immunoglobulin E (sIgE). sIgE is bound to IgE receptors on mast cells in the nasal mucosa and to basophils in the peripheral blood. On subsequent exposure to the allergen, the allergen will bind to the corresponding sIgE on the mast or basophil cell. These cells are activated, and chemical mediators (cytokines, interleukins, histamines, leukotrienes) are released, leading to the immediate and delayed symptoms of allergic rhinitis, such as sneezing, itchy and runny nose, and congestion.
Nonallergic rhinosinusitis, on the other hand, is non-IgE dependent. There are numerous etiologies for nonallergic rhinitis, both inflammatory and noninflammatory. Among the inflammatory sub-types are infectious, irritant, and nonallergic rhinitis with eosinophilia syndrome. The noninflammatory sub-types include atrophic, gustatory, drug- or hormone-induced, senile, post-surgical, and vasomotor. Many commonly prescribed medications can contribute to nasal congestion.
Based on the duration of symptoms, rhinosinusitis can also be classified as acute (symptoms for < 4 weeks), subacute (4–12 weeks), or chronic (> 12 weeks). Recurrent sinusitis is defined as 4 or more acute, non-overlapping episodes of sinusitis per year.
Rhinosinusitis must also be differentiated from nasal obstruction for other reasons. For instance, anatomical deformities, such as a deviated nasal septum, nasal polyps, or the rare nasal mass or neoplasm, can mimic rhinosinusitis by making nasal breathing difficult.
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