Chronic Hypertrophic Rhinitis: Causes, Treatments, and Symptoms

Chronic hypertrophic rhinitis

1.
Is chronic hypertrophic rhinitis considered irreversible? Some websites state this, which implies that once it transitions from acute to chronic, surgical treatment is necessary.
A doctor told me that nasal sprays are ineffective if the nose is congested; they only work if the nose is clear.
Is that correct?
2.
Can chronic hypertrophic rhinitis be triggered by a deviated septum? If so, would patients with both chronic hypertrophic rhinitis and a deviated septum experience rapid recurrence if only treated with laser or radiofrequency methods?
3.
I usually do not have significant nasal congestion, but I experience severe congestion while sleeping.
Is this a symptom of a deviated septum?

Wang Laoban, 30~39 year old female. Ask Date: 2005/07/24

Dr. Ye Dawei reply Otolaryngology

1.
(1) It is irreversible.
(2) It varies from person to person.
2.
It may recur.
3.
Yes, I provide a reference for you.

This article will be organized later on the 【Yeh Da-Wei ENT Clinic website/Health Education】.
Articles on this website are welcome to be cited, but please indicate the source.
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【The 'Comprehensive Cure for Nasal Diseases' That Makes One's Nose Sour】 In the outpatient clinic of an ENT specialist, symptoms such as cough, headache, dizziness, and nasal congestion are quite common.
However, due to their complex causes, treatment can be challenging, leading patients to flock to exaggerated advertisements claiming "cure" and "comprehensive treatment." In the past two years, I have treated many patients after undergoing the so-called "five-minute nasal disease cure," resulting in issues such as nasal mucosa adhesion, nasal vestibule inflammation, nasal passage narrowing, and nasal septum perforation—truly a long list of complications that is disheartening.

The causes of nasal congestion generally include "infection," "structural abnormalities of the nose," "allergic rhinitis," and "vasomotor rhinitis," each with its own pathogenic mechanisms and treatment approaches.
Of course, each condition has its limits in terms of treatment efficacy, which has allowed these alternative practitioners to gain traction.
Below, I will briefly introduce each disease according to this classification.
◎ Infection: The most common cause of nasal congestion is the common cold.
Once the cold resolves, the nasal congestion typically improves.
Bacterial infections leading to sinusitis are more severe, presenting not only with nasal congestion but also with post-nasal drip, headaches, difficulty concentrating, and chronic nighttime cough.
In children, this can significantly affect sleep quality and academic performance.
If conservative treatments such as medication and nasal irrigation are ineffective, surgery may be recommended.
The traditional Luc's procedure, which involved incising the lip to remove the entire sinus mucosa, has now been completely replaced by endoscopic sinus surgery.
Endoscopic surgery allows for selective removal of obstructive mucosal tissue under good visualization, restoring normal sinus function.
◎ Structural Abnormalities of the Nose: Deviated septum and chronic hypertrophic rhinitis.
A deviated septum can occur naturally during birth or as a result of trauma causing cartilage distortion.
The degree of deviation does not always correlate with nasal congestion, and the decision to correct it surgically can depend on the patient's subjective experience.
Chronic hypertrophic rhinitis refers to the hypertrophy of normal turbinate tissue, which can cause nasal congestion.
The turbinates, also known as nasal conchae, are normal physiological structures located on the lateral wall of the nasal cavity, and patients can often see them when examining their own nasal cavities.
Sometimes, patients may be misinformed that these are nasal polyps and subjected to inappropriate cauterization procedures.
◎ Allergic Rhinitis: Currently, there is no definitive cure for allergic rhinitis in medicine.
It is a disease caused by a specific predisposition, leading to edema of the nasal mucosa and resulting in nasal congestion.
Treatment can vary based on the severity of symptoms, utilizing oral medications, nasal sprays, immunotherapy, or surgery to alleviate nasal congestion.
◎ Vasomotor Rhinitis: Various factors can cause vasomotor rhinitis, including work stress, hormonal changes during pregnancy, certain antihypertensive medications, and even irritants such as perfumes, temperature and humidity changes, or cooking fumes.
These factors can cause dilation and congestion of the blood vessels in the nasal mucosa, leading to nasal congestion symptoms.
Treatment options for chronic hypertrophic rhinitis, allergic rhinitis, or vasomotor rhinitis include conservative oral medications, nasal sprays, traditional inferior turbinate reduction surgery, and advanced laser surgery.
There is also a technique using thermal probes placed submucosally in the turbinates, where radiofrequency generates low heat to cause protein coagulation in the submucosal tissue, leading to fibrosis and reduction of the hypertrophied turbinate tissue.
Nasal congestion is not classified as a disease but is a highly bothersome symptom.
It not only makes breathing difficult but can also easily lead to dizziness, headaches, difficulty concentrating, snoring, insomnia, or sleep apnea.
Consulting a professional ENT physician to identify the true cause of nasal congestion and selecting appropriate symptomatic treatment is the right approach.
I sincerely hope not to see any more so-called comprehensive cures for nasal diseases in the outpatient clinic.

Reply Date: 2005/07/24

More Info

Chronic hypertrophic rhinitis is a condition characterized by the inflammation and swelling of the nasal mucosa, leading to symptoms such as nasal congestion, difficulty breathing through the nose, and sometimes a reduced sense of smell. Understanding the causes, treatments, and symptoms of this condition is essential for effective management.

1. Is Chronic Hypertrophic Rhinitis Reversible?
Chronic hypertrophic rhinitis is often considered a persistent condition that may not be fully reversible. While acute rhinitis (such as that caused by a viral infection) can resolve on its own, chronic cases often require more intensive treatment. Some sources suggest that once rhinitis becomes chronic, surgical intervention may be necessary to alleviate symptoms. However, this does not mean that all cases require surgery; many patients can manage their symptoms with medications, such as nasal corticosteroids, antihistamines, or decongestants. The statement about nasal sprays being ineffective when the nasal passages are blocked is partially true; for optimal results, the nasal passages should be clear before application. However, some sprays can still provide relief even when congestion is present.

2. Can Deviated Septum Cause Chronic Hypertrophic Rhinitis?
Yes, a deviated septum can contribute to the development of chronic hypertrophic rhinitis. The deviation can obstruct normal airflow, leading to chronic irritation and inflammation of the nasal mucosa. In patients with both chronic hypertrophic rhinitis and a deviated septum, treatments such as laser therapy or radiofrequency ablation may provide temporary relief, but they may not address the underlying structural issue. Therefore, if the septum is significantly deviated, surgical correction (septoplasty) may be necessary to achieve long-term relief and prevent recurrence of symptoms.

3. Is Nasal Congestion During Sleep Indicative of a Deviated Septum?
Experiencing nasal congestion primarily during sleep can indeed be a symptom of a deviated septum, but it is not exclusive to this condition. Other factors, such as allergies, nasal polyps, or chronic sinusitis, can also contribute to nighttime nasal congestion. When lying down, gravity can exacerbate congestion, especially if there is swelling in the nasal passages. If you notice that your nasal congestion is consistently worse at night, it may be worthwhile to consult an ENT specialist for a thorough evaluation. They may recommend imaging studies, such as a CT scan, to assess the anatomy of your nasal passages and determine the best course of action.

In summary, chronic hypertrophic rhinitis is a complex condition that may require a multifaceted approach to treatment. While surgical options exist, many patients find relief through medical management. If you suspect that a deviated septum or other structural issues are contributing to your symptoms, seeking an evaluation from an ENT specialist is advisable. They can provide personalized recommendations based on your specific situation, which may include medications, lifestyle modifications, or surgical interventions if necessary.

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