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Rinitis
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Rinitis

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Es una enfermedad que afecta a la mucosa nasal y produce estornudos, picor , obstrucción, secreciones nasales y en ocasiones falta de olfato. Suele ser muy persistente y dar síntomas diarios, aunque dependiendo de la causa de la inflamación puede dar síntomas solo en temporada concretas.

Causas

No siempre que hablamos de rinitis lo hacemos de una patología inflamatoria ya que la mucosa nasal tiene una gran cantidad de vasos sanguíneos y por ello cuando estos se dilatan puede producir cuadros de obstrucción nasal, semejantes a una rinitis pero sin otros síntomas (estornudos, picor, etc..).
Dependiendo de esta diferencia y de las características en las causas pueden diferenciarse varios tipos de rinitis .

Las rinitis inflamatorias, presentan síntomas de picor, estornudos, secreciones, obstrucción. Entre ellas están:

  • Rinitis alérgica
    • perenne: puede estar causada por ácaros, hongos, epitelios de animales.
    • aperiódica: puede estar causada por hongos, epitelios de animales, profesional.
    • estacional: puede estar causada por polen de gramíneas, polen de pino polen de parietaria, polen de artemisa.
  • Eosinófila
  • Neutrófila
  • Hipertrófica, suele asociarse a una sinusitis polipoidea.
  • Mastocitaria
  • Infecciosa, viral ó bacteriana.
  • Atrófica-ocena.
  • Las rinitis no inflamatorias, causadas por alteraciones del contenido de los vasos sanguíneos y que solo cursan con obstrucción como síntoma característico.

  • Vasomotora, en general es de causa desconocida o por el uso habitual de medicamentos vasoconstrictores tópicos nasales.
  • Hormonal, secundaria a hipertiroidismo, embarazo.
  • Medicamentosa, secundaria a la toma de antihipertensivos, progesterona, alcohol, vitamina A
  • Física , aparece por aumento del frío ó humedad ambiental.
  • Mecánica causada por cuerpos extraños, tabique desviado, tumores, o las vegetaciones.
  • Diagnóstico

    El diagnóstico va encaminado a definir los síntomas y su época de aparición, su duración, su frecuencia y sus posibles desencadenantes.
    Se utiliza la rinoscopia anterior, que mediante un aparato (rinoscopio), se ve la mucosa nasal y se aprecian diferencias de coloración y de aumento del tamaño de los cornetes o la presencia de pólipos. Las pruebas cutáneas con alergenos (ácaros del polvo doméstico, pólenes epitelios, etc..) nos ofrecen información de las posibles causas.
    La intensidad de la rinitis se puede medir mediante la obtención de las presiones de paso del aire a través de la nariz mediante la medición del pico inspiratorio nasal o la rinomanometría.
    Como exploraciones complementarias, que nos dan información sobre complicaciones de sinusitis podemos utilizar la Rx senos ó el TAC de senos paranasales.
    La medición de células eosinófilas en el exudado nasal se usa cada vez menos por ser poco específico de cada rinitis y no ayuda al diagnóstico.

     

    Tratamiento

    Por un lado se deben tomar medidas de control ambiental para evitar las causas de origen alérgico.
    Para la alergia a ácaros la limpieza más intensa de la casa con aumento de la ventilación, disminución de la humedad ambiental y los acarizidas son las medidas de control ambiental adecuadas.
    En la alergia al polen evitar salidas al campo en días de Mayo o Junio con sol y viento. En la alergia a epitelios se utilizan líquidos desnaturalizadores de proteínas que se aplican en el mobiliario o en el propio animal.
    Como medicamentos se utilizan los antihistamínicos vía oral o tópicos nasales para evitar el picor, el aguilla y los estornudos, los esteroides tópicos mejoran la obstrucción si la rinitis es más crónica.
    Si el desencadenante de alergia es concreto se realiza una Inmunoterapia durante 2 a 6 años. La inmunoterapia a ácaros y pólenes es muy efectiva en la mayor parte de los casos.

     

    Complicaciones

    En el adulto la complicación principal es la asociación de sinusitis polipoidea (en ocasiones con intolerancia a antiinflamatorios no esteroideos AINEs) o la apnea del sueño.
    En los niños la mala respiración puede producir alteraciones del sueño y deformidades en la dentición con la consiguiente necesidad de corrección por el odontólogo.

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