Rhinitis is not a static disease. Its progression is generally divided into four stages, each with distinct symptoms, triggers, and treatment priorities. Many patients ignore early signs or misdiagnose the condition, leading to persistent inflammation and even complications such as asthma and sinusitis. This article systematically explains the four stages of rhinitis to help readers scientifically understand the disease process and take targeted measures to protect their nasal health.
Stage 1: Acute Phase (Initial Viral/Allergen Attack)
Core Characteristics: The nasal mucosa's "first line of defense" is breached, and symptoms develop suddenly and significantly.
Typical Manifestations:
Nasal Congestion: Alternating between one or both sides, worsening at night.
Runny Rhinorrhea: Clear watery initially, but may turn yellow-green later (when bacterial infection is present).
Sneezing: Patients with allergic rhinitis often experience continuous sneezing, accompanied by itchy nose and eyes.
Systemic Symptoms: Acute viral rhinitis may be accompanied by fever, fatigue, and headache.
Key triggers:
Viral infection (such as rhinovirus, influenza virus).
Exposure to allergens (pollen, dust mites, animal hair).
Physical stimulation such as cold air and pungent odors.
Treatment priorities:
Acute viral rhinitis: Symptomatic treatment is the primary focus (such as antipyretics and analgesics to relieve fever, and saline nasal irrigation).
Allergic rhinitis: Immediately remove the allergen and use antihistamines or nasal corticosteroids to quickly control symptoms.
Warning signs: If symptoms persist for more than 10 days, or if yellow-green purulent discharge or facial tenderness develops, be wary of bacterial sinusitis and seek medical attention promptly.
Phase 2: Subacute phase (persistent inflammation, worsening mucosal damage)
Core characteristics: If the acute phase is not completely controlled, inflammation spreads from the surface to deeper layers.
Typical manifestations:
Worsening nasal congestion: Swelling of the nasal mucosa leads to airway obstruction, which may be accompanied by decreased sense of smell. Increased discharge: Thick, purulent nasal discharge may back up into the throat upon waking, triggering coughing.
Increased mucosal fragility: Frequent nasal blowing may lead to nosebleeds or crusting.
Key triggers:
Inadequate acute treatment (e.g., irregular medication use, premature discontinuation of medication).
Continuous exposure to allergens or irritants (e.g., smoking, air pollution).
Weakened immunity (e.g., fatigue, malnutrition, chronic illness).
Treatment priorities:
Intensified anti-inflammatory treatment: Extend the course of nasal corticosteroids to 2-4 weeks. Desensitization therapy may be considered for patients with allergic rhinitis.
Promote mucosal repair: Use saline or sea salt water to irrigate the nasal cavity to maintain a moist environment.
Avoid irritation: Discontinue the use of vasoconstrictor nasal drops (which can easily trigger drug-induced rhinitis).
Warning signs: If nasal congestion persists for more than 3 months, or if recurrent nosebleeds or headaches occur, chronic rhinitis may have developed.
Stage 3: Chronic Stage (Mucosal Structural Alterations, Permanent Functional Impairment)
Core Characteristics: Recurrent inflammation leads to irreversible changes in the nasal mucosa, significantly increasing the difficulty of treatment.
Typical Manifestations:
Persistent nasal obstruction: Thickening of the nasal mucosa or turbinate enlargement, with limited relief from medication.
Olfaction Disorder: Long-term inflammation damages the olfactory nerve, leading to permanent loss of smell in some patients.
Increased Risk of Complications: Sinusitis, otitis media, and sleep apnea syndrome are common.
Key Contributing Factors:
Long-term lack of standardized treatment (e.g., misuse of decongestants, reliance on folk remedies).
Anatomical Abnormalities (e.g., nasal septum deviation, nasal polyps).
Environmental Factors (e.g., occupational dust exposure, dry climate).
Treatment Focus:
Comprehensive Intervention: Combined use of nasal steroids, antihistamines, and leukotriene receptor antagonists.
Surgical Correction: Functional endoscopic nasal surgery is performed for structural problems such as nasal septum deviation and nasal polyps. Long-term management: Regular nasal endoscopy to monitor mucosal condition and prevent recurrence.
Warning signs: Facial tenderness, yellow-green purulent discharge with a foul odor, and the development of fungal sinusitis or nasal tumors require investigation.
Stage 4: Complications (Inflammation Spreads, Involving Adjacent Organs)
Core Characteristics: Uncontrolled nasal inflammation spreads to the sinuses, throat, and lower respiratory tract, creating a "same airway, same disease" situation.
Typical manifestations:
Sinusitis: Facial tenderness, yellow-green purulent discharge, and headache (worsened in the morning).
Asthma: Approximately 30% of patients with allergic rhinitis will develop asthma, experiencing wheezing and chest tightness.
Adenoid hypertrophy in children: Chronic nasal congestion leads to mouth breathing, resulting in "adenoid facies."
Key triggers:
Continuous inflammatory stimulation (such as dust mites and mold).
Extremely weakened immunity (such as in patients with diabetes or HIV infection).
Delayed treatment (patients ignoring early symptoms or misdiagnosis). 3. Treatment Focus:
Multidisciplinary Collaboration: Otolaryngology, respiratory medicine, and pediatrics will jointly develop a treatment plan.
Biologic Therapy: For severe allergic rhinitis or asthma, anti-IgE monoclonal antibodies (such as omalizumab) can be used.
Environmental Modification: Use air purifiers and dust mite removers to reduce allergen exposure.
Warning Signs: If high fever, severe headache, or decreased vision occur, seek urgent medical attention to investigate intracranial complications.
The four stages of rhinitis are not irreversible, but early detection and treatment are crucial. In the acute phase, standardized medication and avoidance of irritation can effectively halt disease progression. In the chronic phase, a combination of medication and surgery is needed to repair mucosal structures. During the complication phase, multidisciplinary intervention is required to prevent organ damage. Additionally, daily nasal care is crucial. Daily nasal irrigation with normal saline (such as the DeepCozy Electric Nasal Irrigator, which gently removes allergens and secretions) keeps the mucosa moist and can significantly reduce the risk of recurrence.
