Nasal Manifestations of Systemic Conditions

Abstract

This article reviews the nasal manifestations of pregnancy, systemic medications, thyroid disease, and systemic immunologic disorders. The most common causes of rhinitis during pregnancy are allergic rhinitis, rhinitis medicamentosa, and bacterial rhinosinusitis; true “vasomotor rhinitis of pregnancy” is relatively uncommon. If nonpharmacologic approaches prove inadequate in relieving rhinitis during pregnancy, several medications appear appropriately safe to warrant their use to combat substantial nasal symptoms. Several systemic medications may cause chronic congestive rhinitis; discontinuation of the responsible medication is the preferred treatment. Although incontrovertible documentation is lacking, hypothyroidism may be associated with chronic nasal symptoms, particularly nasal congestion. Such nasal symptoms improve with thyroid replacement therapy. Nasal symptoms and signs may occur in patients with Wegener’s granulomatosis, Churg-Strauss syndrome, Sjögrens syndrome, sarcoidosis, relapsing polychondritis, systemic lupus erythematosus, and midline granuloma. These nasal manifestations may occasionally be the presenting feature of the above illnesses, but often the nasal symptoms are overshadowed by the systemic abnormalities. The major treatment of nasal symptoms associated with systemic immunologic disorders is the management of the systemic disorder; however, intranasal steroids, intranasal saline, and treatment of secondary bacterial sinusitis may be helpful as adjunctive therapy.