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Upon completion of the chapter, the reader will be able to:

  1. Compare and contrast clinical presentations of various nose, mouth, and throat disorders.

  2. Identify common medications that cause xerostomia and sialorrhea.

  3. Evaluate when pharmacologic treatment is necessary for treatment of nose, mouth, and throat disorders.

  4. Compare and contrast the mechanisms of action of common medications used to treat nose, mouth, and throat disorders.

  5. Develop a treatment plan, including nonpharmacologic and pharmacologic interventions, for the treatment of nose, mouth, and throat disorders.

  6. Educate patients about nose, mouth, and throat disorders and the pharmacologic and nonpharmacologic therapies used to treat them.

  7. Create a monitoring plan for treatment of nose, mouth, and throat disorders.



Allergic rhinitis refers to inflammation of the nasal mucous membrane when exposed to allergens. In contrast, nonallergic rhinitis (NAR) refers to a condition of chronic symptoms of nasal congestion and rhinorrhea, unrelated to a specific allergen.1 Symptoms may be constant or may only present for a brief period of time. Symptoms may develop and resolve year-round. NAR can be divided into acute rhinitis, chronic rhinitis, atrophic rhinitis, and vasomotor rhinitis. NAR was previously referred to as nonallergic vasomotor or vasomotor rhinitis but was renamed because of a lack of evidence showing a vascular origin. The pathophysiology of NAR is complex and mainly unknown.

Epidemiology and Etiology

NAR is thought to be associated with dysregulation of sympathetic, parasympathetic, and nociceptive nerves innervating the nasal mucosa. Rhinitis affects roughly 20% of the population of industrialized countries.2 Annual healthcare costs for this average $1.9 billion in the United States. Symptoms occur most commonly between 30 and 60 years of age and affect women more than men.2

Clinical Presentation and Diagnosis

image NAR is clinically diagnosed by performing a complete medical history, physical examination, and diagnostic testing to rule out other possibilities.3 The most important factor in attaining a proper diagnosis of NAR is a comprehensive medical history and complete physical. Common symptoms that present with both allergic rhinitis (see Chapter 65) and NAR are headache, facial pressure, postnasal drip, coughing, and throat clearing.3-5 Environmental triggers may also affect NAR, such as strong odors, cold air exposure, alcohol, tobacco smoke, and/or spicy foods to name a few.6 If a skin test is performed, patients will typically have a negative skin test and serum antibodies for relevant allergens.6


Desired Outcomes

Minimize or prevent symptoms and prevent long-term complications.

General Approach to Treatment

The best overall treatment of NAR is the avoidance of an identified trigger while utilizing medical therapy as an adjunct option. Management of NAR first requires educating the patient ...

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