Intro: Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward. Here's Melanie Cole.

Melanie Cole, MS (Host): Welcome to UAB MedCast. I'm Melanie Cole. And today, we're talking about the never-ending drippy nose, practical solutions for chronic rhinitis. Joining me is Dr. Do-Yeon Cho. He's an otolaryngologist, a specialist in rhinology and sinus surgery at UAB Medicine.

Dr. Cho, thank you so much for being with us today. So many people struggle with a constantly dripping nose. I hear that all the time. So, what exactly is chronic rhinitis? How is it different when we hear people say, "Oh, I've got seasonal allergies" or a cold? Tell us a little bit about how those three things are different.

Dr Do-Yeon Cho: Yes, chronic rhinitis simply really means like inflammation inside of your nasal cavity, you're lining in your nose. So, symptoms, for example, like you do have runny nose, also congestion, stuffy nose, and sneezing. And also a lot of people complain about postnasal drip, which is lasting more than 12 weeks, about three months, then we call it chronic. So, chronic rhinitis are those symptoms.

Of course, exactly. Melanie, you just really hit the right mark about how people talk about it can be the flus or something cold or allergies. So, cold, usually about very short-lived, which means it's caused mostly by the viruses. And also, more of a like clear, but at the same time sometimes very mucusy and the yellowish drainage. And it's usually less than about four weeks, less than six weeks. And season allergies, they probably tend to fluctuate with a pollen exposure.

So right now, we're in spring. So probably, there are a lot of tree pollens and those symptoms are also combined with some sneezing. And also, it actually gets better when the season is over. Those are the seasonal allergies. But chronic rhinitis, it's an ongoing issue. It also can be related to allergic or can be also non-allergic. But usually, it doesn't really fully resolve on its own.

Melanie Cole, MS: Okay. Well, thank you so much for explaining that. What are the most common reasons that you see every day that someone's nose keeps running all the time?

Dr Do-Yeon Cho: Well, there's two categories: allergic rhinitis and non-allergic rhinitis. I told you earlier, allergic could be triggered by some allergens. For example, like pollen, like your dust mite or if you have a cat or dog dander or some mold. But if you're non-allergic, which are actually triggers like weather changes or any temperature changes or probably strong smells or even eating. I do have a lot of patients coming to the clinic with a chronic drainage from the both side of nostrils when they are eating food. That's really affecting their quality of life.

Melanie Cole, MS: So then, are there triggers? Are there things that make chronic rhinitis worse, Dr. Cho? When we think about, you know, things in the home and filters and just dust mites, I mean, there's all kinds of things that make people with allergies get those triggers. But for rhinitis, are those kind of similar?

Dr Do-Yeon Cho: Yes. Very similar, but the chronic rhinitis symptoms, it has been told that a lot of studies demonstrated it's got worsening when you get older. I'm also getting older, I notice that there are more clear drainage coming out my nose where the environment changes or eating food or any temperature changes.

So, a lot of times, the allergies are exactly related to the dust and pollens, environmental allergies, but also like temperature changes, cold air or strong odors or perfumes, even smoke or somethng like spicy food or even alcohol smells or air pollutions. All these ones can trigger sometimes the non-allergic triggers. And then, a lot of people think that these kind of non-allergic triggers, sometimes they're really unrecognized and they probably didn't know what are actually causing this. But they probably can notice themselves carrying tissues with them all the time. So, that was one of the things you probably can notice it.

Melanie Cole, MS: Yeah, that makes so much sense. So when we think of first-line treatments, do nasal sprays, antihistamines, do those work for people that have this chronic rhinitis that have this all-year-round and it really can affect quality of life and the things that you do.? Are there some treatments for first-line? Tell us what's going on.

Dr Do-Yeon Cho: So if you do have chronic rhinitis symptoms, there's a lot available in your over-the-counter medication. If you don't need any prescriptions, you can start with the oral antihistamines. Also, you can just start nasal steroid sprays. These are usually the first-line of effective treatments, especially when you have allergic rhinitis. Even though you're not allergic, all these steroid nasal spray working as an anti-inflammatory, they reduce some inflammations. And also, some patients really respond pretty well. And, you know, these are the one of the first things that I recommend.

Another option is you can also rinse your nose with saline. That is also going to like mechanically wash out some of the allergens and pollens or dust from your nose that also can help you to relieve some of your symptoms as the first line.

Melanie Cole, MS: Now, tell us about a procedure that you offer at UAB for intractable chronic drippy nose. Is it temperature-controlled ablation of the posterior nasal nerve, that's what you're doing there?

Dr Do-Yeon Cho: Yes. This is an exciting procedure. Before we actually recommend this procedure, when the patients come to our clinic, we also give another spray called anticholinergic nasal spray, which is one of the sprays that really worked for the chronic rhinitis, especially, for those patients who have a lot of drippy nose from the strong smells or eating foods.

So, a lot of these symptoms triggered by—there's a nerve called the parasympathetic nerve. And this anticholinergic nasal spray—sorry about this long name—but this spray really helps these kinds of drainage. So when these people responds to the spray, then they also stay on this spray. However, it's really cumbersome. And they're really affecting their quality of life. They carry tissue all the time, they go to restaurants eating with their friends or families. And these patients now recommend this procedure.

This procedure actually plays very key roles in reducing number of secretions coming out your nostril. So, this can be done under any local or mild sedation. if you don't want to feel anything, you can also have a little bit of more stronger sedation. It really doesn't cut or anything. it's not really the surgical resections. We actually ablate the nerve inside your nose right behind the inferior and middle turbinates. You go home the same day. And the procedure time itself, it is only about 20, 30 minutes in both sides.

Melanie Cole, MS: Wow, that's pretty exciting, Dr. Cho. And as I understand it, you've done more than 200 cases at UAB and in Birmingham so far. So, what have been the outcomes? What are patients saying about their results?

Dr Do-Yeon Cho: Well, the most recent study came out, about 80% of these patients have meaningful reduction in nasal drainage, and they improve quality of lives. So, a lot of my patients told me that it was a life-changing experience. They're really happy with the results. Of course, they're not a hundred percent, but there are 70-80% patients.

Majority of patients respond pretty well, and we're not cutting or anything completely resecting your nerve. So, it usually lasts about two or three years coming out the study. So, you probably can have relief of your symptoms about two, three years; and importantly, not completely eliminating your normal nasal functions. So, it's more of like bringing the system back into the balance.

Melanie Cole, MS: That's really cool, Dr. Cho. And even after this type of procedure, are there some lifestyle home strategies that can help to reduce this? What do you recommend that patients do? And for other providers that are seeing these patients? Do you have some recommendations of some home strategies?

Dr Do-Yeon Cho: Yes, of course. So, nasal hygiene is very important. Sometimes saline rinses try to remove mechanically some of the irritants in your nose, especially when you're very stuffy, and you did a lot of outdoor work or hike or social activities. And also, avoiding trigger is probably number one.

If very dry you can use humidify. That also really helps. And also, for the providers, I've seen a few patients coming with a drainage. It's the drainage only from one side of nostril only on the left or the right. You also have to think about the drainage may not be from the rhinitis. Sometimes in a very typical scenarios also, it can be related from your brain fluid leak called a CSF leak. So, if you have chronic drainage, from one side of nose, you also have to be very careful about what would a diagnosis. As a provider, I also just make sure that when they come to our clinic, I usually go over all these risk and benefits; at the same time, what would be the cause of the symptoms. So, these are the very important before you actually start the management.

Melanie Cole, MS: Dr. Cho, you've given us so much great information today. And if there is one thing that you wish more people understood about managing a constantly running nose, speak to that now. Give us your best advice. And if there's any newer, exciting research treatments, I would love for you to tell us about that.

Dr Do-Yeon Cho: Oh, yes, of course. One of the misconception is that the runny nose is just always allergies. But in many patients, it could be other non-allergic or mixed rhinitis, which requires a different approach. So if the patient has the non-allergic rhinitis, then the allergy medication may not have a real improvement.

So, the key is that we have to identify what's the underlying mechanisms. And we probably have to tailor those treatments accordingly. And then when appropriate, I recommend to consider procedure options earlier than later, which may improve your quality of life. Now, there are several options available for the ablation technologies. They're temperature controlled. There's heat energies. And also, there is cold energies. So, there's options available. So, you probably can have all these options available so you can actually pick and choose which one you want it to go.

Melanie Cole, MS: Thank you so much, Dr. Cho, for joining us today and really sharing your incredible expertise. Thank you again. And for more information, you can visit our website at uabmedicine.org/physician. That concludes this episode of UAB MedCast. I'm Melanie Cole. Thanks so much for joining us today.