Runny noses aren't just for youngsters!

The elderly population (over 65 years old) is one of the fastest growing age groups in the U.S. With age comes, unique causes for rhinitis (stuffy, runny nose) compared to other age groups. Yes, there is overlap, but in the elderly, there are distinctive aspects of care to be considered.

Here is a list of potential causes of stuffy, runny noses in our aging population.

• Allergy: This is much less common than in children and young adults. It affects less than 3 per 1000 elderly persons. Frequently, the allergies are “carry-over” from younger times and can be both indoor or seasonal (pollens). Allergy skin test and blood test results can wane in the elderly but are still helpful.

• Infectious: Viral colds can be more severe in older persons. All elderly are recommended to receive the seasonal influenza vaccine. Sinus infections occur in 17% of 65 to 74 year olds.

• Non-allergic/non-infectious

1. Primary atrophic: This is often seen in the elderly. There is a constant unpleasant smell called ozena due to infection with Klebsiella ozaenae bacteria.

2. NARES (Non-Allergic Rhinitis with Eosinophilia Syndrome): Symptoms are sneezing, profuse, watery runny nose and nasal itching that is year round. The cause and prevalence of this in the elderly is unknown, but thankfully it is easily treatable with nasal steroid sprays such as Nasonex, Qnasl, or Flonase.

3. Rhinitis medicamentosa: This means a medication is causing the nasal congestion. The congestion can be severe and greatly affect quality of life. This can occur with high blood pressure medications including beta-blockers, central adrenergic blockers, postganglionic adrenergic blocker, alpha-adrenergic blockers, vasodilators and diuretics. Aspirin and NSAIDs may cause rhinitis in some and trigger asthma or anaphylaxis in a small proportion. Estrogen treatment may trigger nasal congestion. Medications to treat erectile dysfunction can lead to nasal congestion as well. If the nasal congestion last longer than 4 hours, consult your doctor! One of the most common groups of medications to trigger nasal congestion is overuse of nasal decongestant sprays such as Afrin or Neosynephrine. The rebound congestion when trying to stop can be severe.

4. Geriatric: During the normal aging process, not only does the outward appearance of the nose change, but there are also physiologic and anatomical changes within. There is weakening of the supporting cartilage and connective tissue leading to loss of nasal tip support resulting in air flow restriction at the “nasal valve” area. This causes nasal obstruction. With advancing age, there is less nasal mucus produced and what mucus is produced is thicker and more tenacious. There is also a loss of “tone” from the blood vessels that presents as exaggerated nasal swelling on the downward side due to gravity. There can also be a decrease in sense of smell related to less olfactory neurons, damage from viral illness, or less inspired air.

5. Physical: This means sneezing or runny nose after eating hot or spicy food (gustatory) glancing into the sunlight, or with cold air (skiers’ nose). These are mediated through a nerve reflex and respond to a special nasal spray called ipratropium (Atrovent).

6. Tumors: Tumors in the nose are not very common, but if congestion is persistent, this should be evaluated. Nasal polyps rarely are cancerous and respond to nasal sprays if they are small. If they are large, an ENT surgeon will evaluate and possibly remove them. Interestingly, nasal polyps do not hurt, but the first symptom of a polyp is a decreased sense of smell. Nasal septal deviation can lead to obstruction on one side or the other.

7. Other: less common triggers of nasal problems in elderly consist of 1) granulomas (caused by disorders such as Wegener’s or sarcoid) which frequently include nasal ulcers; 2) collagen vascular disorders such as Behcets or Sjogren syndrome); 3) CSF (cerebrospinal fluid) leak either from tumor, trauma or spontaneous leak; 4) hypothyroidism (low thyroid); and 5) idiopathic (we don’t know!)

At Family Allergy Asthma & Sinus Care, we know the decreased quality of life that comes with chronic nasal congestion. While some nasal symptoms may be “age-related,” frequently there are other conditions that should not be overlooked. Treatment is available!