Chronic nasal complaints developing later in life are usually not allergic in origin. The most likely causes of new-onset rhinitis in patients older than 60 years of age includes nonallergic rhinitis, anatomic obstruction (such as a deviated septum or concha bullosa), drug-induced rhinitis (topical decongestants and some blood pressure medications), and rhinitis associated with systemic dis-eases (most commonly hypothyroidism).
In older patients, nonallergic rhinitis is frequently aggravated by dryness of the nasal membranes and loss of cartilage in the supporting structures of the nose. The loss of cartilage is due to a reduction in collagen protein synthesis, which is present throughout the body. This resultant sagging of the external portion of the nose further adds to the reduction in airflow through the nose. Treatment of nonallergic rhinitis in the elderly should generally include some form of nasal moisturization treatment, such as an over-the-counter nasal saline spray, and a medication. The two medications that have proven most effective for nonallergic rhinitis and that are approved by the U.S. Food and Drug Administration (FDA) for this indication are fluticasone propionate nasal spray, which is an intranasal steroid, and azelastine nasal spray. Both of these med-ications have been shown to reduce nasal congestion and discharge significantly. For patients who primarily have watery discharge without stuffiness, ipratropium bromide nasal spray is an effective alternative and has also been approved by the FDA for treatment of this symptom. Other medications, such as oral antihistamines, oral decongestants, and montelukast, have not been properly evaluated in patients with nonallergic rhinitis, and in my experience, have not been particu-larly helpful to these patients.
Concha bullosa
An air pocket that occurs in the nasal turbinate bones, causing enlargement of the turbinate and often resulting in obstruction to airflow.