The term rhinitis refers to an inflammatory disease of the asal mucosa.

It is a common pathophysiologic process that affects individuals of all ages. A number of discrete mechanisms are involved in the pathogenesis of rhinitis, including both allergic and nonallergic. In the practice of otolaryngology, physicians will be asked to evaluate and treat patients with rhinitis on a daily basis. The ability to understand the specific pathophysiologic mechanisms involved in rhinitis and the accuracy with which otolaryngologists are able to diagnose and characterize this common group of diseases will determine their degree of success in facilitating positive outcomes among patients with both allergic and nonallergic rhinitis.

Rhinitis is defined broadly as a disease of the nasal mucosa that has as its hallmark significant nasal inflammation. This inflammation can be acute or chronic and leads to a duster of symptoms that may include sneezing, nasal itching, rhinorrhea, impairment in smell, and nasal congestion (1). Although many of these symptoms can be experienced commonly by individuals on an intermittent basis, in the patient with rhinitis the symptoms occur more frequently and have significant impact on function_ and quality of life. The diagnosis of rhinitis, therefore, often rests on both the evaluation of the physician and the report of the patient as to the clinical relevance of those symptoms. A recent consensus document has classified rhinitis into one of four categories: (a) structural, (b) infectious,

(c) allergic, and (d) other (2). These categories can be difficult to apply, however, and do not allow a precise understanding of the various types of rhinitis that are placed into the "other" category. In addition, overlap between two or more of these classes is quite common, leading to a classification of rhinitis as being "mixed" in a significant proportion of patients complaining of symptoms of nasal inflammation. Furthermore, the lack of clear diagnostic criteria and the absence of reliable diagnostic tests often add to the confusion in reaching a precise diagnosis of the type of rhinitis and its most favorable treatment. In addition to the importance of rhinitis as a discrete illness, both allergic and nonallergic rhinitis contribute significantly to the pathogenesis of other upper and lower respiratory illnesses. Rhinitis exists as a comorbid condition with common illnesses such as rhinosinusitis, asthma, and otitis media with effusion, contributing to the severity of these illnesses and affecting the ability of patients to achieve adequate control (3). In addition, rhinitis has been noted to play a major role in the pathogenesis and expression of symptoms among individuals with sleep-disordered breathing. The interaction among these respiratory conditions suggests a uniform pattern of diffuse inflammation in the upper and lower airway.
Prevalence

Rhinitis is a very common clinical illness not only in the United States but throughout the world. Recent prevalence surveys by the United States Public Health Service consistently rank rhinitis among the most frequent of chronic illnesses. In one 2001 study, it was estimated that at least 58 million Americans suffer from allergic rhinitis (AR),