La rinitis y sus cuidados

Santo Domingo.- Muchas personas llegan a la consulta de otorrinolaringología con problemas nasales pensando tener sinusitis, aunque no es así.

La rinitis es la inflamación de la mucosa nasal y sinusal (senos paranasales) que cursa generalmente con obstrucción nasal, salida de secreción nasal (rinorrea), disminución del olfato (hiposmia), entre otros.

Tipos de rinitis

La rinitis se clasifica en rinitis alérgica, vasomotora e infecciosa. La primera es la más común, esta se produce por exposición a alérgenos como los ácaros del polvo, también ocurre por exposición a polen o pasto; mientras que la vasomotora generalmente se debe a mal uso de medicamentos (mentol, descongestionantes nasales); y la infecciosa se debe por lo general a virus. Las rinitis se asocian a pólipos y sinusitis.

De acuerdo a la otorrinolaringóloga, rinóloga y especialista en cirugía cérvico facial, doctora Pamela Pol, la sinusitis o rinosinusitis es la inflamación infecciosa de la mucosa nasal y de los senos paranasales; que puede ser aguda cursando por lo general por obstrucción nasal, dolor facial o craneal, fiebre, rinorrea (moco espeso amarillo o verdoso), cuyos síntomas duran menos de 4 semanas y que es producida muchas veces por virus (rinovirus, virus de influenza).

Agrega que es producida por bacterias como el estreptococo neumoneae y el haemofilus influenzae, y rara vez por hongos (en pacientes diabéticos o muy alérgicos).

El lado crónico

Pamela Pol indica que la crónica ocurre con crisis repetitivas o persistentes de sinusitis por más de 4 meses y se asocia a poliposis nasal; sus síntomas son obstrucción nasal, cacosmia (sensación de mal olor en la nariz o al respirar) en ocasiones se acompaña de dolor facial o craneal, dificultad para dormir y comer por la obstrucción respiratoria, entre otros síntomas.

Rinitis alérgica

“En el caso de la rinitis alérgica los pacientes pueden tener síntomas todo el año, es lo que se llama rinitis persistente, debida a los ácaros del polvo, y síntomas por periodos de tiempo que coinciden con el polen de las flores en la primavera en muchos casos a lo que llamamos rinitis intermitente o estacional”, puntualiza la otorrinolaringóloga, rinóloga y especialista en cirugía cérvico facial.

Y agrega que en el país, por el clima y la flora propias de la isla, estos cuadros pueden variar y el diagnóstico de la rinitis se realiza con la historia de la enfermedad y realización de pruebas que confirman la reacción alérgica ante diferentes alérgenos y elevación de los mediadores de la alergia en sangre y moco nasal.

La más común

Pol precisa que la rinitis alérgica es la enfermedad alérgica más común y en muchos pacientes se acompaña de otras enfermedades alérgicas como el asma bronquial, urticaria, conjuntivitis y alergias alimentarias.

“El tratamiento de la rinitis se debe orientar al control de la reacción alérgica y esto se trabaja en equipo: el otorrinolaringólogo y el alergólogo o alergista, el pediatra y el neumólogo según el caso”, sostiene.

La doctora Pamela Pol, quien es coordinadora del Departamento de Otorrinolaringología y Cirugía Cervico facial de Cedimat, indica que “los esteroides tópicos nasales son los más efectivos en el tratamiento y los que usamos por más tiempo, los antialérgicos generalmente de uso intermitente y la inmunoterapia en muchos pacientes es la solución adecuada”.

¿Cuándo se debe recurrir a la cirugía?

Pamela Pol manifiesta que, en caso de que la alergia produzca cambios en las estructuras nasales, como la hipertrofia de cornetes o adenoides, se recurre a la cirugía siempre acompañada del tratamiento médico a mediano y largo plazo.

Recuerda que la sinusitis se diagnostica por la clínica y tomografía de nariz y senos paranasales.

La sinusitis crónica siempre es quirúrgica y debe estar a cargo de otorrinolaringólogos con entrenamiento en cirugía endoscópica nasal.

La médico especialista de Cedimat puntualiza que las cirugías permiten la recuperación pronta del paciente por ser mínimamente invasivas y también ayudan a prevenir y tratar complicaciones, y deben ser complementadas con tratamiento médico.

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