Therapist have often relied upon “clinical signs” to assist in determining if a patient is experiencing aspiration. Those signs have included coughing (see "Cough Up The Facts"
previous blog post), throat clearing, wet vocal quality, runny nose, and many others. There is very little empirical evidence to support the correlation of “clinical signs” to an episode of aspiration. A runny nose is often considered to be a salient sign of aspiration; perhaps this is an over generalization.
Rhinitis is a nonspecific term that covers infections, allergies, and other disorders whose common feature is the location of their symptoms. In rhinitis, the mucous membranes become infected or irritated, producing a discharge, congestion, and swelling of the tissues. The dysfunction can be divided into two major categories: allergic and nonallergic.1
Allergic rhinitis is the more well-known of the two broad types. It affects 10 - 30% of the adult population in the US. Many people suffer from seasonal or persistent allergies that result in a runny nose and watery eyes. Interestingly enough, rhinitis is more common in males during adolescence and young adulthood but shifts to being more common in females in the aged
population.2
An estimated 19 million people in the US suffer from nonallergic rhinitis. The occurrence increases with age and is more common in females. Greater than 60% of rhinitis patients over the age of 50 suffer from this type. The increase of non-allergic rhinitis in the aging population is multifactorial.1
Immunosenescence, the change of immune function with age, occurs due to deterioration of the thymus, decreasing T-cell production. In addition, several anatomical and physiological changes occur in the nose. The loss of nose tip support develops because of weakening of fibrous connective tissue. Weakening and fragmentation of the septal cartilage and retraction of the nasal columella cause changes to the nasal cavity. Decreased airflow caused by these changes may lead to complaints of nasal obstruction, cough, a loss of smell, and a runny nose.3
Geriatric rhinitis is a broad term used to signify rhinitis due to age related changes. These changes lead to persistent mucus, postnasal drip, chronic cough, nasal obstruction and dryness. Patients may also complain of the need to clear the throat frequently.4,5
Many medications commonly prescribed in the geriatric population are known to induce rhinitis. These medications include beta blockers, alpha blockers, antihypertensive, ACE inhibitors, typical antipsychotics, gabapentin (Neurontin), citalopram (Celexa), and niacin (vitamin B3). This information validates the importance of reviewing medications prior to patient assessment.6,7
Although Speech Pathologists have often associated runny nose with swallowing difficulties, the association lacks scientific evidence. Many geriatric individuals may suffer from a runny nose due to seasonal allergies, or simply because of the normal aging process. Medication may also be an important factor. The best practice would be to quickly hand the patient a tissue and be slow to draw additional conclusions.
References:
1. Settipane R, Charnock D: Epidemiology of rhinitis: Allergic and nonallergic. Clin Allergy Immunol 2007, 19:23-34.
2. Ly T, deShazo R, Olivier J, Stringer S, Daley W, Stodard C: Diagnostic criteria for atrophic rhinosinusitis. Am
J Med 2009, 122(8):747-53.
3. Edelstein D: Aging of the normal nose in adults. Laryngoscope 1996, 106(9 Pt 2):1-25.
4. Pinto and Jeswani, Rhinitis in the geriatric population Allergy, Asthma & Clinical Immunology 2010, 6:10.
5. Reiss M, Reiss G: Rhinitis in old age. Praxis 2002, 91(9):353-8.
6. Jordan J, Mabry R: Geriatric rhinitis: What it is, and how to treat it. Geriatrics 1998, 53(76):81-4.
7. Mehrotra R, Singhal J, Kawatra M, Gupta S, Singh M: Pre and posttreatment histopathological changes in
atrophic rhinitis. J Pathol Microbiol 2005, 48(3):310-3.
