Treatment update: nonallergic rhinitis.

Chronic nonallergic rhinitis is a diagnosis of exclusion. The pathophysiology underlying this disorder is unknown. There probably are several mechanisms involved and several different variations of this condition. Therapies which have been approved for use in the treatment of chronic nonallergic rhinitis include topical corticosteroids and azelastine. Topical corticosteroid preparations that have received approval are fluticasone, budesonide, and beclomethasone. Topical nasal saline also has been established as a beneficial adjunct to therapy in some instances. Other therapies have included capsaicin, silver nitrate, botulin toxin, and various surgical procedures. These procedures include turbinate reduction, which has been performed by a number of techniques including submucosal diathermy, cryosurgery, laser cautery, and classic resection. Ethmoidal and vidian neurectomies have been performed by excision, diathermy, and cryotherapy. These procedures have met with varying degrees of success.