Among unconditioned reflexes embedded from birth, a protective reaction of the organism is evolved such as sneezing-a strong sudden uncontrolled release of air from the lungs through the nasopharynx, which occurs when the nasal mucosa irritates. The only function of this vegetative reflex is to clean the nasal cavity by removing the mucus containing foreign particles or irritants.
But sneezing can be a symptom of a number of diseases, and in this case it is a medical problem that has a code for ICD-10 - R06.7.
Causes of the sophistication
The mucous membrane of the nasal cavity has many functions, the fulfillment of which is provided by mucociliary clearance, the system of blood vessels, and also by local feedback systems through the mucous membrane, including sensory and autonomic reflexes. Normal sneezing occurs with certain disturbances in the performance of the vital vital function-respiration, and, in fact, is one of the physiological manifestations of the work of the parasympathetic nervous system, striving to maintain a stable state of the internal environment and to adapt the respiratory system to its temporal changes.
Sneezing is provoked by irritation of the receptors, which literally "stuffed" the mucous membrane of the ciliary (ciliary) epithelium of the nasal passages and sinuses of the nose. In addition to the receptors of the olfactory analyzer (which through the axons of neurons signal through the olfactory nerve into the orbitofrontal cortex of the brain), these are cold receptors (TRPM8); peptide receptors and tyrosine receptors for arteriovenous anastomoses (carrying blood to the sinuses of the nose); histamine receptors; beta and alpha-1-adrenergic receptors; muscarinic receptors (m-cholinergic receptors), etc. Receptor neurons are bipolar cells with unmyelinated axons on the basal surface.
The signal from them is transmitted "along the chain," and the reflex arc of sneezing (i.e., the sequence of signal transmission) in a simplified form looks like this:
neuron receptor → terminal processes of the olfactory nerve (I cranial) and trigeminal nerve (V cranium) → ventromedial spinal nucleus of the trigeminal nerve and autonomic reticular formation of the brainstem → peripheral motoneurons of somatic afferent fibers of the facial nerve (VII), lingagogy (IX), wandering X) and intercostal muscles → the effectors of muscles (pharyngeal, trachea and respiratory).
When the threshold value is reached, the efferent or respiratory phase of sneezing occurs. The first signs are well known to everyone: in the depths of the nasal passages there is a tickling (itching, seizure). Then there is an involuntary intermittent deep breath with the epiglottis closed and the glottis (the back of the tongue rises to partially close the passage into the oral cavity). Due to excess air volume, pulmonary pressure increases, and this air - with the participation of a whole group of muscles - is forcefully pushed out of the lungs through the nose, while the glottis widens. Since the mouth is not closed completely, a significant amount of air can escape through it. And the speed of the air that comes out during sneezing is such that with it, foreign particles, pathogenic microbes and droplets of mucous secretion "blow away" from the nasal mucosa. After this, the ciliary apparatus - the cilia of the epithelium lining the nasal cavity - is cleaned and performs its functions better.
In the same way, such kinds of sneezing as reaction to a sharp change in air temperature (cooling) and "solar sneezing" also occur. According to some sources, 10% of the world's population are sneezing when they come out to bright light, while others - at least 34%. And it manifests itself as an irresistible sneezing reflex of adaptation to light after being in the dark, which was called the Achoo syndrome (Autosomal Dominant Compelling Helioophthalmic Outburst). Most researchers associate the pathogenesis of this type of sneezing with the fact that the eyes and nose are innervated by one nerve - trigeminal.
Symptoms of the sophistication
Symptoms of almost all respiratory diseases include sneezing, and allergic sneezing and stuffy nose are almost the main signs of hay fever.
To the painful conditions in which sneezing and runny nose, as well as temperature and sneezing are leading symptoms, include an acute respiratory viral infection (usually caused by rhinovirus) and influenza. Response to infection - sneezing with colds - also causes rhinorrhea (a watery rhinitis), which quickly enough passes into a dingy rhinitis. In addition to rhinitis, with chills, sneezing and coughing occur, as well as pain in the throat, and then acute nasopharyngitis (or rhinopharyngitis) is diagnosed , and in advanced cases - sinusitis.
In addition to rhinovirus infection, nasopharyngitis or influenza, sneezing in a child is accompanied by infectious diseases such as chickenpox (chicken pox) and measles.
Fungal infections as a sneeze trigger are rare, and are usually found in patients with impaired immune function or diabetic ketoacidosis.
Itching in the nose and sneezing with allergies - including dust mites, pollen (seasonal allergies to plant pollen) - a result of sensitization of the body, which leads to the formation of persistent immune hyperreactivity of nasal mucosa. Studies have shown that in patients with an allergic rhinitis that accompanies itching and sneezing, the number of m-cholinergic receptors in the nasal mucosa is increased, and the density of beta and alpha-1-adrenergic receptors is significantly reduced. But the main cause of allergic sneezing is the release of histamine, which acts on the h1 and h2 receptors in the nose, as well as the stimulation of the sinus nerve caused by nasal congestion in allergies.
A trigger that causes frequent sneezing in adults and children (especially in the first year of life) can be reduced indoor air humidity (for example, when the air conditioner is used), house dust, mold on walls, household chemicals, tobacco smoke, etc. It should be borne in mind that chronic or frequent sneezing in 90% of cases is associated with an allergy, and its seizures occur even in the absence of direct exposure to allergic agents, which aggravates the problem.
A characteristic feature of allergic rhinitis is sneezing in the morning - on awakening. Nasal congestion, watery discharge from the nose, sneezing and lacrimation, itching in the eyes (especially in the late evening) are also common symptoms of this pathology. A similar clinical picture is observed with non-allergic rhinitis with eosinophilia syndrome.
However, as noted by otolaryngologists, excessive dryness in the nose , as well as polyps in the nasal cavity also provokes sneezing in the morning.
And such diseases as vasomotor rhinitis and atrophic rhinitis, as well as congenital or acquired curvature of the nasal septum cause sneezing without a cold.
Much less frequent sneezing without a cold appears when the stomach is full immediately after a plentiful meal. Physicians consider such phenomena as genetically caused disorder.
It is noteworthy that sneezing during pregnancy, which complains many future mothers, is due to all the same hormones, the development of which changes in the process of bearing a child. The fact is that in the nasal mucosa in women there are beta-estrogen receptors (ERbeta), so an increase in the synthesis of estrogen during pregnancy and causes the reaction of these receptors and, accordingly, a slight itch in the nose and sneezing. In addition, edema of the nasal mucosa is provoked by progesterone, which increases the production of mucin.
Since many muscle groups are strained, there is often such a nuisance as incontinence when sneezing (especially if the bladder is full at the time of sneezing).
Iatrogenic causes of sneezing include a variety of medications that irritate the nasal mucosa. First of all, they are drops-decongestants for the nose, with the help of which they struggle with its stuffiness. Further follows, NSAIDs, beta-blockers, diuretics and antidepressants. In women of childbearing age, sneezing attacks are possible with prolonged use of hormonal contraceptives.
Complications and consequences
It should be remembered that the consequences and complications of stopping sneezing by closing the mouth and nose can cause damage to the eardrums, and mucus (with microbes or particles of pus) from the nasal cavity can get into the Eustachian tube that connects the nasopharynx with the middle ear and cause otitis .
There have been reports of cases of rupture of cervical intervertebral discs as a result of severe sneezing. This is the so-called whip effect, when the head moves forward and back very quickly.
A few years ago in the British press there was a message about the death of 18-year-old Dean Rice from South Wales, who sneezed several times in a row, fainted and, unconscious, died due to a vast brain hemorrhage that triggered sneezing.
Diagnostics of the sophistication
In fact, the diagnosis of sneezing is the identification of its cause. With a common cold, no tests are required, but when there are reasons to suspect an allergic nature of the pathology, allergic tests and differential diagnosis may be required. And the diagnosis will be made by an allergist.
Rhinoscopy, as an instrumental diagnosis of the state of the nasal cavity, is a nasal examination with the help of special nasal and nasopharyngeal mirrors. For an otolaryngologist, such an examination gives practically all the necessary information that it is necessary to put the right diagnosis and prescribe a treatment.
The formulation "treatment of sneezing" is incorrect from the medical point of view, because it is impossible to cure an unconditioned reflex (sneezing remains a reflex even in the form of a symptom), and a disease that causes this symptom should be treated.
In most cases, patients are prescribed symptomatic topical solutions - various drops and sprays for the nose.
Thus, vasoconstrictive drops Vibrocil with phenylephrine and dimethindene help with nasal congestion and rhinorrhea and are intended to relieve symptoms in the rhinitis and sneezing of any etiology (except atrophic rhinitis). Adults and children older than six years are recommended to instill 1-2 drops of the drug in each nasal passage three times during the day. Also there is a Vibrocil spray, which is applied one injection three times a day. This remedy can not be used for more than a week; it can cause side effects in the form of dryness and burning in the nose; pregnant women Vibrocilum is contraindicated (due to the presence of a derivative of ephedrine in its composition).
To remove the swelling of the nasal mucosa and improve nasal breathing with vasomotor rhinitis or sinusitis, the aerosol drug Rinofluucimil (method of administration and dosage as in Vibrocil) is used. Sneezing during pregnancy, they also do not need to be treated, since in the list of its side effects, there are more frequent pulses, increased blood pressure and problems with urination.
Medications for allergic rhinitis and sneezing Aldecin (Beklazone) and Nazonex also have the form of a spray. They contain corticosteroids and are best used for allergic rhinitis (1-2 injections per nostril once a day). In this case, possible side effects of drugs with GCS include irritation, itching and dryness in the nose, bleeding of the mucosa, and with prolonged use - perforation of the nasal septum.
Homeopathy uses in the treatment of rhinitis allergic etiology such preparations in the form of a spray, like Rinalital and Delufen, which are recommended to be applied once in a single injection 3-4 times a day (adults and children 12 years and older).
If sneezing is associated with a stuffy nose with a cold, then herbal treatment can help fight the swelling of the nasal mucosa. Firstly, they are steam inhalations with oils of peppermint, eucalyptus, juniper, which have antibacterial properties.
When infections of the upper respiratory tract, accompanied by a runny nose and sneezing, it is recommended to use broths of chamomile flowers, kaprya, elecampane (tablespoon per 250 ml of water). You can drink tea with the root of ginger, lemon and honey.
They advise twice a day to drink a decoction of fenugreek seeds. For its preparation, it is enough to boil two tablespoons of seeds in 300 ml of water and insist for 40-45 minutes.
In addition, the cleaning of the nasal passages is promoted by the paste from garlic. It is necessary to crush four to five cloves of garlic in a container and from time to time to inhale its strong flavor. It is useful to include raw garlic in your diet, adding it to salads or sauces.
In the treatment of the symptoms of respiratory viral infection, vitamins, especially ascorbic acid, whose antioxidant properties are able to control the production of histamine, help.
Sneezing a sick person is the most common way of spreading bacterial infections: influenza, rhinovirus, measles, mumps, rubella, tuberculosis, etc. Therefore, sneezing prevention is a prevention of infection by airborne diseases.
The tried and tested methods for reducing the risk of sneezing consist in reducing the interaction with irritating substances that cause an allergic reaction.
Examples of preventive methods are: deep breaths at the time of the onset of sneezing; holding the breath with a slight pinching of the nose for a few seconds.
Last update: 05.10.2018
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"