Sneezing

Among the unconditional, innate reflexes, such a protective reaction of the body as sneezing stands out - a strong, sudden, uncontrolled release of air from the lungs through the nasopharynx, which occurs when the mucous membrane of the nose is irritated. The only function of this vegetative reflex is to cleanse the nasal cavity by removing 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 with the ICD-10 code R06.7.

Causes sneezes

The mucous membrane of the nasal cavity has many functions, the performance of which is ensured by mucociliary clearance, the blood vessel system, and local feedback systems through the mucous membrane, including sensory and vegetative reflexes. Normal sneezing occurs when there are certain interferences in the implementation of the most important vital function - breathing, and, in fact, is one of the physiological manifestations of the parasympathetic nervous system, which strives to maintain a stable state of the internal environment and adapt the respiratory system to its temporary changes.

Sneezing is provoked by irritation of receptors, which literally “stuff” the mucous membrane of the ciliated epithelium of the nasal passages and sinuses. In addition to the receptors of the olfactory analyzer (which send a signal through the olfactory nerve to the orbitofrontal cortex of the brain via the axons of neurons), these are cold receptors (TRPM8); peptide receptors and tyrosine receptors of arteriovenous anastomoses (carrying blood to the sinuses); histamine receptors; beta- and alpha-1-adrenergic receptors; muscarinic receptors (m-cholinergic receptors), etc. The neurons of the receptors are bipolar cells with unmyelinated axons on the basal surface.

The signal from them is transmitted “along a chain”, and the sneezing reflex arc (that is, the sequence of signal transmission) in a simplified form looks like this:

• receptor neuron → endings of the processes of the olfactory nerve (I cranial) and trigeminal nerve (V cranial) → ventromedial spinal nucleus of the trigeminal nerve and the autonomic reticular formation of the brainstem → peripheral motor neurons of the somatic afferent fibers of the facial nerve (VII), glossopharyngeal (IX), vagus (X) and intercostal muscles → effectors of the muscles (pharyngeal, trachea and respiratory).

When the threshold value is reached, the efferent or respiratory phase of sneezing begins. The first signs are familiar to everyone: a tickling sensation (itching, itching) is felt deep in the nasal passages. Then an involuntary, intermittent deep breath occurs with the epiglottis and glottis closed (the back of the tongue rises to partially close the passage into the oral cavity). Due to the excess volume of air, intrapulmonary pressure increases, and this air - with the participation of a whole group of muscles - is forcefully pushed out of the lungs through the nose with a simultaneous expansion of the glottis. Since the mouth is not completely closed, a significant amount of air can come out through it. And the speed of the air coming out during sneezing is such that it “blows away” foreign particles, pathogenic microbes and droplets of mucous secretion 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.

The same way occurs such types of sneezing as a reaction to a sharp change in air temperature (cold weather) and "solar sneezing". According to some data, 10% of the world's population sneeze when going out into bright light, according to others - at least 34%. And this manifests itself as an irresistible sneezing reflex of adaptation to light after being in the dark, which is called 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 - the trigeminal.

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Symptoms sneezes

Symptoms of almost all respiratory illnesses include sneezing, and allergic sneezing and nasal congestion are among the main symptoms of hay fever.

Painful conditions in which sneezing and runny nose, as well as fever and sneezing, are the leading symptoms include acute respiratory viral infection (usually caused by rhinoviruses) and influenza. The response to infection - sneezing with a cold - also causes rhinorrhea (runny nose), which quite quickly turns into a thick runny nose. In addition to rhinitis, with a cold there is sneezing and coughing, as well as a sore throat, and then acute nasopharyngitis (or rhinopharyngitis) is diagnosed, and in advanced cases - sinusitis.

In addition to rhinovirus infection, nasopharyngitis or flu, sneezing in a child accompanies infectious diseases such as chickenpox and measles.

Fungal infections as a sneezing trigger are rare and are usually found in patients with compromised immune function or diabetic ketoacidosis.

Itching in the nose and sneezing due to allergies, including dust mite allergies, hay fever (seasonal allergy to plant pollen) are a consequence of sensitization of the body, which leads to the formation of persistent immune hyperreactivity of the nasal mucosa. Studies have shown that patients with allergic rhinitis, which is accompanied by itching and sneezing, have an increased number of m-cholinergic receptors in the nasal mucosa, and the density of beta- and alpha-1-adrenergic receptors is significantly reduced. But the main reason causing allergic sneezing is the release of histamine, which acts on h1 and h2-receptors in the nose, as well as stimulation of the sinus nerve caused by nasal congestion due to allergies.

A trigger that causes frequent sneezing in adults and children (especially in the first year of life) can be low humidity in the room (for example, when the air conditioner is running), house dust, mold on the walls, household chemicals, tobacco smoke, etc. It should be borne in mind that chronic or frequent sneezing in 90% of cases is associated with allergies, and its attacks 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 - upon awakening. Nasal congestion, watery nasal discharge, sneezing and watery eyes, itchy eyes (especially late in the evening) are also common symptoms of this pathology. A similar clinical picture is observed in non-allergic rhinitis with eosinophilia syndrome.

However, as otolaryngologists note, excessive dryness in the nose, as well as polyps in the nasal cavity, also provoke sneezing in the morning.

And diseases such as vasomotor rhinitis and atrophic rhinitis, as well as congenital or acquired curvature of the nasal septum cause sneezing without a runny nose.

Much less often, a sneezing attack without a runny nose occurs when the stomach is full immediately after a large meal. Doctors consider this phenomenon to be a genetically determined disorder.

It is noteworthy that sneezing during pregnancy, which many expectant mothers complain about, is caused by the same hormones, the production of which changes during the process of bearing a child. The fact is that in the nasal mucosa of women there are receptors of beta-estrogen (ERbeta), so the increase in the synthesis of estrogen during pregnancy causes a reaction of these receptors and, accordingly, slight itching in the nose and sneezing. In addition, swelling of the nasal mucosa is provoked by progesterone, which increases the production of mucin.

Since many muscle groups are heavily strained, such an unpleasant thing as incontinence when sneezing often occurs (especially if the bladder is full at the time of sneezing).

Iatrogenic causes of sneezing include many medications that irritate the nasal mucosa. First of all, these are decongestant drops for the nose, which are used to combat nasal congestion. Next come 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 enter the Eustachian tube, which connects the nasopharynx to the middle ear, and cause otitis.

There have been reports of cervical discs rupturing as a result of a violent sneeze. This is called the whiplash effect, where the head moves back and forth very quickly.

Several years ago, the British press reported the death of 18-year-old Dean Rice from South Wales, who sneezed several times in a row, fainted and, without regaining consciousness, died due to a massive brain hemorrhage, which was provoked by the sneezing.

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Diagnostics sneezes

In essence, sneezing diagnostics is identifying its cause. No tests are required for a common cold, but when there is reason to suspect an allergic nature of the pathology, allergy tests and differential diagnostics may be required. And the diagnosis will be made by an allergist.

Rhinoscopy, as an instrumental diagnostics of the nasal cavity, is an examination of the nose using special nasal and nasopharyngeal mirrors. For an otolaryngologist, such an examination provides almost all the necessary information to make the correct diagnosis and prescribe treatment.

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Treatment sneezes

The wording “treatment of sneezing” is incorrect from a 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 it is necessary to treat the disease that causes this symptom.

In the vast majority of cases, patients are prescribed symptomatic topical agents – various nasal drops and sprays.

Thus, vasoconstrictor drops Vibrocil with phenylephrine and dimethindene help with nasal congestion and rhinorrhea and are intended to relieve symptoms of runny nose and sneezing of any etiology (except atrophic rhinitis). Adults and children over six years old are recommended to instill 1-2 drops of the drug in each nasal passage three times during the day. There is also a Vibrocil spray, which is used one spray three times a day. This product cannot be used for more than a week; it can cause side effects in the form of dryness and burning in the nose; Vibrocil is contraindicated for pregnant women (due to the presence of an ephedrine derivative in its composition).

To relieve swelling of the nasal mucosa and improve nasal breathing in vasomotor rhinitis or sinusitis, the aerosol agent Rinofluimucil is used (method of administration and dosage, as for Vibrocil). Sneezing during pregnancy should not be treated with it either, since its list of side effects includes increased heart rate, increased blood pressure and problems with urination.

Medicines for allergic rhinitis and sneezing Aldecin (Beclazone) and Nasonex also come in the form of a spray. They contain corticosteroids and are best used for allergic rhinitis (1-2 sprays per nostril once a day). However, possible side effects of drugs with GCS include irritation, itching and dryness in the nose, bleeding of the mucous membrane, and with prolonged use - perforation of the nasal septum.

How to Reduce Sneezing in a Child - See Nasal Drops for Children

Homeopathy uses such drugs in the form of a spray as Rinital and Delufen in the treatment of rhinitis of allergic etiology, which are recommended to be used one spray 3-4 times a day (for adults and children 12 years and older).

And an accessible and effective home physiotherapy treatment for everyone is rinsing the nose with salt.

Folk remedies

If sneezing is associated with a stuffy nose due to a cold, then herbal treatment can help combat swelling of the nasal mucosa. Firstly, these are steam inhalations with peppermint, eucalyptus, and juniper oils, which have antibacterial properties.

For upper respiratory tract infections accompanied by a runny nose and sneezing, it is recommended to drink decoctions of chamomile flowers, fireweed, and elecampane (a tablespoon per 250 ml of water). You can drink tea with ginger root, lemon, and honey.

It is recommended to drink a decoction of fenugreek seeds twice a day. To prepare it, just boil two tablespoons of seeds in 300 ml of water and leave for 40-45 minutes.

Garlic paste also helps clear the nasal passages. Chop four or five cloves of garlic, put them in a container, and inhale its strong aroma from time to time. It is useful to include raw garlic in your diet by adding it to salads or sauces.

Vitamins, especially ascorbic acid, whose antioxidant properties can control the production of histamine, help treat the symptoms of respiratory viral infections.

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Prevention

Sneezing of a sick person is the most common way of spreading bacterial infections: flu, rhinovirus, measles, mumps, rubella, tuberculosis, etc. Therefore, sneezing prevention is a warning of infection with airborne diseases.

Proven methods for reducing the risk of sneezing include reducing exposure to irritants that cause an allergic reaction.

Examples of preventive methods include: taking deep breaths at the onset of a sneeze; holding your breath while lightly pinching the bridge of your nose for a few seconds.

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