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Chronic catarrhal rhinitis
Last reviewed: 05.07.2025
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Causes of chronic catarrhal rhinitis
Most often, chronic catarrhal rhinitis is a consequence of repeated acute rhinitis described above. In children, this form of rhinitis often accompanies chronic adenoiditis and chronic tonsillitis. Factors contributing to the development of chronic catarrhal rhinitis are hypo- and avitaminosis and lack of microelements, allergies, various types of diathesis, adiposogenital dystrophy, etc. In adults, factors contributing to the chronicization of acute rhinitis are atmospheric occupational hazards, smoking, alcoholism, drug addiction. In the pathogenesis of chronic catarrhal rhinitis, the leading role is played by a sharp decrease in the oxygen content in the nasal cavity and the so-called greenhouse effect, described by Ya.A. Nakatis (1996), occurring in the closed space of this cavity.
Microbiologically, chronic catarrhal rhinitis is characterized by polymorphism of pyogenic microbiota. Chronic catarrhal rhinitis is distinguished in children and adults.
Chronic catarrhal rhinitis in children
Symptoms of chronic catarrhal rhinitis in children include constant nasal discharge causing maceration of the skin of the upper lip, difficulty breathing through the nose, a nasal and hoarse voice, frequent colds, constant cough, frequent acute runny nose, laryngitis, tracheitis, poor appetite, poor nutrition, general lethargy, etc. Long-term chronic catarrhal rhinitis leads to dysmorphism of the facial skeleton (adenoid type of face), malocclusion, and sometimes to developmental disorders of the chest. Such children are always pale, lag behind their peers in physical and mental development, and often have hearing loss due to catarrhal salpingootitis. Rhinoscopy reveals mucopurulent discharge, purulent crusts in the nasal vestibule, and sometimes superficial lesions of the epithelium of the nasal entrance and the upper lip, which is constantly hyperemic and thickened at the level of the nasal vestibule. The mucous membrane of the nasal cavity is hyperemic, edematous, the nasal turbinates are enlarged, covered with mucopurulent discharge, which may indicate the presence of chronic sinusitis. Usually, nasal discharge in chronic catarrhal rhinitis does not have an unpleasant odor, but the presence of the latter may indicate stagnation of discharge in the nasal cavity or chronic sinusitis or adenoiditis. A putrid odor from the mouth may indicate chronic caseous tonsillitis, adenoiditis, or dental caries. X-rays often reveal edema of the mucous membrane of the maxillary sinus.
The diagnosis is established on the basis of the symptoms described above. Chronic catarrhal rhinitis should be differentiated from foreign bodies in the nasal cavity, chronic purulent sinusitis, the first phase of ozena, chronic adenoiditis, as well as from congenital partial or complete atresia of the choanae.
Complications: acute and chronic inflammatory diseases of the paranasal sinuses, auditory tube and middle ear, nasal polyps, nosebleeds. Chronic catarrhal rhinitis contributes to the development of acute laryngitis, tonsillitis, tracheobronchitis, as well as infection with pulmonary tuberculosis. Children who cannot blow their nose swallow nasal discharge and thus infect the digestive tract, as a result of which they may develop chronic gastritis, gastroduodenitis, colitis and appendicitis. Due to pyophagia, children suffering from chronic catarrhal rhinitis experience a coated tongue, aerophagia, bloating, nausea, vomiting, and foul-smelling diarrhea.
Chronic catarrhal rhinitis in adults
An important role in the development of chronic catarrhal rhinitis in adults is played by previous recurring acute runny noses since childhood, a number of anatomical and constitutional dysmorphias of the internal nose, chronic inflammatory diseases of the lymphoid apparatus of the upper respiratory tract. As noted by V. Racoveanu (1964), chronic catarrhal rhinitis often accompanies diseases of the digestive, cardiovascular and endocrine systems, neurovegetative dysfunctions, debility, etc. Contributing, and often primary factors in the development of chronic catarrhal rhinitis in adults are physicochemical and microbiological professional atmospheric hazards (the presence of aggressive chemicals, dust particles in the inhaled air, as well as exposure to an atmosphere of excessively cooled or overheated air).
In the pathogenesis of chronic catarrhal rhinitis, a major role is played by local oxygen deficiency in the nasal cavity, which is facilitated by such dysmorphias as narrow nasal passages, deviations of the nasal septum, post-traumatic deformations of the internal structures of the nose, etc., as well as latent sinusitis. Most often, people living in regions with a humid cold climate are affected.
Based on the above, it should be emphasized that chronic catarrhal rhinitis in the pathogenetic aspect should not be attributed to purely local diseases, since its occurrence is significantly influenced by general pathophysiological processes caused by dysfunction of many systems (vegetative, endocrine, histohematic, etc.), dysfunctions of which are extrapolated to the links of the body that have the least resistance to external pathogenic factors, certain morphological and anatomical malformations, constitutional predisposition to the development of "own" pathological conditions. Therefore, when treating chronic catarrhal rhinitis, one should proceed from this position.
Pathological anatomy
Metaplasia of the columnar ciliated epithelium of the nasal mucosa into stratified squamous epithelium, edema and infiltration of the choroid by lymphocytes and histiocytes, hypertrophy of acinar cells, expansion of the subchoroidal vascular networks, decreased permeability and edema of the connective tissue elements of the nasal mucosa, the surface of which is covered with viscous exudate that dries into crusts that are difficult to separate. Some authors consider chronic catarrhal rhinitis as a stage preceding chronic hypertrophic or atrophic rhinitis.
Symptoms of chronic catarrhal rhinitis in adults
Symptoms of chronic catarrhal rhinitis are divided into subjective and objective.
Subjective symptoms: complaints of a long-term runny nose, the signs of which usually begin in the fall, intensify in winter, subside in spring and may disappear in summer in dry hot weather; difficulty breathing through the nose; constant mucous or mucopurulent nasal discharge flowing down the back of the throat; sensation of a foreign body in the nasopharynx; decreased olfactory acuity, often taste sensitivity, and hypoacusis. Common subjective symptoms include periodic headaches, especially during periods of exacerbation of the disease, increased psycho-intellectual fatigue, as well as various cardiovascular, cardiopulmonary and gastrointestinal syndromes. Patients often complain of a feeling of constant cold in the feet and hands, damp palms, increased sweating and sensitivity to cold.
Objective symptoms: at the entrance to the nasal cavity and in the vestibule of the nose, traces of ostiofolliculitis or furuncle, cracks and areas of maceration of the skin, various types of eczematids and dermatitis may be observed.
Rhinoscopy reveals mucous secretions covering the elements of the nasal cavity and spreading in it in the form of strands crossing the nasal passages, as well as grayish crusts tightly soldered to the atrophic areas of the mucous membrane. The mucous membrane is hyperemic, inflamed, often edematous with a bluish tint, in other cases - pale and thinned. The nasal conchae, especially the lower one, are enlarged due to paresis of the venous plexuses, easily yield to pressure with a button probe and quickly restore their volume when the pressure is stopped. Lubrication of the conchae with an adrenaline solution leads to an immediate vasospastic effect, a decrease in its volume and improvement of nasal breathing.
Posterior rhinoscopy and pharyngoscopy often reveal signs of chronic adenoiditis, especially in children, chronic tonsillitis, hypertrophic pharyngitis, inflammation of the lingual tonsil and other signs of chronic inflammation.
When examining the paranasal sinuses, edema of the mucous membrane of the paranasal sinuses is often observed, and often the presence of transudate in them.
Otoscopy often reveals signs of chronic tubootitis (retraction of the eardrum and hyperemia of its vessels) or chronic catarrhal otitis. Such patients (both children and adults) often develop acute inflammation of the middle ear and, more often than other people, chronic purulent otitis media is observed.
Complications arise mainly at a distance and manifest themselves as chronic inflammatory diseases of the larynx, trachea and bronchi, dysfunctions of the digestive organs, various cardiovascular syndromes, dysfunctions of the liver, kidneys, endocrine system, etc.
Diagnosis of chronic catarrhal rhinitis in adults
In typical cases, diagnosis is straightforward and is based on the symptoms described above. However, in atypical cases, certain difficulties arise in differential diagnosis. First of all, chronic catarrhal rhinitis should be differentiated from hypertrophic (hyperplastic) rhinitis, the difference between which is that with true hypertrophy of the nasal turbinates, they do not contract under the action of vasoconstrictor drugs, and when pressing on them with a button probe, a characteristic density of the tissue is felt. Chronic catarrhal rhinitis is also differentiated from ozena, especially in its initial stage, when the clinical picture of this disease is not so pronounced. Signs that reveal ozena are a specific (fetid) odor from the nose, yellowish-green crusts covering the endonasal surfaces, atrophy of all internal structures of the nasal cavity, pronounced hyposmia, more often anosmia, concomitant atrophic pharyngitis. Chronic catarrhal rhinitis should also be differentiated from various forms of allergic rhinitis - periodic, seasonal and permanent. In some cases, both forms transform into each other, and the resulting seasonal crises can end with symptoms characteristic of chronic catarrhal rhinitis. In addition, latent forms of sinusitis can often manifest themselves with symptoms of chronic catarrhal rhinitis, but in this case, most often the changes in the nasal cavity correspond to the side of the affected sinus.
Among specific infections that may cause some symptoms common to chronic catarrhal rhinitis, it is necessary to keep in mind first of all tertiary syphilis and tuberculosis of the nose, which are distinguished by monolateral localization and characteristic pathological signs. At the same time, the clinical course of these nasal diseases is distinguished by high specificity and rapid development.
Chronic catarrhal rhinitis should be differentiated from rhinolithiasis and foreign bodies in the nasal cavity. Important distinguishing features of these diseases are unilateral lesions, ichorous purulent discharge from one half of the nose, its obstruction, pain in the affected half of the nose, headaches.
The prognosis is generally good, but can be serious if complications occur.
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Treatment of chronic catarrhal rhinitis
Treatment of chronic catarrhal rhinitis should be aimed primarily at identifying the causes that caused the occurrence of chronic catarrhal rhinitis. Often, eliminating these causes, such as occupational hazards or a particular chronic disease, leads to an improvement in the patient's condition and dramatically increases the effectiveness of treatment. In general, treatment of severe forms of chronic catarrhal rhinitis is long-term, requiring the constant use of various methods, and the result is often unstable.
Local treatment is divided into symptomatic and pathogenetic. Symptomatic treatment involves the use of vasoconstrictors to improve nasal breathing, which provide only a temporary effect. With prolonged use, they aggravate the clinical course of chronic catarrhal rhinitis, contributing to the occurrence of hypertrophic and sclerotic phenomena in the nasal turbinates, described under the name of drug-induced rhinitis, characterized by the so-called "rebound" syndrome. The latter is manifested by a sharp obstruction of the nasal passages when canceling a particular nasal decongestant. Such essential drugs include sanorin, naphthyzine, adrenaline mixed with novocaine or dicaine, as well as a number of modern drugs produced by the domestic and foreign pharmaceutical industry. The latter include drugs from the group of a-adrenomimetics (naphazoline, trizoline).
Of great importance in the treatment of chronic catarrhal rhinitis, given the complexity of its etiology, pathogenesis and individual features of the clinical course, is pathogenetic treatment, which uses antihistamine drugs (acrivastine, loratadine), decongestants (xylometazoline, oxymetazoline), glucocorticoids (bstametazoline, mometasone, nasonex), regenerators and reparants (sodium deoxyribonucleate, derinat), mast cell membrane stabilizers (cromoghexal, cromoglyn, cromoglycic acid), tetracycline (metacycline) and cephalosporin (cefadroxil, cefuroxime) antibiotics. A certain positive effect can also be given by homeopathic remedies such as traumsl C, euphorbim compositum, nazentrofen C, which have anti-inflammatory, reparative, antiallergic properties.
In addition to the above preparations, various mixtures with essential oils of mint, eucalyptus, thuja, etc. can be used, which have a beneficial effect on the trophism of the nasal mucosa, normalizing the tone of its vessels and the function of the glandular apparatus. Local physiotherapeutic methods include UV and laser therapy, thermal installations of various solutions. With an abundance of viscous mucous secretions and crusts in the nasal passages, rinse the nasal cavity with a solution of proteolytic enzymes or the classic Lermoyer mixture: sodium monosulfate 10 g, distilled water and glycerin 50 g each; apply in the form of thermal installations in the nasal cavity in a dilution of 1 teaspoon per 1 liter of water 1-2 times a day.
In the treatment of chronic catarrhal rhinitis, great importance is attached to the normalization of the functions of internal organs, mineral metabolism, biochemical and cytological indices of blood, vitamin therapy, per os administration of mineral salts and microelements, immunocorrection (according to indications). Diet therapy methods are also used, the use of spicy extragenic dishes, smoking tobacco, and alcohol consumption are excluded.
In the presence of chronic foci of infection in the ENT organs, anatomical changes in the nasal cavity that impede nasal breathing, their non-surgical or surgical treatment is carried out.
Balneological and spa treatments are of great importance in the treatment of persistent cases of chronic catarrhal rhinitis, as they help to increase the body's resistance, enrich it with oxygen, and normalize metabolism and central nervous system functions.
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