Chronic catarrhal rhinitis

Chronic catarrhal rhinitis is a form of rhinitis that is characterized by chronic catarrhal inflammation of the nasal mucosa, the main symptoms of which are more or less abundant discharge from the nose and a violation of nasal breathing.

[1], [2], [3], [4]

Causes of chronic catarrhal rhinitis

Most often, chronic catarrhal rhinitis is a consequence of repeated acute acute rhinitis described above. In children this form of rhinitis often accompanies chronic adenoiditis and chronic tonsillitis. Factors contributing to the emergence of chronic catarrhal rhinitis are hypo- and avitaminosis and a deficiency of trace elements, allergy, various types of diathesis, adiposogenital dystrophy, etc. In adults, the factors contributing to the chronic acute rhinitis chronicity are atmospheric occupational hazards, tobacco smoking, alcoholism, and 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 Ja. A. Nakatis (1996), which arises in the confined space of this cavity.

Microbiologically chronic catarrhal rhinitis is characterized by polymorphism of pyogenic microbiota. Distinguish between chronic catarrhal rhinitis in children and adults.

[5], [6], [7], [8], [9]

Chronic catarrhal rhinitis in children

Symptoms of chronic catarrhal rhinitis in children consist in permanent discharge from the nose, causing maceration of the skin of the upper lip, difficulty in nasal breathing, nasal breathing, nasal breathing, frequent colds, persistent cough, frequent acute colds, laryngitis, tracheitis, poor appetite, general lethargy, etc. A prolonged course of chronic catarrhal rhinitis leads to dysmorphia of the facial skeleton (adenoid type of face), malocclusion, and sometimes to disorders of the development of the thorax. Such children are always pale, lag behind in their physical and mental development from their peers, often they detect a decrease in hearing on the basis of catarrhal salpingotitis. With a rhinoscopy, mucopurulent discharge, purulent cortex on the threshold of the nose, and sometimes superficial lesions of the epithelium of the entrance to the nose and upper lip, which is constantly hyperemic and thickened at the level of the nose are found. The mucous membrane of the nasal cavity is hyperemic, edematic, nasal conchaes enlarged, covered with mucopurulent discharge, which may indicate the presence of chronic sinusitis. Usually, discharge from the nose with chronic catarrhal rhinitis does not have an unpleasant odor, but the presence of the latter may indicate a stagnant discharge in the nasal cavity or chronic sinusitis or adenoiditis. Putrid odor from the mouth can indicate chronic caseous tonsillitis, adenoiditis or tooth decay. X-ray often determines the edema of the mucous membrane of the sinus maxillary sinus.

The diagnosis is made based on the symptoms described above. Differentiation of chronic catarrhal rhinitis follows from foreign bodies of the nasal cavity, chronic purulent sinusitis, from the first phase of the ozen, chronic adenoiditis, and also from congenital partial or complete atresia of the khohan.

Complications: acute and chronic inflammatory diseases of the paranasal sinuses, auditory tube and middle ear, polyps of the nose, nosebleeds. Chronic catarrhal rhinitis contributes to the emergence of acute laryngitis, tonsillitis, tracheobronchitis, as well as infection with pulmonary tuberculosis. Children who can not blow their nose, swallow the discharge from the nose and thus infect the digestive tract, as a result of which they can develop chronic gastritis, gastroduodenitis, colitis and appendicitis. Due to piofagy in children suffering from chronic catarrhal rhinitis, there is observed lipped tongue, aerophagia, bloating, nausea, vomiting, diarrhea with fetid odor.

[10], [11], [12], [13]

Chronic catarrhal rhinitis in adults

An important role in the emergence of chronic catarrhal rhinitis in adults is played by previous recurring acute rhinitis starting from childhood, a number of anatomical and constitutional dysmorphs 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 the diseases of the digestive, cardiovascular and endocrine systems, neurovegetative dysfunctions, debilizma, etc. The contributing factors, often the primary causes of the onset of chronic catarrhal rhinitis in adults are physicochemical and microbiological professional atmospheric hazards (presence in the inspired air of aggressive chemicals, dust particles, as well as being in the atmosphere excessively chilled or pereg etogo air).

In the pathogenesis of chronic catarrhal rhinitis, local oxygen deficiency in the nasal cavity plays a big role, which is facilitated by such dysmorphic disorders as narrow nasal passages, nose-septum deviations, posttraumatic deformations of the internal structures of the nose, etc., as well as latent sinusitis. The most common are people living in regions with a damp cold climate.

Based on the foregoing, it should be emphasized that chronic catarrhal rhinitis in the pathogenetic aspect should not be attributed to purely local diseases, since in its emergence an important role is played by general pathophysiological processes caused by dysfunction of a multitude of systems (vegetative, endocrine, histogematic, etc.) whose dysfunctions extrapolated to the links of the body, which have the least resistance to external pathogenic factors, certain morphological and anatomical malformation and constitutional predisposition to the development of "own" pathological conditions. Therefore, the treatment of chronic catarrhal rhinitis should be based on this situation.

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Pathological anatomy

Metaplasia of the cylindrical ciliated epithelium of the nasal mucosa into the multilayered flat, edema and infiltration of choroid lymphocytes and histiocytes, hypertrophy of the acinous cells, expansion of the subchoroid vasculature, decreased permeability and swelling of connective tissue elements of the nasal mucosa, the surface of which is covered with viscous exudate drying into hard-to-remove crusts. 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 begin, as a rule, in the autumn, intensify in the winter, decrease in the spring and can pass in the summer in dry hot weather; obstruction of nasal breathing; permanent discharge from the nose of the mucous or mucocutaneous nature, flowing down the back wall of the pharynx; sensation of foreign body in the nasopharynx; a decrease in the severity of the sense of smell, often - and taste sensitivity, as well as hypoacusia. Of the general subjective symptoms should be noted periodically arising headaches, especially during periods of exacerbation of the disease, increased psycho-intellectual fatigue, as well as various cardiovascular, cardio-pulmonal and gastroenteric syndromes. Often, patients complain of a feeling of constant cold in the feet and hands, palm moisture, excessive sweating and sensitivity to cold.

Objective symptoms: at the entrance to the nasal cavity and on the eve of the nose there may be traces of ostiofolliculitis or furuncle, cracks and areas of maceration of the skin, various kinds of zematids and dermatitis phenomena.

In the case of a rhinoscopy, mucus secretions are found covering the elements of the nasal cavity and propagating in it in the form of strands crossing the nasal passages, as well as grayish crusts tightly soldered to the atrophic sites of the mucous membrane. The mucous membrane is hyperemic, inflamed, often edematic with a cyanotic shade, in other cases - pale and thinned. Nasal conchaes, especially the lower ones, are enlarged due to the paresis of the venous plexus, they easily give in to pressure by a button probe and quickly restore volume when the pressure stops. Greasing the shell with a solution of adrenaline leads to an immediate vasospastic effect, a decrease in its volume, and an improvement in nasal breathing.

With the back of the rhinoscopy and pharyngoscopy, signs of chronic adenoiditis often appear, especially in children, chronic tonsillitis, hypertrophic pharyngitis, inflammation of the lingual tonsil and other signs of chronic inflammation.

Radiography of the paranasal sinuses often causes edema of the mucous membrane of the paranasal sinuses, often the presence of transudate in them.

With otoscopy, there are often signs of chronic tubootitis (retraction of the tympanic membrane and hyperemia of its vessels) or chronic catarrhal otitis. In such patients (both in children and in adults), an acute inflammation of the middle ear often occurs, and more often than in others, chronic purulent otitis media is observed.

Complications arise mainly at a distance and are manifested by chronic inflammatory diseases of the larynx, trachea and bronchi, dysfunctions of the digestive organs, various cardiovascular syndromes, impaired functions of the liver, kidneys, endocrine system, etc.

Diagnosis of chronic catarrhal rhinitis in adults

Diagnosis in typical cases is not difficult and is based on the symptoms described above. However, in atypical cases, certain difficulties arise in differential diagnosis. First and foremost, chronic catarrhal rhinitis should be differentiated from hypertrophic (hyperplastic) rhinitis, the difference of which is that with true hypertrophy of nasal concha they do not contract with the action of vasoconstrictive drugs, and when pressure is exerted on them with a probe probe, a characteristic tissue density is felt. Differentiate chronic catarrhal rhinitis also from ozena, especially in its initial stage, when the clinical picture of this disease is not so pronounced. The signs that reveal the ozena are a specific (smelly) 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 accompanying atrophic pharyngitis. Chronic catarrhal rhinitis should also be differentiated from different forms of allergic rhinitis - periodic seasonal and permanent. In some cases, both forms pass into each other, and the resulting seasonal crises can result in signs that are characteristic of chronic catarrhal rhinitis. In addition, often latent forms of sinusitis can manifest as signs of chronic catarrhal rhinitis, but most often changes in the nasal cavity correspond to the side of the affected sinus.

Among the specific infections in which there may be some common symptoms with chronic catarrhal rhinitis, one should keep in mind primarily tertiary syphilis and tuberculosis of the nose, which differ in monolateral localization and characteristic pathologic anatomical features. In this case, the clinical course of these diseases of the nose is characterized by high specificity and rapid development.

Differentiation of chronic catarrhal rhinitis follows from rhinolithiasis and foreign bodies of the nasal cavity. Important distinctive signs of these diseases are one-sided lesion, and ishorous purulent discharge from one half of the nose, its obstruction, pains in the affected half of the nose, headaches.

The prognosis, in general, is favorable, but it can be serious in case of complications.

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Treatment of chronic catarrhal rhinitis

Treatment of chronic catarrhal rhinitis should be directed primarily to identifying the causes that caused the emergence of chronic catarrhal rhinitis. Often, eliminating these causes, for example, occupational disease or a particular chronic disease, leads to an improvement in the patient's condition and sharply increases the effectiveness of treatment. In general, the treatment of severe forms of chronic catarrhal rhinitis is prolonged, requiring constant application of various methods and the result is often unstable.

Local treatment is divided into symptomatic and pathogenetic. Symptomatic treatment consists in the use of vasoconstrictors to improve nasal breathing, which give only a temporary effect. With prolonged use, they exacerbate the clinical course of chronic catarrhal rhinitis, contributing to the emergence of hypertrophic and sclerotic phenomena in the nasal cone, described under the name of drug rhinitis, characterized by the so-called "bounce" syndrome. The latter is manifested by a sharp obstruction of the nasal passages with the cancellation of one or another nasal decongestant. Such essential drugs include sanorin, naphthyzine, epinephrine in a mixture with novocaine or dicaine, as well as a number of modern drugs produced by domestic and foreign pharmaceutical industry. The latter include drugs from the group of a-adrenomimetics (naphazoline, trisolin).

An important role in the treatment of chronic catarrhal rhinitis, taking into account the complexity of its etiology, pathogenesis and individual features of the clinical course, is given to pathogenetic treatment, in which aytygistamine drugs (acrivastine, loratodine), anticongestants (xylometazoline, oxymetazoline), glucocorticoids (bstametasop, mometasone, nazonex ), regenerators and reparants (sodium deoxyribonucleate, derinat), fat cell membrane stabilizers (cromogexal, cromoglin, cromoglycic acid), antibiotics tetracycline Vågå (methacycline) and cephalosporin (cefadroxil, cefuroxime) series. A certain positive effect can also be given by homeopathic remedies, such as Traumble C, Euphorbium compositum, Zentrofen C, which have anti-inflammatory, reparative, anti-allergic properties.

In addition to these preparations, various mixtures with essential oils of peppermint, eucalyptus, thuja, etc. Can be used, which have a beneficial effect on the trophic of the nasal mucosa, normalizing the tone of its vessels and the function of the glandular apparatus. Local physiotherapeutic methods include UFO and laser therapy, thermal installations of various solutions. With an abundance of viscous mucous secretions and crusts in the nasal passages, the nasal cavity is washed with a solution of proteolytic enzymes or the classic Lermuaye mixture: sodium monosulfate 10 g, distilled water and glycerin 50 g each; apply in the form of thermal installations in the nasal cavity in the dilution of 1 teaspoon per 1 liter of water 1-2 times a day.

In the treatment of chronic catarrhal rhinitis, the importance of normalizing the functions of internal organs, mineral metabolism, biochemical and cytological parameters of blood, vitamin therapy, the appointment of per os of mineral salts and trace elements, immunocorrection (according to indications) is important. Apply also methods of dietotherapy, exclude the use of acute extragenic dishes, smoking tobacco, drinking alcohol.

If there are chronic foci of infection in the ENT organs, anatomical changes in the nasal cavity that interfere with nasal breathing, perform nonoperative or surgical treatment.

An important role in the treatment of persistent cases of chronic catarrhal rhinitis is given to balneological and sanatorium treatment, which contributes to increasing the resistance of the organism, enriching it with oxygen, normalizing the metabolism and functions of the central nervous system.