Chronic rhinitis (chronic rhinitis): diagnosis
Last reviewed: 23.04.2024
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In order to make the correct diagnosis, it is necessary to carefully collect the anamnesis - it is important to find out the time and nature of the onset, duration and dynamics of the development of the above symptoms, whether earlier the examination and treatment, including independent, its adequacy and effectiveness.
Physical examination
In case of physical examination determine:
- obstruction of nasal breathing (sample with fleece);
- the presence of discharge from the nose (the nature of the discharge, the amount, odor, etc.):
- a condition of a mucous membrane of a nose at a forward rhinoscope (a hyperemia, a cyanosis, a pallor, a puffiness, a hypertrophy, etc.):
- the presence of crusts, their nature, localization and prevalence;
- presence of unpleasant odor;
- changes in the mucous membrane of the nasal cavity (sample with anemia 0.1% solution of epinephrine);
- concomitant acute and chronic pathology of ENT organs (the presence of sinusitis, adenoids, curvature of the septum of the nose, etc.).
Chronic catarrhal rhinitis
With rhinoscopy, the mucous membrane is swollen and swollen, with a slight thickening mainly in the lower shell and the anterior end of the middle shell. The mucous membrane of the nasal cavity is hyperemic with a cyanotic shade. Hyperemia and cyanosis are most pronounced in the area of the inferior and middle nasal concha. The last swollen, however, narrowed nasal passages, they, as a rule, do not completely cover them. The walls of the nasal cavity are usually covered with mucus. In the general nasal passage, a spotted-purulent discharge is identified, which drains to the bottom of the nasal cavity, where its congestion is particularly pronounced. The detachable easily marks, but soon re-fills the nasal passages.
Chronic hypertrophic rhinitis
Rinoscopic examination can reveal an increase in shells (diffuse or limited). Overgrowth and thickening of the nasal mucosa is observed mainly in the area of the inferior nasal concha and, to a lesser extent, in the middle, that is, in places of localization of cavernous tissue. However, hypertrophy can occur in other parts of the nose, in particular on the vomer (at the posterior margin), in the anterior third of the septum of the nose. The surface of the hypertrophied areas can be smooth, bumpy, and in the region of the posterior or anterior ends of the shell - coarse. The mucous membrane is usually full-blooded, slightly cyanotic or purple-cyanotic, gray-red, covered with mucus. When the papillomatous form of hypertrophy on the mucosa appears papillae, with the polypoid end of the shell resembling a polyp. Nasal passages in all cases narrowed due to the increase in the size of the shells. With a diffusive increase in the shells, the nature of the changes is determined by probing them, as well as by lubricating with 0.1% solution of epinephrine. When anemic, and identify limited areas of hyperplasia, which are visible against the background of a reduced mucous membrane.
Chronic atrophic rhinitis
With anterior and posterior rhinoscopy, depending on the degree of severity of atrophy, more or less wide nasal passages, reduced in the volume of the shell, covered with a pale, dryish, thin mucosa, on which there are crusts or viscous mucus in places. With anterior rhinoscopy, after removing the crusts, you can see the posterior wall of the pharynx.
Rhinoscopic signs of vasomotor rhinitis are the swelling and pallor of the nasal mucosa, blue (bluish) or white spots on it. The same changes are observed in the region of the posterior ends of the nasal concha. Cyanotic-whitish spots sometimes appear in the pharynx, less often in the larynx. Outside the attack, a rhinoscopic picture can completely normalize.
Laboratory research
A general clinical study is carried out (general analysis of blood, urine, biochemical blood test, determination of IgE content in blood, etc.), bacteriological examination of the nasal discharge (determine species composition of microflora, sensitivity to antibiotics), and histological examination of the mucous membrane of the nasal cavity.
Instrumental research
Perform radiographs of the paranasal sinuses of the nose (according to the indications of CT), endoscopic examination of the cavity of the nasal cavity, and also the rhinopneumometry.
Differential diagnosis of chronic rhinitis
Chronic rhinitis is differentiated with acute rhinitis, allergic rhinitis, paranasal sinus diseases, tuberculosis, syphilis, scleroma, Wegener's granulomatosis.
Indications for consultation of other specialists
With chronic rhinitis, allergist consultation is necessary in case of suspected allergic rhinitis, and also consultations of other specialists to determine the presence of concomitant pathology.
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