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Chronic rhinitis (chronic runny nose) - Diagnosis
Last reviewed: 06.07.2025
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To make a correct diagnosis, it is necessary to carefully collect anamnesis - it is important to find out the time and nature of occurrence, duration and dynamics of development of the above symptoms, whether examination and treatment were carried out earlier, including independent, its adequacy and effectiveness.
Physical examination
During physical examination the following is determined:
- difficulty breathing through the nose (cotton wool test);
- presence of nasal discharge (nature of discharge, quantity, odor, etc.):
- condition of the nasal mucosa during anterior rhinoscopy (hyperemia, cyanosis, pallor, swelling, hypertrophy, etc.):
- the presence of crusts, their nature, localization and prevalence;
- presence of an unpleasant odor;
- changes in the mucous membrane of the nasal cavity (test with anemia with 0.1% epinephrine solution);
- concomitant acute and chronic pathology of the ENT organs (the presence of sinusitis, adenoids, curvature of the nasal septum, etc.).
Chronic catarrhal rhinitis
Rhinoscopy reveals pastosity and edema of the mucous membrane, slight thickening mainly in the area of the inferior turbinate and the anterior end of the middle turbinate. The mucous membrane of the nasal cavity is hyperemic with a cyanotic tint. Hyperemia and cyanosis are most pronounced in the area of the inferior and middle turbinates. The latter are swollen, but narrowing the nasal passages, they, as a rule, do not close them completely. The walls of the nasal cavity are usually covered with mucus. In the common nasal passage, mucopurulent discharge is determined, which flows to the bottom of the nasal cavity, where its accumulation is especially pronounced. The discharge is easily blown out, but soon fills the nasal passages again.
Chronic hypertrophic rhinitis
Rhinoscopic examination reveals enlargement of the turbinates (diffuse or limited). Overgrowth and thickening of the nasal mucosa is observed mainly in the area of the inferior turbinate and, to a lesser extent, the middle turbinate, i.e., in places where cavernous tissue is localized. However, hypertrophy may also occur in other parts of the nose, in particular on the vomer (at its posterior edge), in the anterior third of the nasal septum. The surface of the hypertrophied areas may be smooth, uneven, and coarse-grained in the area of the posterior or anterior ends of the turbinate. The mucosa is usually full-blooded, slightly cyanotic or purple-blue, gray-red, covered with mucus. In the papillomatous form of hypertrophy, papillae appear on the mucosa, while in the polypoid form, the end of the turbinate resembles a polyp. The nasal passages are narrowed in all cases due to the enlargement of the turbinates. In case of diffuse enlargement of the turbinates, the nature of the changes is determined by probing them and lubricating them with a 0.1% solution of epinephrine. In case of anemia, limited areas of hyperplasia are also detected, which are visible against the background of the contracted mucous membrane.
Chronic atrophic rhinitis
With anterior and posterior rhinoscopy, depending on the degree of atrophy, more or less wide nasal passages are visible, the turbinates are reduced in volume, covered with a pale, dry, thin mucous membrane, on which there are crusts or viscous mucus in places. With anterior rhinoscopy, after removing the crusts, the posterior wall of the pharynx can be seen.
Rhinoscopic signs of vasomotor rhinitis include swelling and pallor of the mucous membrane of the nasal cavity, bluish (blue) or white spots on it. The same changes are observed in the area of the posterior ends of the nasal conchae. Cyanotic-whitish spots are sometimes detected in the pharynx, less often in the larynx. Outside of an attack, the rhinoscopic picture can completely normalize.
Laboratory research
A general clinical examination is carried out (general blood and urine tests, biochemical blood tests, determination of IgE levels in the blood, etc.), a bacteriological examination of nasal discharge (determine the species composition of microflora, sensitivity to antibiotics), as well as a histological examination of the mucous membrane of the nasal cavity.
Instrumental research
They perform radiography of the paranasal sinuses (as indicated by CT), endoscopic examination of the nasal cavity, and rhinopneumometry.
Differential diagnosis of chronic rhinitis
Chronic rhinitis is differentiated from acute rhinitis, allergic rhinitis, diseases of the paranasal sinuses, tuberculosis, syphilis, scleroma, Wegener's granulomatosis.
Indications for consultation with other specialists
In case of chronic rhinitis, a consultation with an allergist is necessary if allergic rhinitis is suspected, as well as consultations with other specialists to determine the presence of concomitant pathology.
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