Rhinorrhea in adults and children: signs, how to treat with drugs?

If a common cold is called rhinitis (Greek rhino – nose), then a symptom such as rhinorrhea is manifested by an intense release of liquid and almost transparent nasal secretions that literally flow from the nose (Greek rhoia – stream).

But doctors also call inflammation of the mucous membrane lining the nasal cavity rhinitis, and rhinorrhea is considered its initial symptom.

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Epidemiology

It is estimated that between 10% and 25% of the world's population suffers from symptoms of chronic rhinitis. Allergic and nonallergic rhinitis affect approximately 30% of the U.S. population.

In this case, the symptom of rhinorrhea is not recorded separately, but the ratio of patients with non-infectious rhinitis of allergic and non-allergic etiology is 3:1. And a mixed clinical picture is observed in almost half of the cases of visits to otolaryngologists or therapists.

The incidence of rhinoliquorrhea after basal skull fracture is 15-20%; spontaneous cerebrospinal rhinorrhea is observed in 4-23% of patients.

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Causes rhinorrhea

Clear, watery nasal discharge most often occurs when the mucous membrane lining the nasal cavity, one of the most frequently infected tissues in adults and children, requires cleansing from viruses that cause acute rhinitis during colds and flu.

In the case of a viral infection, the typical first signs of the body's reaction include itching in the nose and sneezing, increased lacrimation and rhinorrhea. But at the next stage, when the immune cells of the mucous tissue begin to react to the virus, the nasal secretions increase in mucin (mucus), which absorbs the liquid and swells, due to which they become thicker and change color to yellow-greenish (due to the iron-containing enzyme myeloperoxidase secreted by leukocytes); nasal congestion is also noted.

Very often, the causes of rhinorrhea are irritating substances entering the nasal cavity, provoking non-allergic rhinitis with eosinophilia or allergic rhinitis. And, thus, seasonal allergies or hay fever manifest themselves with such a symptom as allergic rhinorrhea (but the late phase of the disease, again, is characterized by nasal congestion). And the risk factors for its development are associated with increased sensitization of the body, in which patients experience bilateral chronic rhinorrhea. More information in the material - Causes of respiratory allergies.

Rhinorrhea can also be a symptom of:

• chronic catarrhal rhinitis;
• acute sinusitis of viral origin and chronic bacterial inflammation of the paranasal sinuses;
• the presence of a foreign body in the nasal cavity (especially in small children);
• the formation of nasal polyps (which are usually the result of chronic allergies or inflammation);
• dysfunction of the nasal mucosa due to long-term use of vasodilator nasal drops or sprays;
• use of psychoactive substances (drug addiction);
• the first stages of development of bronchial asthma, that is, before the main symptoms of the disease become shortness of breath, cough and bronchospasm;
• initial stage of Churg-Strauss syndrome;
• Wegener's granulomatosis with polyangiitis;
• hormonal changes during pregnancy;
• genetically determined (primary) ciliary dyskinesia or Kartagener syndrome;
• basal cell carcinoma (more often diagnosed in the elderly).

Postnasal rhinorrhea, in which the bulk of liquid discharge flows into the nasopharynx, is characteristic of acute pharyngitis, nasopharyngitis or tonsillopharyngitis (more often this occurs in children) or inflammation of the sinuses of the facial part of the skull - acute ethmoidosphenoiditis. A similar clinical picture, with periodic nasal congestion, can be caused by vasomotor rhinitis - an idiopathic syndrome with non-specific triggers.

Otolaryngologists also note rhinorrhea in case of perforation of the eardrum and as a complication after laryngotomy.

Copious watery nasal discharge (often from only one nostril) can occur after a traumatic brain injury, due to cerebrospinal fluid fistulas that form after operations on the paranasal sinuses or brain, as well as after an epidural injection of steroids. And this is already traumatic or iatrogenic cerebrospinal rhinorrhea - a leak of cerebrospinal fluid (CSF), defined as nasal CSF rhinorrhea or rhinoliquorrhea. With it, a metallic or salty taste is felt in the mouth, the sense of smell is reduced, ringing in the ears is heard, postural headaches occur.

In addition, spontaneous cerebrospinal rhinorrhea is diagnosed: primary is rarely detected - with congenital hydrocephalus or malformation (anomaly) of the skull, when cerebrospinal fluid leaks from under the membranes of the brain through the cribriform plate between the anterior part of the cranial vault and the nasal cavity. And secondary spontaneous rhinocerebrospinal fluid rhinorrhea can accompany meningitis, encephalitis or a brain tumor.

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Pathogenesis

The mechanism of rhinorrhea development is associated with an excessive amount of mucus produced by the pseudostratified squamous ciliated epithelium covering the nasal cavity, which, in essence, demonstrates the activation of its protective and homeostatic functions.

In response to infection or allergens, the number of mucus-producing goblet cells in the epithelium increases, and the activity of the submucous tubular Bowman glands increases to capture large particles (including viruses and bacteria) that enter with inhaled air and moisturize it.

By the way, increased nasal discharge in the cold - cold rhinorrhea - is a normal functional reaction of the nasal mucosa. When inhaling cold air, fluid is simply lost, and in order to maintain homeostasis and avoid dryness and damage to the mucosa, a reflex mechanism is activated (with activation of sensory nerves), and the volume of nasal secretion is replenished by passive transfer of fluid through the paracellular spaces of the nasal cavity epithelium.

In allergic rhinorrhea, the pathogenesis of the inflammatory process in the nasal mucosa is caused by sensitization, leading to the generation of allergen-specific IgE (immunoglobulin E), which circulates in the peripheral blood and attaches to the surface of all mast cells and basophils, including those present in the nasal mucosa. Subsequent nasal exposure to the allergen activates these cells, releasing the mediator of all allergic reactions of the body - histamine, which stimulates sensory nerve endings in the nasal mucosa, which is manifested by itching, sneezing and a reflex increase in mucous secretion - rhinorrhea.

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Complications and consequences

Serious consequences and complications are observed in cases of cerebrospinal rhinorrhea in posttraumatic cerebrospinal fluid fistulas. Firstly, ascending infection (in most cases – Pneumococcus, Streptococcus and Haemophilus influenzae) can cause inflammation of the meninges – bacterial meningitis, which is the main cause of death (up to 2%) of patients with this pathology.

Secondly, when the volume of cerebrospinal fluid decreases, the hemodynamics of the brain and the proper nutrition of its tissues are disrupted, which creates a risk of complications from the nervous system - autonomic and central.

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Diagnostics rhinorrhea

Anamnesis, recording of the patient's complaints and his physical examination are sufficient for a cold or flu accompanied by a runny nose. But in other (listed above) cases, the diagnosis of rhinorrhea may include such tests as:

• microbiological analysis of nasal mucus, for the level of neutrophils and eosinophils;
• analysis of secretions for beta-2-transferrin (if rhinocerebrospinal fluid rhinorrhea is suspected);
• blood test for IgE antibodies, skin tests. Read also – Diagnosis of allergic rhinitis

Visualization, that is, instrumental diagnostics, is carried out using:

• rhinoscopy;
• nasal endoscopy;
• X-ray of the nasal cavity and paranasal sinuses;
• Ultrasound of the paranasal and frontal sinuses;
• ultrasound encephalography or MRI of the brain.

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Differential diagnosis

To determine the true cause of rhinorrhea, differential diagnostics are necessary, taking into account the entire range of symptoms and the characteristics of their manifestation.

For example, if rhinorrhea is prolonged and discharge is observed from both nostrils, then this is most often associated with allergic or vasomotor rhinitis, and persistent loss of smell raises suspicion of nasal polyps, atrophy or Wegener's granulomatosis.

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Treatment rhinorrhea

In most cases, there is no need to treat rhinorrhea separately from acute rhinitis, although doctors recommend using saline nasal sprays and rinsing the nose with salt (NaCl solution).

Atrovent (Normosecretol) aerosol with an atropine derivative (ipratropium bromide) provides a rapid therapeutic effect, but it can cause side effects such as dry mouth, headache, nausea and increased heart rate. More information in the material - Nasal sprays for a runny nose

When the period of liquid nasal secretion passes into the stage of its thickening, the runny nose is treated and drops for rhinitis are used for this, since special nasal drops for rhinorrhea are not produced.

Inhalation therapy for rhinorrhea may be prescribed, for example, with atropine sulfate. All details are in the publication - Treatment of the common cold with inhalations.

Aerosols for allergic rhinorrhea - reducing mucus production due to the presence of corticosteroids or blocking histamine receptors - the same as for allergic rhinitis; all about these drugs in the article - Sprays for allergic rhinitis.

Also antihistamines in tablets are taken orally, full information about them in the material - Allergy medications

If cerebrospinal rhinorrhea (rhinoliquorrhea) is diagnosed, diuretic drugs are used, most often Diacarb (twice a day, 0.1-0.2 g, but the exact dose is determined by the attending physician). And folk treatment consists of taking decoctions of medicinal plants with a diuretic effect (horsetail, etc.).

For details on how physiotherapy treatment is carried out, see – Physiotherapy for rhinitis

Surgical treatment is used if there are polyps in the nasal cavity (which are removed); in case of post-traumatic cerebrospinal fluid fistulas causing cerebrospinal rhinorrhea (in cases where drainage is ineffective); in case of spontaneous rhinocerebrospinal fluid rhinorrhea caused by a brain tumor.

Prevention

Specific methods for preventing rhinorrhea have not been developed.

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Forecast

The prognosis for the development and duration of rhinorrhea depends on the disease causing this symptom: if with the flu and acute cold rhinorrhea passes quickly, then with allergies rhinorrhea is chronic and requires constant treatment.