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

If the common rhinitis is called rhinitis (Greek rhino - nose), then such a symptom as rhinorrhea manifests itself by an intense secretion of a liquid and almost transparent nasal secretion that literally flows from the nose (Greek rhoia - flow).

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

[1], [2], [3], [4], [5]

Epidemiology

According to some estimates, from 10% to 25% of the world's population suffer from symptoms of chronic rhinitis. Allergic and non-allergic rhinitis affect about 30% of the US population.

However, the symptom in the form of rhinorrhea is not separately fixed, however, the ratio of patients with non-infectious rhinitis of allergic and non-allergic etiology is 3: 1. A mixed clinical picture is observed in almost half of cases of treatment to otolaryngologists or therapists.

The frequency of rinolikvorei after fracture of the base of the skull is from 15-20%; Spontaneous cerebrospinal rhinorrhea occurs in 4-23% of patients.

[6], [7], [8], [9], [10], [11], [12],

Causes of the rhinorrhea

Transparent watery discharge from the nose often appears when the lining of the nose is mucous - one of the most commonly infected tissues in adults and children - requires cleaning from viruses that cause it, causing acute rhinitis with colds and flu.

In the case of a viral infection, the typical first signs of an organism's reaction include itching in the nose and sneezing, increased tear and rinorrhea. But in the next stage, when the immunocompetent cells of the mucosal tissue react to the virus, the mucin (mucus) content increases in the nasal secretions, which absorbs the liquid and swells, causing them to become thicker with a color change to yellowish-greenish (due to the secreted leukocytes iron-containing enzyme myeloperoxidase); Then the nasal congestion is noted.

Very often, the causes of rhinorrhea are irritants that enter the nasal cavity, causing non-allergic rhinitis with eosinophilia or  allergic rhinitis. And, thus,  seasonal allergy  or pollinosis is manifested by 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 have bilateral chronic rhinorrhea. More information in the material -  Causes of respiratory allergies.

Also rhinorrhea can be a symptom:

• chronic catarrhal rhinitis ;
• acute sinusitis of  viral origin and chronic form of bacterial inflammation of the paranasal sinuses;
• the presence of a foreign body in the nasal cavity (especially in young children);
• the formation of nasal polyps (which are usually the result of chronic allergies or inflammation);
• dysfunctions of the nasal mucosa due to prolonged use of vasodilating 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 are shortness of breath, cough and bronchospasm;
• the initial stage  of the Cherdja-Strauss syndrome ;
• Wegener's granulomatosis  with polyangititis;
• hormonal changes during pregnancy;
• genetically determined (primary) ciliary dyskinesia or  Kartagener's syndrome ;
• basal cell carcinoma (more often diagnosed in the elderly).

Postnazalnaya rhinorrhea, in which the bulk of liquid discharge flows into the nasopharynx, is characteristic of acute pharyngitis, nasopharyngitis or tonsillopharyngitis (more often it occurs in children) or sinus inflammation of the facial part of the skull -  acute etmoidosphenoiditis. Such a clinical picture, with periodic nasal congestion, can give a  vasomotor rhinitis  - an idiopathic syndrome with nonspecific triggers.

Also, otolaryngologists noted rhinorrhea in the  perforation of the tympanic membrane  and as a complication after laryngotomy.

Copious watery discharge from the nose (often only from one nostril) can be after a craniocerebral trauma, due to liquor fistulas, which are formed after operations on the paranasal sinuses or the brain, as well as after epidural injection of steroids. And it's already traumatic or iatrogenic cerebrospinal rhinorrhea - outflow of cerebrospinal fluid (CSF), defined as nasal  liquorrhea  or rinolikvoreya. With her mouth feels metallic or salty taste, the sense of smell is reduced, there is a ringing in the ears, postural headaches occur.

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

[13], [14], [15], [16], [17], [18], [19]

Pathogenesis

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

In response to infection or allergens in the epithelium, the amount of secretory goblet cells that develop mucous secretion increases, and the activity of the submucosal tubular glands of Bowman increases - to capture large particles (including viruses and bacteria) that are inhaled with air, and moisten it.

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

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

[20], [21], [22], [23]

Complications and consequences

Serious consequences and complications are noted in cases of cerebrospinal rhinorrhea in post-traumatic cerebrospinal fistulas. First, ascending infection (in most cases - Pneumococcus, Streptococcus and Haemophilus influenzae) can cause inflammation of the membranes of the brain - bacterial meningitis, which is the leading cause of death (up to 2%) in patients with this pathology.

Secondly, with a decrease in the volume of cerebrospinal fluid, hemodynamics of the brain and full nutrition of its tissues are disturbed, which creates a risk of complication from the nervous system - vegetative and central.

[24], [25], [26], [27]

Diagnostics of the rhinorrhea

Anamnesis, fixation of patient complaints and physical examination is sufficient for a cold or flu accompanied by a runny nose. But in other (listed above) cases, diagnosis of rhinorrhea can include such analyzes as:

• microbiological  analysis of mucus from the nose, on the level of neutrophils and eosinophils;
• analysis of excretion into beta-2-transferrin (with suspected rinolikvorei);
• a 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.

[28], [29], [30], [31], [32]

Differential diagnosis

To determine the true cause of rhinorrhea, differential diagnosis is necessary, taking into account the whole complex of symptoms and the features of their manifestation.

For example, if the rhinorrhea is long and the discharge is observed from both nostrils, this is most often associated with allergic or vasomotor rhinitis, and a persistent loss of smell causes suspicion of polyps in the nose, atrophy or Wegener's granulomatosis.

[33], [34], [35], [36],

Treatment of the rhinorrhea

In most cases, in the treatment of rhinorrhea separately from acute rhinitis is not necessary, although physicians recommend using physiological nasal sprays and  washing the nose with salt  (NaCl solution).

A quick therapeutic effect is produced by Aerosol Atrovent (Normosecretol) with an atropine derivative (ipratropium bromide), but it can cause side effects such as dry mouth, headache, nausea and increased heart rate. More information in the material -  Sprays for the nose from the cold

When the period of secretion of the liquid nasal secretion passes to the stage of its thickening, the rhinitis is treated and a drop of rhinitis is used for this , since special drops in the nose are not released in rhinorrhea.

It may be prescribed inhalation therapy of rhinorrhea, for example, with atropine sulfate. All the details in the publication -  Treatment of a runny nose inhalation.

Aerosol products from allergic rhinorrhea - which reduce the production of mucus due to the presence of corticosteroids in them or blocking histamine receptors - are the same as in allergic rhinitis; All about these preparations in the article -  Sprays from allergic rhinitis.

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

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

How physiotherapy is performed, for details, see  Physiotherapy for rhinitis

Surgical treatment is used if there are polyps in the nasal cavity (which are removed); with post-traumatic cerebrospinal fistula, causing cerebrospinal rhinorrhea (in the absence of drainage effect); with spontaneous rinolikvoree, caused by a brain tumor.

Prevention

Specific methods for the prevention of rhinorrhea have not been developed.

[37], [38], [39], [40],

Forecast

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