Rhinitis is the most common disease of the upper respiratory tract.
The main factor predisposing to the development of rhinitis can be considered hypothermia, which contributes to the violation of the protective mechanisms of the body and the activation of conditionally pathogenic microflora in the nasal cavity, nasopharynx and oral cavity. Another factor is the decrease in the resistance of the organism due to acute or chronic diseases.
Warming, moisturizing and filtering the inhaled air, the nasal cavity performs a protective function. The nasal cavity and bronchi are anatomically interrelated, covered with ciliated epithelium and equipped with an arsenal of congenital and acquired protective mechanisms. Therefore, conditions that cause a runny nose, can be a triggering factor for the development of diseases of the lower respiratory tract.
Rhinitis may be the first sign of an acute respiratory viral infection ( ARVI ), as well as the onset of an allergic reaction. The following types of rhinitis are distinguished:
- non-allergic, non-infectious rhinitis.
Seasonal and perennial allergic rhinitis, as well as intermittent and persistent course of each of these forms, are distinguished.
By non-allergic, non-infectious persistent rhinitis is understood as a heterogeneous group of nasal breathing disorders, including occupational rhinitis, drug rhinitis, hormonal rhinitis, elderly rhinitis, and idiopathic vasomotor rhinitis.
Infectious rhinitis occurs in about half of the adult population. In children, especially young children, the incidence of infectious rhinitis is much higher. It may be non-specific (the onset of a respiratory infection) and specific, for example, caused by pathogens of infectious diseases – diphtheria, measles, scarlet fever, tuberculosis.
In addition, acute traumatic rhinitis, caused by trauma of the nasal mucosa (foreign bodies, cauterization, surgical interventions, as well as environmental conditions – dust, smoke, inhalation of chemicals), is also isolated.
The classic signs of rhinitis are nasal congestion, nasal discharge, sneezing. Rhinitis begins quickly with a general deterioration of the patient’s condition: the body temperature rises, headache , worsening nasal breathing, decreased sense of smell, due to the spread of the inflammatory process in the olfactory region. The patient notes a burning sensation, tickling and scratching in the nasal cavity. Then there is a discharge due to the liquid, sweating from the vessels, and enhancing the function of the mucous glands. This discharge has an irritating effect, especially in children, on the skin of the vestibule of the nose and upper lip, manifested in the form of redness and painful cracks. Nasal breathing is impaired due to edema of the concha.
Characteristic tearing due to irritation of the sensitive reflexogenic zones of the nasal mucosa, sneezing. Swelling of the mucous membrane of the nasal cavity leads to impaired drainage of the paranasal sinuses and the middle ear, which creates favorable conditions for the activation of conditionally-pathogenic flora and contributes to the development of bacterial complications. The nature of the discharge from the nasal cavity changes, it becomes cloudy, then yellowish and greenish. This is due to the presence of pus in it.
The patient’s condition improves: the headache decreases, the amount of discharge, the discomfort in the nose disappears (sneezing, tearing), nasal breathing improves. The total duration of acute rhinitis is 8-14 days, it can vary in one direction or another for various reasons. Acute rhinitis can stop in 2–3 days if the child’s general and local immunity is not impaired. In weakened children (often ill with ARVI), in the presence of chronic foci of infection, acute rhinitis may be prolonged in nature – up to 3-4 weeks.
Acute rhinitis in infants has its own characteristics. It usually proceeds as rhinopharyngitis ; often the inflammatory process extends to the nasopharynx ( adenoiditis ), middle ear, larynx, trachea, bronchi, lungs. The child is disturbed by the act of sucking, which leads to loss of body weight, sleep disturbance , increased excitability. Especially severe acute rhinitis occurs in premature, weak children, with a sharply reduced body resistance.
Chronic catarrhal rhinitis characterized by a number of common manifestations: the main complaint is a violation of nasal breathing with alternate laying one or the other half of the nose. Depending on the contents of certain elements exudate, nasal discharge can be serous, mucous ormucopurulent -gnoynym. Chronic hypertrophic rhinitis is characterized by the duration of the course. Nasal congestion is more permanent than with the catarrhal form of rhinitis, and does not go away after instillation of vasoconstrictor agents. In addition to obstructed nasal breathing, patients suffer from headaches, poor sleep. The mucous membrane of the nose is usually pale pink, reddish or with a bluish tint. Abundant thick discharge fill the nasal passages and flow into the nasopharynx, but in rare cases, discharge may not be.
With chronic atrophic rhinitis patients complain of a feeling of dryness in the nose, the formation of crusts, a feeling of pressure and headaches. Discharge of the nose is thick, yellow-green; sometimes drying out, forms a crust. Increased patency of the nasal passages, purulent discharge in large quantities can cause the spread of chronic inflammation of the mucous membrane of the pharynx and larynx.
Vasomotor rhinitis is a disease caused by an organism’s hypersensitivity (allergic form) or neuro-vegetative disorders (neuro-vegetative form). These two forms have similar manifestations of the disease: sneezing, nasal congestion, and abundant liquid discharge.
A constant sign for allergic rhinitis is sneezing, accompanied by abundant transparent watery discharge from the nose and difficulty in nasal breathing. Discharge preceded by itching in the nose.
The diagnosis of acute rhinitis is made on the basis of complaints of the patient, subjective and objective signs, anterior rhinoscopy. Sometimes clinical observations are not enough for diagnosis. In these cases, they resort to laboratory methods of research: general blood analysis, the study of the cytological picture of imprints from the nasal concha mucosa, virological tests.
With signs of rhinitis on the background of normal body temperature prescribed
- home (not bed rest) mode,
- plenty of warm drink
- thermal procedures (hot foot baths and warm compresses on the back surface of the hands).
How to blow your nose correctly
The main thing is to blow your nose correctly, so that, firstly, to clean the nasal cavity, and secondly, so that the discharge from the nasal cavity does not fall into the paranasal sinuses and the middle ear cavity. To do this, it is necessary to blow your nose without effort, with a half-open mouth and free each half of the nose, alternately pressing the wing of the nose to the septum. In the case of drying of the crusts at the entrance to the nose, soften them with oil (olive, sunflower) and then carefully remove it with a cotton wick. But only After that, you can peel the mucus from the nose.
When rhinitis is recommended plenty of warm drinks (tea with lemon and raspberry, milk with honey). In cases of high temperature (above 38), antipyretic agents can be used. Although it must be borne in mind that antipyretic drugs, increasing sweating, can predispose to various kinds of complications and worsen the course of the disease, reducing the body’s resistance to infectious aggression.
In the period of exacerbation in chronic rhinitis use the same medicines as in acute rhinitis (vasoconstrictor drops, drops and ointments with drugs that have anti-inflammatory, antimicrobial action). Astringent drugs are used: 2-5% solution of protargol ( colargol ) in the form of drops in the nose (5 drops in each half of the nose 3 times a day).
Treatment of chronic subatrophic and atrophic rhinitis based on a specific program: topically prescribed drugs to improve the condition of the nasal mucosa and stimulate the function of the mucous glands. Used in the form of drops of alkaline solutions, spraying, lubrication with a light massage, furatsilinu ointment at the rate of 1: 5000. Conduct courses for restorative therapy (autohemotherapy, protein therapy, vaccine therapy, injections of aloe extract, cocarboxylase , vitreous body, FIBS), vitamin therapy, prozerin therapy according to generally accepted schemes.
Treatment of chronic hypertrophic rhinitis requires more radical measures: cauterization (produced by chemicals – trichloroacetic acid, lapis, chromic acid, etc.), galvanic caustic, diathermocoagulation, ultrasonic disintegration, cryosurgery , exposure to a laser beam.
With acute rhinitis from physiotherapy methods apply
- ultraviolet irradiation locally and in the area of the soles (6-8 bio doses);
- UHF (areas of the nose for 5-8 minutes, the first 3 days daily, and then every other day);
- microwave effect on the nose area;
- effective inhalation (warm-alkaline, alkaline-oil, oil-adrenaline, phytoncides, honey, etc.).
In chronic catarrhal rhinitis , UHF currents, sollux, ultraviolet irradiation, if there are no contraindications to them, microwave therapy, aerosols, and negatively charged electro- aerosols with antibiotics are more often prescribed.
Of the various forms of chronic rhinitis, low-energy laser radiation is more often used in the treatment of patients with chronic catarrhal rhinitis and subatrophic rhinitis, as well as the neuro-vegetative form of vasomotor rhinitis. The total irradiation time of each half of the nose is 3-4 minutes.The course of daily treatment 10-12 procedures.
In the treatment of rhinosinusitis The following methods of quantum hemotherapy are also used: intravenous irradiation of blood with a helium-neon laser in combination with skin irradiation in the projection area of the vessels with an infrared laser.
Treatment of vasomotor rhinitis should be comprehensive and focused. All types of proposed therapeutic effects on the body can be divided into specific and non-specific. The success of a specific hyposensitization depends on the early detection of an allergen, since over time, patients develop polyallergy . Novocaine blockades, exposure to cold, infrared coagulation, ultrasonic disintegration, vasotomy , hypobarotherapy combined with hyposensitization , ultraviolet irradiation, therapeutic exercises, air and sun baths and many other methods of physiotherapy are used, taking into account indications and contraindications. The beneficial effect of laser therapy for vasomotor rhinitis is associated with improved capillary exchange in the nasal mucosa, leading to the elimination of edema and swelling.
In the absence of the effect of conservative therapy, in the presence of irreversible changes in the mucous membrane of the nasal cavity, a gentle surgical treatment is recommended. Various variants of submucosal operations performed on the nasal conchs are also performed: galvano-acoustics, electrocautery, osteoconchotomy, submucosal microsurgery of vaccines , mucosotomy, conchotomy, and other methods.
The most effective method treatment of allergic rhinitis is the termination of the patient’s contact with the allergen. Drug therapy includes two main aspects of exposure: specific immunotherapy with a significant allergen and the use of antihistamine drugs (tavegil, terfenadine , loratadine ,cetiresin ). Antihistamines of the first generation have a number of side effects (pronounced hypnotic effect). Therefore, the use of these drugs must be carried out with caution (a certain group of people – drivers, etc., must abandon them).
Treatment of allergic rhinitis is also carried out comprehensively and in stages. The first step is the recovery of secretion through irrigation of the nasal mucosa using mineral water, decoction of black tea, massage of the nasal mucosa, acupressure of the nasal wings and collar area;enterosorption (removing metabolic products, toxins, immune complexes, using for this purpose sorbents – Polyphepanum, ultrasorb, sums et al.). The second stage is drug therapy. The third step is carried out specific and nonspecific immunotherapy, increases the content of immunoglobulin A. As bacterial immunostimulants used ribomunil, bronhovakson, bronhomunal. Specific immunotherapy is a causal allergen.