Chronic rhinitis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Chronic rhinitis symptoms
- Diagnostics
- Chronic rhinitis treatment
- Possible complications and consequences
- Forecast
- Prevention
Chronic rhinitis (chronic rhinitis) is a chronic inflammatory process that occurs in the nasal mucosa.
Frequently recurring or untreated acute rhinitis is a common cause of chronic rhinitis
The human nasal cavity is divided into two parts by a nasal septum, which is formed by a vomer, cartilage and a vertical plate of the ethmoid bone. The common nasal passage is located between the nasal septum and the turbinates, in the lateral portions of the nasal cavity there are three nasal passages, which correspond to the three turbinates (inferior, middle and superior). Conchs in the nose allow for increased surface area of the nose. The wing of the nose includes connective tissue formations that form the nostrils (posterior inferior parts of the nasal openings). The main function of the nose is to cleanse, warm and humidify the inhaled air, and to capture odors.
There are a large number of blood vessels in the nasal mucosa. With the development of chronic rhinitis, the blood circulation in this area is disrupted, which provokes blood stagnation. As a result of inflammation, the mucous membrane swells, due to which the nasal passages narrow, respectively, nasal breathing becomes difficult. One of the manifestations of inflammation is inflammatory exudate - a pathological discharge, the nature of which varies depending on the form of the disease.
Causes and risk factors
The main reasons for the development of chronic rhinitis include:
- recurrent or untreated coryza;
- genetic predisposition;
- allergy;
- infectious processes in the upper respiratory tract;
- metabolic disorders (in particular, metabolic disorders of arachidonic acid);
- changes in hormonal levels;
- inhaling too cold, hot, dry, polluted or dusty air;
- violations of the anatomical structure of the nose (in particular, curvature of the nasal septum);
- surgical interventions in the nasal cavity;
- foreign bodies in the nasal cavity;
- abuse of local vasoconstrictor drugs (drops, sprays);
- bad habits.
Chronic rhinitis can result from a deviated septum
Forms of the disease
Chronic rhinitis can take the following forms:
- hypertrophic;
- atrophic;
- allergic (seasonal or year-round);
- non-allergic;
- professional;
- vasomotor.
In accordance with the generally accepted clinical classification, chronic rhinitis occurs in the following forms:
- catarrhal;
- hypertrophic;
- atrophic.
Classification of chronic rhinitis
Chronic hypertrophic rhinitis, in turn, is of two types:
- limited;
- diffuse.
Chronic atrophic rhinitis:
- plain;
- fetid coryza (ozena).
Chronic rhinitis symptoms
The symptoms of chronic rhinitis, regardless of the form of the disease, include:
- discharge from the nasal cavity;
- dryness of the nasal mucosa;
- difficulty in nasal breathing;
- decreased sense of smell;
- nasal voice;
- itching sensation in the nasal cavity;
- sore throat;
- sneezing (especially in the morning);
- reflex cough;
- snore;
- persistent headaches.
These symptoms in patients with chronic rhinitis can have varying degrees of severity and appear in various combinations.
With chronic rhinitis, nasal breathing is difficult
One of the most common signs of chronic rhinitis is the presence of postnasal syndrome, which is the accumulation of abnormal secretions in the back of the nose and throat, which causes the patient to feel discomfort. Postnasal syndrome can cause chronic sore throat and / or chronic unproductive cough.
Allergic chronic rhinitis usually manifests itself in a sensation of itching in the nose, ears and throat, redness of the eyes and watery eyes, absence or difficulty in nasal breathing, and rapid fatigue. Discharge from the nose is clear, watery.
In chronic catarrhal rhinitis, nasal congestion is usually more pronounced in one side of the nose. Violation of nasal breathing is aggravated in the cold. Discharge from the nasal cavity is mucous or mucopurulent, moderate, but may become profuse and purulent.
In chronic hypertrophic rhinitis, overgrowth and thickening (hyperplasia) of the nasal mucosa is observed. The overgrown mucous membrane impedes nasal breathing until it stops completely due to blockage of the nasal passage, patients are forced to breathe through the mouth. In addition, the openings of the nasolacrimal canals are compressed, which can cause dacryocystitis (inflammation of the lacrimal sac) and conjunctivitis. Compression of the mouth of the Eustachian tubes can lead to the development of Eustachitis.
Dacryocystitis is one of the complications of chronic hypertrophic rhinitis
In chronic atrophic rhinitis, scanty viscous mucus is secreted from the nasal cavity, which forms a crust when it dries. Attempts to remove the crusts lead to injury to the atrophic mucous membrane of the nasal cavity. Permanent microtrauma causes ulceration, nosebleeds, and secondary infection. When the ulcers of the mucous membrane are infected with Klebsiella, a type of chronic atrophic rhinitis occurs, such as a fetid rhinitis, or ozena. At the same time, dirty gray crusts form in the nasal cavity, which are the cause of a sharp unpleasant (putrid, nauseous) odor, which can spread quite far. At the same time, dryness of the nose increases, dystrophic processes are aggravated, and nasal breathing becomes difficult, despite the expansion of the nasal cavity.
Diagnostics
For the diagnosis of chronic rhinitis, data obtained from the collection of complaints, physical examination, rhinoscopy are used. With anterior rhinoscopy, slight hyperemia and edema of the mucous membrane of the nasal cavity (mainly in the region of the lower and middle nasal conchas), pastiness are usually found.
If necessary, resort to X-ray and / or computed tomography of the sinuses (to exclude chronic sinusitis), rhinomanometry. Allergy tests are carried out. In case of a negative result of allergic tests, a laboratory study of discharge from the nose for eosinophils is carried out. In addition, a general and biochemical blood test, a general urine test, a culture study of pathological discharge with determination of the sensitivity of an infectious agent to anti-infectious drugs, a histological examination of a biopsy specimen of the nasal mucosa are prescribed.
Rhinoscopy is one of the main methods for diagnosing chronic rhinitis
To differentiate the catarrhal form of chronic rhinitis from hypertrophic, a test with anemization is performed: the mucous membrane of the nasal cavity is lubricated with a vasoconstrictor drug. A pronounced decrease in the volume of the inferior nasal concha indicates the absence of true hypertrophy. A slight decrease in the volume of the inferior turbinates or the complete absence of their contraction indicates a hypertrophic process.
Chronic rhinitis treatment
Treatment of chronic rhinitis is complex, one of the conditions for its success is the exclusion of the influence of factors that caused the development of the disease.
For dryness of the nasal mucosa, moisturizing sprays are used. Prescribed topical medications that improve the trophism of the nasal mucosa, rinsing the nasal cavity with isotonic saline. Frequent use of vasoconstrictor drops should be avoided. With rhinitis of infectious etiology, local antibacterial drugs are prescribed in the form of an ointment, spray, drops, the choice of which is based on the results of determining the sensitivity of microorganisms to antibiotics.
In chronic allergic rhinitis, contact with the allergen is excluded after its identification. Local antiallergic drugs are shown, in some cases specific immunotherapy is carried out. In severe cases, intranasal spray corticosteroids may be prescribed. Drops with a vasoconstrictor effect do not have a pronounced positive effect in this case, and their prolonged use may lead to the development of rhinitis medicamentosa.
In chronic rhinitis, topical preparations are prescribed in the form of sprays, drops, ointments.
For chronic catarrhal rhinitis, nasal drops with anti-inflammatory and astringent effects are used.
With a curvature of the nasal septum, surgical removal of the defect (septoplasty) is indicated.
Treatment for chronic atrophic rhinitis is symptomatic. The therapeutic effect is achieved by constant moistening of the nasal mucosa with saline (drops, sprays, irrigators), instillation of an oil solution of vitamins A and E, and other oil drops is shown.
In chronic hypertrophic rhinitis, in the absence of a positive effect from conservative therapy, surgical treatment is indicated, which consists in removing the overgrown mucous membrane of the nasal cavity. In most cases, the intervention is performed using a minimally invasive method (electrocoagulation, radio wave surgery, cryodestruction, ultrasound or laser methods). In some cases, with slight hypertrophy, a submucosal vasotomy is performed, during which the vascular connections between the mucous membrane and the periosteum of the turbinates are dissected. The operation makes it possible to completely restore nasal breathing. In the case of severe hypertrophy, complete or partial removal of the inferior turbinate (conchotomy) may be required.
Possible complications and consequences
Against the background of chronic rhinitis, complications such as chronic oxygen starvation, chronic tonsillitis, non-allergic rhinitis with eosinophilic syndrome, obstructive apnea syndrome, sinusitis can develop. Chronic allergic rhinitis is a high risk factor for developing bronchial asthma.
Forecast
With timely and correctly selected treatment, the prognosis is favorable.
Prevention
In order to prevent the development of chronic rhinitis, it is recommended:
- timely treatment of acute diseases of the respiratory tract;
- avoiding contact with allergens;
- correction of disturbances in the anatomy of the nasal cavity;
- rejection of bad habits;
- avoidance of uncontrolled use of vasoconstrictor drops.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
