Causes
Inflammation of the nasal mucosa occurs under the influence of various factors, which are called etiological (causal). Rhinitis can be:
- infectious;
- allergic;
- vasomotor;
- traumatic.
Rhinitis of a viral or bacterial nature is the most common, while trauma to the nasal mucosa is often accompanied by the addition of an infection - that is, traumatic rhinitis becomes infectious. Inflammation, provoked by infection, most often takes on an acute character (serous, catarrhal, purulent). There is also a chronic course (catarrhal, hypertrophic, atrophic inflammation). Fungal infection, mycosis, is often secondary and develops against the background of a primary bacterial infection, immunodeficiency, long-term antibiotic therapy.
Allergic rhinitis occurs as a result of increased sensitivity to certain provocateurs (allergens), contact with which causes an allergic reaction. With vasomotor, or neurovegetative rhinitis, dysfunction of the autonomic nervous system is important - this leads to a hyperergic (overly pronounced) reaction to ordinary stimuli (cold air, pungent odor, cleansing the nose when blowing your nose, etc.). A type of vasomotor rhinitis is a runny nose of pregnant women. The listed diseases are observed in a chronic form and proceed with stages of exacerbation and remission (subsidence of clinical manifestations).
The occurrence of chronic catarrhal, hypertrophic and atrophic rhinitis is associated with impaired blood supply to the mucous membrane, damage (regular inhalation of dust, chemical vapors), frequent acute infections, as well as chronic diseases of the cardiovascular, excretory, and respiratory systems. Chronic rhinitis can occur with chronic sinusitis.
Main manifestations
What are the leading symptoms of rhinitis in the clinical picture of rhinitis? By itself, a runny nose is just one of the signs of the disease, which is otherwise called rhinorrhea and implies the release of a pathological secretion from the nasal cavity. Rhinitis, on the other hand, is a specific nosological unit, that is, a specific disease or syndrome that combines symptoms characteristic of a lesion of the nasal mucosa.
Regardless of the etiology and form of the course, the acute period of rhinitis includes such general manifestations as:
- Nasal congestion, difficulty in nasal breathing, nasal sounds.
- Unpleasant sensations in the nose (burning, tingling, dryness, irritation).
- Rhinorrhea with the release of serous, mucous, mucopurulent secretions.
- Sneezing, in some cases - coughing, impaired sense of smell.
- Headache, dizziness, weakness, fever.
With traumatic rhinitis, a unilateral inflammatory process may occur, with all other types of rhinitis, the process is bilateral.
Depending on the type of injury, only one half of the nose may be affected, as well as pain in the nose - it is localized mainly in the area of damage to the mucous membrane.
Due to congestion, the patient often has to breathe through the mouth - this contributes to the drying out of the mucous membrane of the nose and throat, prevents adequate rest and sleep. The voice changes, becoming muffled, nasal. In connection with the violation of nasal breathing, the patient becomes lethargic, irritable, it is difficult for him to concentrate on important tasks, which significantly reduces the ability to work. Coughing is especially pronounced in the morning hours, after sleep and is caused by the flow of pathological discharge from the nasal cavity along the back of the pharynx.
The general condition of patients with rhinitis is determined, first of all, by the etiology of the disease. The vast majority of infectious rhinitis is viral; inflammation of the nasal mucosa is observed simultaneously with other manifestations (pharyngitis, tonsillitis, tracheitis, bronchitis) and is characteristic of ARVI (acute respiratory viral infection). The course of acute infections includes intoxication syndrome, the presence of which is due to weakness and fever. However, complaints of a violation of the general condition can also be observed with non-infectious forms of rhinitis.
Features of individual forms of rhinitis
When assessing the clinical picture of rhinitis, it is important to have an idea of the features of the common cold and systemic manifestations in different forms of the disease. Clarification of individual characteristics allows for differential diagnosis of various types of inflammation and the correct choice of therapy.
Infectious rhinitis
Catarrhal and purulent inflammation occurs, and the catarrhal variant is not always provoked only by viruses, bacteria can also act as pathogens. The disease has stages (irritation, serous discharge and mucopurulent discharge), begins with a feeling of dryness and burning, after which an abundant discharge of a watery-mucous secretion appears, which subsequently becomes cloudy, becomes viscous, yellowish-green. Fever is subfebrile or febrile, all the previously described general manifestations are present.
Allergic rhinitis
Allergy is characterized by a profuse runny nose - symptoms develop almost immediately after contact with an allergen (pollen, food, etc.). There is severe itching, tickling in the nose, repeated sneezing, discharge of a watery consistency. Breathing through the nose is difficult until it stops completely due to edema. Pain and crackling in the ears may join; the skin above the upper lip and on the wings of the nose is swollen and irritated. Patients are also worried about weakness and headache.
Rhinitis of allergic etiology may be accompanied by an increase in body temperature and general weakness.
Fever should not become the only criterion for the differential diagnosis between infectious and allergic rhinitis, since fever, although not a mandatory symptom, can appear with an allergic form of the common cold. Rhinitis associated with an allergic reaction often manifests itself simultaneously with allergic conjunctivitis, pharyngitis, dermatitis.
Vasomotor rhinitis
This form of the disease is characterized by the classic triad of symptoms: paroxysmal, or paroxysmal sneezing, profuse discharge of colorless watery mucus, congestion alternately in one nostril, which manifests itself more clearly when lying on its side. Additionally noted:
- decreased sense of smell;
- headache;
- a sensation of mucus flowing down the throat.
The manifestations of vasomotor rhinitis resemble an allergic rhinitis, and in some classifications, sensitivity to an allergen is considered as a type of neurovegetative dysfunction combined with immunopathological mechanisms.However, it is now customary to separate these pathologies; before establishing the diagnosis of "vasomotor rhinitis", it is necessary to exclude the possibility of allergic inflammation. Unlike allergies, vasomotor rhinitis is not characterized by eye or skin symptoms, and the risk of developing the disease is higher in individuals with vegetative-vascular dystonia.
Chronic rhinitis
Difficulty in nasal breathing and a runny nose are present in all types of chronic rhinitis. The patient's voice becomes nasal, frequent headaches are observed, sensitivity to odors is impaired (hyposmia). With atrophy, painful dryness of the mucous membrane occurs, a tendency to nosebleeds, and numerous crusts form. Hypertrophic rhinitis can, as a result of an increase in the inferior concha, lead to compression of the opening of the nasolacrimal canal, which is clinically manifested by the occurrence of lacrimation, conjunctivitis. The training of accountants in the school outline is one of the main services.
Rhinoscopic picture
Rhinoscopy, that is, an examination of the nasal cavity, is carried out to clarify the causes of a cold. Comparison of patient complaints and objective signs allows you to formulate a preliminary diagnosis, determine the need for additional research methods. Therefore, it is important to know how rhinitis manifests itself - symptoms include:
- Redness (flushing), edema.
- Accumulation of pathological secretions.
- Spots, crusts, erosion, ulceration, wounds (with traumatic rhinitis).
The objective picture has features for each form of the disease; when examining patients suffering from infectious rhinitis, changes in the mucous membrane correspond to the stages of the inflammatory process.
Infection
Signs of rhinitis at the onset of the disease are redness, swelling and dryness of the mucous membrane. After a while, you can see the accumulation of mucous, then mucopurulent secretions, an increase in the volume of the turbinates. At the stage of resolution of the runny nose, the nasal mucosa acquires a cyanotic (cyanotic) color.
Allergy
The mucous membrane does not turn red; it retains a pink tint with moderate pallor, and pronounced edema is also noted. In the nasal cavity there is a significant amount of discharge of a watery consistency. Bright hyperemia, no pus.
Neurovegetative dysfunction
There is pallor and swelling of the mucous membrane, the appearance on its surface of spots of a white or bluish tint. A mucous secret is visible in the nasal cavity.
Chronic inflammation
In chronic catarrhal rhinitis, edema, a bluish tinge of the mucous membrane can be detected. The discharge is mucous, in moderation. With hypertrophic rhinitis, the mucous membrane thickens, becomes denser, becomes bluish or gray-red, and is covered with mucus.
Chronic hypertrophic rhinitis is characterized by the persistence of swelling even after the use of vasoconstrictors.
This symptom is checked using a special test, during which the mucous membrane is lubricated with a drug that leads to vasoconstriction (anemization). Edema, in contrast to hypertrophy, decreases after anemization, which makes it possible to clarify the etiology of the pathological process.
Atrophic rhinitis is characterized by thinning and dryness of the mucous membrane, the presence of a viscous secretion and the formation of crusts. Inaccurate removal of crusts (for example, with fingers, improvised objects) leads to the formation of defects (ulceration), wounds that are noticeable during examination.
When assessing the symptoms of inflammation of the nasal mucosa, it is necessary to understand that the development of a pathological process of a mixed type, an atypical or erased course, is possible. The diagnosis of rhinitis should only be made by a physician.
