Runny nose, acute rhinitis, rhinopharyngitis

Symptoms of Acute Rhinitis (Runny Nose)

Acute rhinitis typically progresses through several stages, with symptoms evolving over a few days:

1. Prodromal Stage (Dry/Irritative Stage): Often begins with a sensation of dryness, tickling, or burning in the nose and nasopharynx, followed by sneezing.
2. Catarrhal Stage (Serous Stage): Characterized by:
   • Sharply expressed hyperemia (redness) and swelling (edema) of the nasal mucosa.
   • Abundant, clear, watery nasal discharge (serous rhinorrhea).
   • Nasal congestion, making nasal breathing difficult and sometimes completely obstructed.
   • Reduced sense of smell (hyposmia).
   • Watery eyes (epiphora) due to nasolacrimal duct involvement.
3. Mucous/Mucopurulent Stage: After a few days, the discharge typically thickens and may become mucoid (cloudy white) and then mucopurulent (yellowish or greenish) as inflammatory cells and bacteria accumulate. This does not always signify a bacterial superinfection requiring antibiotics, as it can be part of the natural resolution of a viral infection.

Associated systemic symptoms are also common with acute rhinitis:

• Fever (usually low-grade, but can be higher in children or with influenza).
• Malaise and weakness.
• Lack of appetite.
• Headache, often due to nasal congestion and sinus pressure.

Typically, the symptoms of uncomplicated acute rhinitis (common cold) subside within 7 to 10 days.

Potential Complications

However, complications can arise, especially in children or immunocompromised individuals:

• Acute Otitis Media (Middle Ear Infection): Due to spread of inflammation/infection up the Eustachian tube.
• Acute Sinusitis: Inflammation of the paranasal sinuses due to obstruction of their drainage ostia.
• Lower Respiratory Tract Infections: Such as laryngitis, tracheitis, bronchitis, or pneumonia, particularly with more virulent viruses like influenza or RSV, or in susceptible individuals.
• Pharyngeal Abscess (Rare): Such as peritonsillar or retropharyngeal abscess.
• Exacerbation of underlying chronic respiratory conditions like asthma.

 

Treatment of Acute Rhinitis (Runny Nose)

The primary goals of treating acute rhinitis are to alleviate symptoms, prevent complications (such as progression to chronic rhinitis, sinusitis, or otitis media), and address the underlying etiological factors where possible (e.g., avoiding irritants, managing allergies if they are a trigger for recurrent episodes).

 

General Measures and Symptomatic Relief

• Rest: Especially important in the first few days of illness, particularly if fever or significant malaise is present. Bed rest in a warm room is often recommended.
• Hydration: Drinking plenty of fluids (water, clear broths, diluted juices) helps to thin mucus and prevent dehydration, especially with fever.
• Humidification: Using a cool-mist humidifier or vaporizer can help soothe irritated nasal passages and loosen secretions. Steam inhalation (e.g., from a shower or bowl of hot water, with caution to avoid burns) can also be beneficial.
• Nutrition: A balanced diet is important. For children, nutrition should limit salt and excessive fluids (if edema is a concern, though hydration is generally encouraged), be regular, complete, and provide sufficient vitamins. There is a common misconception that taking vitamin C prophylactically prevents colds or flu; evidence for this in the general population is weak, though adequate vitamin C is part of a healthy diet.

 

Pharmacological Interventions

• Nasal Saline: Isotonic or hypertonic saline nasal sprays or drops are safe and effective for all ages. They help to moisturize the nasal mucosa, loosen thick secretions, and facilitate their removal.
• Topical Nasal Decongestants (Vasoconstrictors):
  • Examples include oxymetazoline, xylometazoline, phenylephrine. Historically, solutions like 1% boric acid (10 ml) with 0.1% adrenaline solution (10 drops), instilled as 3-6 drops in each nostril 3 times a day, or solutions of naphazoline (Naphthyzin) and Sanorin (0.05% or 0.1%) were prescribed.
  • These provide temporary relief from nasal congestion by shrinking swollen nasal tissues.
  • **Caution:** Prolonged use (more than 3-5 days) can cause rebound congestion (rhinitis medicamentosa), leading to increased swelling and dependence. Incorrect instillation (e.g., with the head thrown far back) can lead to the medicine being swallowed or spat out, reducing its effectiveness and increasing systemic absorption.
• Oral Decongestants: Pseudoephedrine or phenylephrine can help reduce nasal congestion but may have systemic side effects (e.g., increased heart rate, blood pressure, insomnia) and should be used with caution, especially in young children and individuals with certain medical conditions.
• Analgesics and Antipyretics: Acetaminophen or ibuprofen can be used to relieve fever, headache, and general discomfort. It is not always necessary to aggressively lower a mild fever with antipyretics like aspirin (aspirin should be avoided in children and adolescents with viral illnesses due to the risk of Reye's syndrome), as fever is part of the body's natural immune response. However, high fever or significant discomfort warrants treatment. Overuse of antipyretics might increase sweating and potentially predispose to complications or worsen the course by suppressing some aspects of the immune response, though this is debatable.
• Antihistamines: First-generation antihistamines (e.g., diphenhydramine) may help with rhinorrhea due to their anticholinergic effects but can cause drowsiness. They are generally not recommended for uncomplicated colds unless there is a significant allergic component.
• Cough Suppressants and Expectorants: Their efficacy in common colds is limited, especially in children. Honey (for children over 1 year) may be more effective for cough than some over-the-counter medications.
• Herbal Medicine/Remedies: Various herbal preparations are used, but their efficacy often lacks strong scientific backing.
• Belladonna Tincture (Historical): Older children with abundant watery nasal discharge were sometimes prescribed belladonna tincture (e.g., 5 ml with valerian 10 ml, 10 drops up to 3 times a day) or Belloid pills (up to 2 per day) for a quick effect by reducing parasympathetic tone and glandular secretion. This is not standard modern practice due to potential toxicity and availability of safer alternatives.

 

Physiotherapy and Other Modalities

During periods of absent or severely difficult nasal breathing, especially in the initial days of illness with fever and headache, certain adjunctive measures may be considered:

• Local Heat Applications (Warming): Such as warm compresses to the nasal area.
• UVRO (Ultraviolet Irradiation of Erythemal Dose) on Soles: A historical physiotherapy technique.
• Mustard Plasters on Calves or Hot Mustard Foot Baths: Traditional remedies aimed at reflexively reducing nasal congestion.
• Physiotherapeutic Procedures: Sollux lamp (infrared heat), UHF currents, or ozokerite applications have been used in some settings.
• Insufflation of Powders: Historical practice of blowing antibiotic or sulfonamide powders into the nose.

Children under 3 years of age are contraindicated for cocaine (due to toxicity) and menthol-containing preparations (due to risk of laryngospasm/glottic spasm).

 

Important Considerations

• Nasal Hygiene: If there is abundant mucus in the nasal cavity, it should be gently aspirated with a rubber bulb syringe, especially in infants before feeding. Nasal crusts forming at the entrance to the nose should be softened with sterile boiled oil (olive, sunflower), petroleum jelly, or a product like Oxycort (which contains an antibiotic and corticosteroid) and then carefully removed with a cotton wick.
• Antibiotics: Antibiotics are NOT indicated for uncomplicated viral acute rhinitis (common cold). They should only be prescribed if a secondary bacterial infection (e.g., acute bacterial sinusitis, otitis media) is diagnosed or strongly suspected.

 

Acute Rhinopharyngitis (Nasopharyngitis) in Infants and Young Children

Acute rhinopharyngitis, also known as nasopharyngitis or the common cold involving the nasopharynx, occurs when the inflammatory process of acute rhinitis spreads to the pharynx (throat), particularly the nasopharynx (the area behind the nose). This is very common in newborns and infants.

 

Specific Challenges in Infants

The disease course can be more severe in infants due to several factors:

• Less Adaptation: Compared to adults, infants are less adapted to changes in the external environment due to the functional and morphological immaturity of their central nervous system and tissues.
• Narrow Nasal Passages: Newborns and infants have very narrow nasal passages. Even slight swelling of the mucous membrane can lead to severe breathing difficulties.
• Obligate Nasal Breathing: Young infants are primarily nasal breathers. Nasal obstruction significantly impairs their ability to breathe, especially during feeding (sucking), forcing them to interrupt feeding to breathe through the mouth.
• Sleep Disturbances: During sleep, nasal obstruction can cause bouts of shortness of breath (dyspnea), suffocation sensations, and even apnea (temporary cessation of breathing).
• Risk of Lower Respiratory Involvement: The need for oral breathing can lead to drying of the pharyngeal and laryngeal mucosa and can facilitate the spread of infection to the lower respiratory tract, potentially causing laryngitis, tracheitis, bronchitis, or pneumonia.
• Immature Immune System: Acute rhinitis/rhinopharyngitis in infants is most often caused by viral infections. Their immune mechanisms to combat these viruses are not yet fully developed, which can contribute to the severity of the illness.
• High Fever: Body temperature can sometimes rise to 40°C (104°F) in infants with severe rhinopharyngitis.

 

Treatment of Acute Rhinopharyngitis in Infants

The treatment approach for acute rhinopharyngitis in infants is largely similar to that for acute rhinitis, with a strong emphasis on supportive care and maintaining nasal patency:

• Antibiotics: Prescribed only if a secondary bacterial infection is confirmed or strongly suspected (e.g., persistent high fever, purulent discharge with signs of bacterial sinusitis or otitis media).
• Vasoconstrictor Nasal Drops: Have a short-term effect and should be used judiciously, typically only before feeding, to help the baby breathe while nursing or bottle-feeding. Use formulations appropriate for infants (e.g., lower concentration oxymetazoline) and for a limited duration (3-5 days).
• Nasal Aspiration: If there is abundant discharge in the nasal cavity, gentle mucus aspiration with a bulb syringe or nasal aspirator before feeding is indicated to clear the airway.
• Saline Nasal Drops/Sprays: Help to liquefy mucus and moisturize nasal passages.
• Hydration and Humidification.
• Monitoring for Complications: Close observation for signs of otitis media, sinusitis, or lower respiratory tract infection.

The overall treatment strategy mirrors that for acute rhinitis, focusing on symptomatic relief and prevention of complications.

 

Differential Diagnosis of Acute Rhinitis/Rhinopharyngitis

While acute viral rhinitis/rhinopharyngitis (common cold) is very common, other conditions can present with similar initial symptoms, especially in children:

Condition	Key Differentiating Features
Acute Viral Rhinitis/Rhinopharyngitis (Common Cold)	Gradual onset, nasal congestion, watery to mucopurulent discharge, sneezing, cough, sore throat, mild fever. Usually self-limiting.
Allergic Rhinitis	Itching (nose, eyes, palate), paroxysmal sneezing, clear watery rhinorrhea, nasal congestion. Often seasonal or related to specific allergen exposure. Family history of atopy common. Eosinophils in nasal smear.
Acute Bacterial Rhinosinusitis	Symptoms persisting >10 days without improvement, or severe onset (high fever, purulent discharge for 3-4 days), or "double sickening." Facial pain/pressure more prominent.
Influenza	Abrupt onset, high fever, myalgia, headache, severe malaise, cough. Nasal symptoms similar to common cold but systemic illness more severe.
Foreign Body in Nose (especially in young children)	Unilateral, foul-smelling, purulent nasal discharge, possible epistaxis.
Adenoiditis	Persistent nasal obstruction, purulent rhinorrhea, snoring, mouth breathing. Symptoms may be subacute or chronic.
Prodromal Phase of Exanthematous Diseases (e.g., Measles)	Rhinitis, cough, conjunctivitis, fever may precede characteristic rash (e.g., Koplik's spots in measles).

 

Prevention Strategies

Preventing acute rhinitis and rhinopharyngitis involves general measures to reduce the transmission of respiratory viruses:

• Hand Hygiene: Frequent and thorough handwashing with soap and water or use of alcohol-based hand sanitizers.
• Respiratory Etiquette: Covering coughs and sneezes (e.g., into an elbow or tissue).
• Avoiding Close Contact with Sick Individuals: Especially important for infants and young children.
• Cleaning and Disinfecting Surfaces: Regularly clean frequently touched surfaces.
• Promoting General Health: Adequate sleep, balanced nutrition, and regular physical activity to support immune function.
• Vaccinations: Annual influenza vaccination can prevent flu-related rhinitis. Routine childhood immunizations protect against other viral illnesses that can present with rhinitis (e.g., measles).
• Avoiding Overcrowded Environments: Particularly during peak respiratory virus season.

 

When to Seek Medical Attention

While most cases of acute rhinitis are self-limiting, medical attention should be sought if:

• Symptoms are severe or persist for more than 10-14 days without improvement.
• High fever (e.g., >39°C or 102.2°F) is present, especially in young children.
• There are signs of complications, such as:
  • Severe ear pain or discharge (suggesting otitis media).
  • Persistent facial pain or pressure, severe headache (suggesting sinusitis).
  • Difficulty breathing, wheezing, or rapid breathing (suggesting lower respiratory tract involvement).
  • Persistent vomiting or refusal to feed in infants.
  • Unusual lethargy or irritability.
• The child is very young (e.g., <3 months old) and develops cold symptoms.
• The child has underlying chronic health conditions (e.g., asthma, cystic fibrosis, immunodeficiency).
• Symptoms worsen after initial improvement ("double sickening").

A healthcare provider can help differentiate viral rhinitis from bacterial superinfections or other conditions and recommend appropriate management.