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Rhinitis-like conditions (runny nose) in adolescents and adults

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Understanding Rhinitis-Like Conditions (Runny Nose)

The term "runny nose" (coryza) and the manifestations of rhinitis-like conditions, along with approaches to their treatment, are generally well-known to the public. However, the concept of a "runny nose" lacks strictly defined boundaries in everyday language and patient perception. One individual might describe a "runny nose" primarily as nasal stuffiness, another might focus on profuse nasal discharge, a third might consider insufficient discharge as a sign, and yet another may associate it with bouts of sneezing. It is important for clinicians to understand these varied interpretations to accurately diagnose and manage underlying nasal conditions.

 

Defining "Runny Nose" and its Subjectivity

None of these individual symptoms (nasal congestion, discharge, sneezing) in isolation necessarily constitutes acute rhinitis, nor are they singularly critical for diagnosis and therapy. The patency of the nasal passages can be impaired for numerous reasons, and nasal congestion can increase transiently due to various stimuli, which is often mistakenly regarded as a common cold or "runny nose." For instance, many individuals, especially those with underlying conditions like hypertrophy of the inferior turbinates, may experience temporary swelling of the nasal mucosa in response to changes in temperature, alcohol consumption, olfactory irritants (strong smells), or other factors. These transient reactions should not be confused with the clinical picture of acute infectious rhinitis.

Swelling of the nasal mucosa is a common physiological response in conditions presenting as a "runny nose," leading to symptoms like congestion and discharge. (Image illustrative of nasal discharge).

 

Distinguishing Banal Rhinitis from Transient Nasal Reactions

A "banal runny nose," or acute common rhinitis (often the common cold), implies a catarrhal condition characterized by swelling of the mucous membrane of the upper respiratory tract, frequently of infectious (primarily viral) origin. It typically follows a defined cyclical course lasting at least several days. In contrast, transient vasomotor or reflex nasal reactions often resolve quickly once the stimulus is removed.

For example, some individuals with heightened nasal sensitivity may experience an urge to sneeze upon minimal dust exposure (e.g., when flipping through a book). Others react to drafts of air cooling exposed parts of the body, or to sharp irritation of the eyes by strong light. These conditions, almost exclusively of a vasomotor or reflex nature, usually subside soon after the trigger is removed. The inflammatory phenomena accompanying acute infectious rhinitis, however, persist for several days.

 

Etiology of Acute Banal Rhinitis (Common Cold)

The occurrence of a common cold is usually associated with exposure to cold temperatures (hypothermia) or, less often, with the influence of mechanical (e.g., dust) or chemical irritants, which can compromise local nasal defenses. Despite common perception, the direct contagiousness of the common cold through simple experimental transmission from one person to another has proven difficult to consistently demonstrate in controlled settings, though it is clearly transmissible in community settings. The specific causative agent for "the common cold" is not singular; numerous viruses (rhinoviruses, coronaviruses, adenoviruses, etc.) and sometimes bacteria (e.g., pneumococcus, *Haemophilus influenzae*, *Moraxella catarrhalis*, often as secondary invaders) can cause its clinical symptoms.

It's also important to recognize that several systemic infectious diseases, such as influenza, SARS, measles, scarlet fever, and diphtheria, can present in their initial period with symptoms characteristic of a common cold or acute rhinitis.

Treatment and Management of Rhinitis-Like Conditions and Acute Rhinitis

When discussing the treatment of the common cold or acute rhinitis, it is important to note that there is generally no specific "causal" treatment for the underlying viral infection itself, other than specific antiviral medications for influenza if initiated early. Management is primarily symptomatic and supportive.

 

General Principles and Symptomatic Relief

  • Environmental Control: Many people find that being outdoors, even in winter, helps with a cold. However, cold, damp, and mobile air can cause harmful irritation and may not shorten the disease process. An even, calm, warm environment is generally more conducive to recovery from coryza. For some chronic nasal conditions, however, controlled exposure to specific air conditions might be appropriate under medical guidance.
  • Rest: If a runny nose is accompanied by fever, the patient should rest in bed.
  • Hydration: Maintaining adequate fluid intake is important.
  • Symptomatic Medication: Antipyretic drugs may be given 2-3 times a day for fever. Pathogenetic treatment aimed at underlying mechanisms can also improve well-being.

It is important to avoid harsh irritants such as tobacco smoke, inhalation of powders, or very warm vapors, as these can increase hyperemia (blood flow and redness) of the mucous membrane and exacerbate symptoms.

In the case of a runny nose or rhinitis-like condition, medical or supportive treatment is administered depending on the nature and severity of the symptoms.

 

Pharmacological Interventions (Historical and Modern Context)

Many remedies exist to combat nasal congestion. It should be borne in mind that any drug that shrinks the swollen cavernous tissue of the nasal mucosa (vasoconstrictors) can also cause some degree of irritation, which should be mitigated if possible.

  • Topical Preparations:
    • Mentholated Oils: Menthol oil was traditionally used several times a day while lying down. A few drops could be poured into the nose using a spoon or dropper, or a cotton swab moistened with oil inserted. Pressing the wings of the nose helped distribute the oil. (Caution: Menthol should not be used in young infants due to risk of laryngospasm).
    • Ointments: Remedies in ointment form (e.g., 1-2% concentrations, often with a base of lanolin and petroleum jelly) could be applied to the anterior part of the nose with the index finger or a brush.
    • Decongestants (Short-Term Relief): For temporary relief of painful pressure in the head and to make the nose passable (e.g., for singers, artists, business people), a weak solution of cocaine with a few drops of adrenaline was historically instilled. Modern practice uses safer topical decongestants like oxymetazoline or xylometazoline for short periods (3-5 days).
  • Post-Acute Phase Management: After the acute period of a cold, if the stage of increased secretion is unduly prolonged, careful lubrication with a 2% solution of silver nitrate (a mild astringent and antiseptic) was sometimes considered appropriate historically.
With a runny nose, topical medications are sometimes applied to the anterior part of the nose using an index finger or a soft cotton swab. (Image illustrative of nasal contents).

 

Prevention of Complications

A common complication of acute rhinitis is the spread of the inflammatory process to the mucous membrane of the pharynx, larynx, deeper parts of the respiratory tract (trachea, bronchi), paranasal sinuses (sinusitis), and, via the Eustachian tubes, to the middle ear (otitis media). Measures that ensure the patient's rest and reduce irritation can help prevent such a course. However, achieving this is often difficult since a common runny nose is not always recognized by patients as a serious enough illness to warrant significant rest or alteration of daily activities. If a patient with a runny nose cannot stay in bed, they should at least restrict strenuous movement, go to bed on time, avoid strong alcoholic drinks, and refrain from smoking.

 

Prevention of Common Colds and Rhinitis-Like Conditions

General preventive measures are aimed at strengthening the body's overall resilience and minimizing exposure to pathogens or irritants:

  • General Hardening/Strengthening Measures: Historically, practices like water procedures (e.g., contrast showers) and air baths were advocated for their effect on the skin and general constitution, aiming to make the body more resilient to cold.
  • Nasal Hygiene (with caution): While some historical practices involved "hardening" the nasal mucosa with cold or warm irritations (nasal showers, infusions, injections, inhalations), such procedures are now generally considered potentially harmful. They pose a danger to the ears (risk of otitis media), even if performed with precautions, and can limit the bactericidal properties of the nasal mucosa by washing away protective mucus and potentially damaging epithelial cells. These practices should be especially avoided in children.
  • Addressing Underlying Nasal Abnormalities: If there is a predisposition to frequent coryzal attacks, a thorough nasal examination by an ENT specialist is necessary. Eliminating detected anomalies (e.g., significant mucosal hypertrophy, nasal polyps, adenoid enlargements in children) can often resolve this dangerous tendency to recurrent runny noses.
  • Standard Infection Prevention: Frequent handwashing, avoiding close contact with sick individuals, and respiratory etiquette (covering coughs/sneezes) are crucial.

 

Differential Diagnosis of Persistent Nasal Symptoms

While a "runny nose" often implies a common cold, persistent or atypical symptoms warrant further investigation to differentiate from other conditions:

Condition Key Differentiating Features
Acute Viral Rhinitis (Common Cold) Nasal congestion, watery to mucopurulent discharge, sneezing, mild fever, sore throat. Usually self-limiting (7-10 days).
Allergic Rhinitis Itching (nose, eyes, palate), paroxysmal sneezing, clear watery rhinorrhea, nasal congestion. Often seasonal or perennial, related to specific allergen exposure. Family history of atopy.
Non-Allergic Rhinitis (e.g., Vasomotor Rhinitis, Gustatory Rhinitis) Nasal congestion, rhinorrhea triggered by non-allergic stimuli (irritants, temperature changes, spicy foods, stress). Itching usually absent. Allergy tests negative.
Acute Bacterial Rhinosinusitis Symptoms persisting >10 days, or severe onset (high fever, purulent discharge, facial pain for 3-4 days), or "double sickening." Facial pain/pressure more prominent.
Chronic Rhinitis (Catarrhal, Hypertrophic, Atrophic) Persistent nasal congestion and/or discharge lasting >12 weeks. Specific mucosal changes visible on examination.
Nasal Foreign Body (especially in children) Unilateral, foul-smelling, purulent nasal discharge, possible epistaxis.
Cerebrospinal Fluid (CSF) Rhinorrhea Clear, watery, unilateral nasal discharge, often salty taste, history of head trauma or surgery. Positive for beta-2 transferrin. Requires urgent attention.
Medication-Induced Rhinitis (Rhinitis Medicamentosa) Rebound nasal congestion from overuse of topical decongestant sprays.

 

When to Seek Medical Attention

While most "runny noses" are self-limiting, medical advice should be sought if:

  • Symptoms are severe or unusually prolonged (e.g., lasting more than 10-14 days without improvement).
  • High fever is present, especially in young children or the elderly.
  • There are signs of complications, such as severe ear pain, significant facial pain or swelling, shortness of breath, or wheezing.
  • Symptoms are recurrent or chronic, suggesting an underlying condition like allergy, chronic rhinitis, or sinusitis.
  • There is unilateral nasal discharge, especially if foul-smelling or bloody (to rule out foreign body, tumor, or other specific pathology).
  • The individual has underlying chronic health conditions that might make them more vulnerable to complications.

An accurate diagnosis by a healthcare professional can ensure appropriate management and prevent unnecessary treatments or complications.

References

  1. Heikkinen T, Järvinen A. The common cold. Lancet. 2003 Jan 4;361(9351):51-9.
  2. Eccles R. Understanding the symptoms of the common cold and influenza. Lancet Infect Dis. 2005 Nov;5(11):718-25.
  3. Turner RB. The common cold. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Elsevier; 2020:chap 349.
  4. Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020 Oct;146(4):721-767. (Covers various rhinitis types)
  5. Middleton E Jr, Reed CE, Ellis EF, Adkinson NF Jr, Yunginger JW, Busse WW, eds. Allergy: Principles and Practice. 5th ed. Mosby; 1998. (Historical context for some treatments)
  6. Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy. 2017;47(7):856-889.
  7. Pappas DE, Hendley JO. The common cold and croup. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020:chap 410.

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