Rhinitis is caused byViruses、Bacteria、AllergenInflammation of nasal mucosa caused by, etc. may originate from various physical and chemical factors or some systemic diseases.Among many types, the most common isrhinallergosisByDust mite、mould, pets, pollen and other allergens, and there is a genetic tendency.Non allergic rhinitis is caused by virus, bacteria, pungent odor, temperature change and other factors, includingVasomotor rhinitis、Atrophic rhinitisHormone rhinitis, etc.Acute rhinitis, also known as "cold" and "cold", is caused by a variety of upper respiratory tract virus infections and has a certain degree of infectivity, while chronic rhinitis is a chronic inflammation of nasal mucosa and lower layer, which lasts for more than a few months and has recurrent attacks.
The main symptoms of rhinitis include stuffy nose, sneezing, runny nose and itchy nose, but the specific manifestations can vary according to the type of rhinitis.Acute rhinitis often manifests itself as dryness, burning or itching in the nose at the initial stage, and finally develops into obliterative nasal sounds and hypoolfaction.The main symptoms of chronic rhinitis are nasal congestion and increased nasal mucus, headache, discomfort at the nose root and other symptoms may also occur.If the condition is serious, inflammation may also affect other upper respiratory tract parts and lower respiratory tract, causingiaryngopharyngitis、tympanitis、Tracheitis、bronchitisandpneumoniaAnd other complications.
The main treatment for rhinitis is medication. If the condition is serious enough to affect the quality of life or complicated with chronic rhinosinusitisnasal polypAnd other diseases, surgical treatment may also be considered.
The prognosis of rhinitis varies with the etiology and treatment effect.For acute rhinitis, patients can generally improve themselves.Chronic rhinitis usually occurs repeatedly, and its therapeutic effect varies significantly between individuals.In addition, allergic rhinitis, as an allergic disease, requires long-term symptom control and management.In general, keeping good living habits, scientific use of drugs and regular reexamination will help alleviate the condition of rhinitis and improve the quality of life of patients.
TCM disease name
rhinitis
Foreign name
Rhinitis
Alias
catch cold、cold
Visiting department
Otolaryngology Department, Allergy Department
Multiple population
All people
Common causes
Viruses, bacteria, allergens (such as pollen), various physical and chemical factors (such as irritating gases)
It is caused by upper respiratory tract virus infection or combined with bacterial infection. More than 100 viruses are known to cause this disease, the most common of which areRhinovirus、adenovirusEtc.
The etiology of chronic rhinitis is still unclear.Chronic rhinitis is often caused by chronic congestion or reflex congestion of nasal mucosa blood vessels due to repeated attacks or incomplete treatment of acute rhinitis, disorder of the body's own endocrine or immune system, retention of pathogens due to poor nasal ventilation, chronic diseases, local drugs, and long-term inhalation of dust and irritating gases.
It is mainly caused by endocrine disorder, vitamin deficiency, genetic factors, improper nasal surgery, infection and other factors, with obvious genetic tendency.
Hormonal rhinitis
It is mainly caused by periodic changes of hormones in the body, such as obvious nasal congestion during pregnancy.
Occupational rhinitis
Most of them are caused by the stimulation of substances exposed to specific working environment. Common substances include grains, wood chips, chemicals, irritant gases, etc.
Predisposing factors
Rhinitis can be induced when the body immunity is reduced due to cold, overwork, excessive smoking and drinking, nutritional deficiency and other diseases.
symptom
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Rhinitis patients often have one or more nasal symptoms, such as nasal congestion, nasal itching, sneezing, and runny nose.
Typical symptoms
Acute rhinitis
At the initial stage of virus infection, there will be dryness, burning or itching sensation, sneezing in the nose, followed by nasal congestion, watery nasal mucus, decreased sense of smell and occlusive nasal sounds.After secondary bacterial infection, nasal mucus becomes mucinous, mucopurulent or purulent.
Chronic rhinitis
The main symptoms are stuffy nose and increased nasal mucus. It can also be accompanied by decreased sense of smell, occlusive nasal sounds, nasal root discomfort, headache and other symptoms.
Other types of rhinitis
Allergic rhinitis: mainly manifested as nasal itching, sneezing, clear water snot, nasal congestion, reduced sense of smell, and can be accompanied by eye or throat itching and discomfort;
Atrophic rhinitis: mainly manifested as nasal obstruction, nasal scab, dryness, odor and headache;
Hormone rhinitis: nasal obstruction is the main manifestation, and the symptoms change periodically with the change of hormone level;
Occupational rhinitis: mainly manifested as stuffy nose, runny nose, itchy nose, sneezing, etc.
When patients have symptoms such as stuffy nose, itchy nose, sneezing, runny nose, etc., they can go to the otorhinolaryngology department of the hospital for treatment;For patients suspected of allergic rhinitis who have tried basic drug treatment without sufficient relief, they can be referred to the Allergic Reaction Department for further treatment.
Visiting department
Otolaryngology Department, Allergy Department.
Relevant inspection
physical examination
The nose andUpper respiratory tractWhether there is any abnormal tissue structure in the relevant parts, and observe the state of the mucosa in the nose and other parts of the upper respiratory tract, such as congestion, edema, secretion, etc.
Nasal endoscopy
Nasal endoscope is used to examine the nasal cavity, nasopharynx and even the internal structure of the nasal sinus through the narrow nasal cavity and structures in the nasal passage. It is only used for those patients with atypical symptoms or inadequate treatment response.
Skin prickle
Identify whether there is specific skin reaction caused by allergen, and judge whether it is related to clinical symptoms according to the test results, so as to distinguish allergic rhinitis from non allergic rhinitis.
Serological examination of allergy
according toImmunoglobulin E(IgE) immunoassay distinguishes between allergic rhinitis and non allergic rhinitis. It is applicable to patients who cannot perform skin pricking, but it is more expensive than skin tests, and is less sensitive to the diagnosis of allergic reactions caused by inhalation allergens.
Nasal cytology
Although the test is not specific and insensitive, some researchers still use it to help distinguish allergic rhinitis and infectious rhinitis.
Objective evaluation of nasal qi ventilation function
Nasal resistance measurement and nasal acoustic reflex measurement are the most commonly used methods to objectively evaluate nasal ventilation.The evaluation of nasal ventilation has extensive application value in the auxiliary diagnosis of diseases, the selection of treatment methods and the evaluation of curative effects.
Imaging examination
Nasal tomography (CT) and magnetic resonance imaging (MRI) are used to evaluate the nasal anatomy for differential diagnosis.
differential diagnosis
Acute and chronic sinusitis
It is caused by swelling of nasal sinus mucosa or nasal polyps blocking the sinus opening, which is more serious than rhinitis. When nasal inflammation affects the sinuses, pus, headache, and sinus tenderness can be seen, and even systemic symptoms can be accompanied in serious cases.
Influenza
Also known as "flu", it is an acute respiratory infectious disease caused by influenza virus. The systemic symptoms are severe, such as high fever, chills, headache, joint and muscle aches and other symptoms are obvious, while the upper respiratory symptoms such as runny nose and sneezing are not obvious.
Nasal neoplastic lesions
Usually, the nasal symptoms of patients are mostly unilateral, while the symptoms of rhinitis are mostly bilateral. CT and MRI of the sinuses can help to identify such diseases.
Cerebrospinal rhinorrhea
Cerebrospinal fluid rhinorrhea can be caused by skull or nasal bone fracture, intracranial surgery, etc. Compared with rhinitis, it usually causes unilateral or bilateral watery nasal secretions, which are obvious when the head is lowered, without obvious nasal obstruction, sneezing, etc. It is mainly differentiated by endoscopy combined with imaging examination.
Some acute respiratory infectious diseases, such asmeasles、Scarlatina、pertussisCan appear at an early stageAcute rhinitissymptom.Except forAcute rhinitisIn addition to the symptoms, there are symptoms of its own disease, and the systemic symptoms are severe, such as high fevershiver, headache, aching muscles, etc.It can be identified by detailed physical examination and close observation of the course of disease.
Children should pay attention to the identification of the disease.Nasal diphtheria has bloody nose and serious systemic symptoms, often accompanied by pharyngeal diphtheria.
treatment
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Rhinitis is mainly treated by drug therapy. If the symptoms of rhinitis are not improved after drug therapy, which seriously affects the quality of life or patients with chronic rhinosinusitis, nasal polyps and other diseases, surgical treatment can be considered.
Acute treatment
Acute rhinitis, commonly known as "cold" and "cold", is infectious. There is no simple and effective treatment method yet. It is mainly symptomatic and supportive treatment. Antibiotics can be used when combined with bacterial infection.In addition, patients should drink more water, eat a light diet, clear their bowels, and pay attention to rest.
medication
Nasal cleaning
It refers to the use of physiological saline nasal spray or nasal lavage to clean nasal mucosa to reduce inflammatory symptoms. It is forbidden for patients with extensive nasal trauma, severe sodium chloride metabolic disorders and allergies.
Intranasal hormone
For local use of nasal spray, the common hormone components areBudesonide、Fluticasone propionate, mometasone furoate, etc., sprayed on the nasal mucosa to reduce the inflammatory reaction of the nasal mucosa and promote the repair of damaged ciliated epithelium, but attention should be paid to the possiblepharyngitis, coughBronchospasm, nasal irritation, epistaxis and other adverse reactions.
Antihistamine
It has anti allergic effect, especially suitable for patients with sneezing and itching nose. Common drugs areLevoca- bastine de 、Cetirizine、loratadineEtc.Applicable to allergic rhinitis, but pay attention to possible dry mucosaUroschesisAnd other adverse reactions.
Anticholinergic drug
asIpratropium bromideIt has the function of relaxing bronchial smooth muscle and can reduce nasal secretion, but attention should be paid to possible adverse reactions such as nasal dryness, burning, irritation, nasal congestion, headache and dry mouth.
Decongestant
asHydroxymetazolineIt can shrink blood vessels, relieve symptoms and reduce congestion, but has no effect on nasal itching, sneezing or runny nose.It should be noted that continuous use should not exceed one week. Long term use may cause drug rhinitis.
Leukotriene receptor blocker
asMontelukast sodium It can prevent and reduce mucosal inflammation.It is applicable to seasonal allergic rhinitis and perennial allergic rhinitis, but it is necessary to pay attention to possible allergic reactions, hallucinations, lethargy, excitement, nausea, diarrhea and other adverse reactions.
surgical treatment
Rhinitis is mainly treated with drugs. If the drug treatment fails, surgery can be selected.
Selective neurotomy
It refers to the neurotomy of pterygoid canal under nasal endoscope.It is suitable for patients with allergic rhinitis, drug and immunotherapy effects are not obvious.
Partial submucosal resection of inferior turbinate
It refers to the removal of submucosal soft tissue under nasal endoscope.It is applicable to patients with chronic hypertrophic rhinitis in non allergic rhinitis. When the patients have hypertrophic inferior turbinate bone and mucosa, surgery is feasible.
Lateral wall of nasal cavity internal transfer plus fixation, anterior nostril closure, nasal cavity narrowing
It is suitable for patients with atrophic rhinitis. It can shrink the nasal cavity, reduce water evaporation in the nasal cavity, and reduce nasal mucosa dryness and crusting.
Before operation, check the nasal cavity for acute inflammation or secretion to determine the scope of resection and clean the nasal cavity;Anti infection treatment is needed after operation, and spicy and stimulating food is not eaten.
Endoscopic sinus surgery
It is suitable for patients with nasal sinusitis and nasal polyps. It can clear the lesion, ventilate and drain through removing edema mucosa and opening the sinuses.
TCM treatment
At present, there is a lack of evidence on the efficacy and safety of traditional Chinese medicine in the treatment of rhinitis, and the use of Chinese herbal medicine is not recommended.Some patients with allergic rhinitis can choose acupuncture to reduce nasal congestion, or catgut embedding can be used to treat allergic rhinitis.
prognosis
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The prognosis of patients with rhinitis is different due to different causes and treatment effects.Acute rhinitis is self-healing, and can generally improve after 1 week;Chronic rhinitis often occurs repeatedly, and the therapeutic effect varies from person to person.Other rhinitis, such as allergic rhinitis, belongs to allergic reaction disease and needs long-term symptom control and management.
With the development of the disease, there will be collapse of the nasal back, perforation of the nasal septum, suppurative sinusitis, dacryocystitis, and secondary sinus mucoceles.
other
Other types of rhinitis have no obvious complications.
