Nasal inflammatory disease, or rhinitis, is an inflammation of the nasal mucosa caused by viruses, bacteria, allergens, various physicochemical factors, and certain systemic diseases. The main pathological changes are congestion, swelling, exudation, hyperplasia, atrophy or necrosis of the mucosa of the nasal cavity. Nasal inflammatory diseases are classified into acute rhinitis, chronic rhinitis (chronic simple rhinitis, chronic hypertrophic rhinitis), allergic rhinitis, atrophic rhinitis, drug rhinitis, dry rhinitis, etc. according to different etiology, pathogenesis and pathological changes. Now we mainly introduce acute rhinitis and chronic rhinitis (chronic simple rhinitis, chronic hypertrophic rhinitis).
Acute rhinitis is an acute inflammatory disease of the mucous membrane of the nasal cavity caused by viral infection, commonly known as “cold” “cold”, contagious, the onset of the four seasons, but in the autumn, winter and spring seasons, the body due to systemic and local factors and resistance to decline when easy to develop.
I. Etiology and pathogenesis
1, viral infection is its primary cause, or in the viral infection on the basis of secondary bacterial infection. More than 100 kinds of viruses are known to cause this disease, the most common is rhinovirus, followed by influenza and parainfluenza virus, adenovirus, coronavirus, coxsackievirus and mucus and paramucus virus. The mode of transmission is mainly virus droplet transmission, inhalation through the respiratory tract, followed by entering the organism through contaminated objects.
2. The body under the influence of certain triggers, resulting in a decrease in resistance, so that the virus invades the mucosa of the nasal cavity. Common triggers are: (1) systemic factors: cold, overwork, excessive smoking and alcohol, vitamin deficiency, endocrine disorders or other systemic chronic diseases (such as heart, liver, kidney); (2) local factors; nasal septal deviation, chronic rhinitis, nasal polyps and other chronic diseases of the nasal cavity; adjacent infectious lesions, such as chronic purulent sinusitis, chronic tonsillitis, etc.
Second, pathological manifestations
Early vasospasm, mucosal ischemia, and reduced glandular secretion. In the early stage, vasodilation, mucosal congestion, edema, increased secretion of glandular and cupular cells, and infiltration of submucosal mononuclear cells and phagocytes. In cases of secondary bacterial infection, the submucosa is infiltrated with neutrophils, and the cilia and epithelial cells are necrotically shed. In the recovery period, epithelial and ciliated cells are reborn, and the function and morphology of cilia gradually return to normal.
Clinical manifestations
There are three stages:
1, the initial or prodromal stage: about 1 to 3 days. Most of the symptoms are general discomfort, dryness of mucosa due to vasoconstriction of nasal mucosa and reduction of glandular secretion, burning and dryness in the nose without secretions. The nasal mucosa is acutely congested with dry appearance.
2.Acute phase or wet phase:about 2-7 days. The patient’s systemic symptoms gradually worsen, fever appears, and local symptoms become more and more pronounced. Nasal congestion, occlusive nasal sounds, sneezing, decreased sense of smell, nasal secretions gradually change from clear water-like to mucus-like, and the amount of snot increases. If the inflammation and swelling of the nasal mucosa and the retention of secretions cause obstruction of sinus drainage and complicate acute sinusitis, headache may result, and inflammation may spread to the eustachian tube and lower respiratory tract and cause otitis media or lower respiratory tract and lung infection. Complications mostly occur in the frail and children, but if treated properly, most of the above complications heal with the healing of acute rhinitis. In addition to acute congestion of the nasal mucosa, there is also swelling of the nasal mucosa or turbinate tissue, and the nose is filled with clear water-like or mucus-like secretions; sometimes the skin of the nasal vestibule may become red, swollen and cracked, and if the inflammation migrates through the nasolacrimal duct, it may also cause acute conjunctivitis.
3.Terminal or recovery period: about 2-3 days, the above systemic symptoms gradually reduce, after the secondary bacterial infection, the nasal discharge becomes mucous, mucopurulent or purulent, which is not easy to blow out, so sometimes the nasal obstruction is heavier, and sometimes the nasal discharge can have a little blood in it; if the discharge flows into the throat, it can cause cough. If there is no complication, it can be cured after about 1 to 2 weeks. There is an immune period of about one month after an infection, so patients can have multiple attacks in a year.
Systemic symptoms vary from individual to individual and can be progressively more severe. Most of them show general malaise, lethargy, headache and fever (37~38℃). In children, systemic symptoms are more severe than those in adults, with high fever (39℃ or more) and even convulsions, and often gastrointestinal symptoms such as vomiting and diarrhea.
Nasal examination: nasal mucosa is congested and swollen, inferior turbinate is congested and enlarged, and there is more secretion from the common nasal passage or nasal floor, which is watery at first and gradually becomes mucous, mucopurulent or purulent later. If there is no complication, the above symptoms will gradually decrease or even disappear, and the course of the disease is about 7~10 days.
IV. Complications
When the resistance of the body is lowered or the anti-discharge function of the nasal mucosa is damaged, it can cause the virus to invade the body, grow and multiply and develop. At the same time, the pathogenic bacteria (streptococcus, staphylococcus, streptococcus pneumoniae, influenza bacillus and other bacteria) present in the patient’s nose and pharynx also take advantage of the opportunity to actively reproduce and form secondary infections.
1, acute sinusitis nasal inflammation through the sinus openings to the sinuses, causing acute purulent sinusitis, which is more common in the maxillary sinusitis and septal sinusitis.
2, acute otitis media infection through the eustachian tube to the middle ear spread caused by.
3.Acute pharyngitis, laryngitis, tracheitis and bronchitis infection spreads downward through the nasopharynx. In children, the elderly and those with low resistance, pneumonia can also be complicated.
4.Infection of nasal vestibulitis spreads directly forward.
5, other infections spread through the nasolacrimal duct, can also cause ocular complications, such as conjunctivitis, dacryocystitis, etc.
V. Differential diagnosis
1, the flu systemic symptoms are heavy, such as high fever, chills, headache, generalized joint and muscle pain. The upper respiratory tract symptoms are not obvious.
2. Allergic rhinitis is often misdiagnosed as acute rhinitis. The disease manifests itself as episodes of sneezing and clear watery snot, which rarely lasts more than half a day. After the attack, everything returns to normal. There are no systemic symptoms such as fever. Cytological examination of nasal secretions, skin test, nasal excitation test and specific IgE antibody assay are helpful for diagnosis.
3, vasomotor rhinitis symptoms are similar to allergic rhinitis, with sudden onset, rapid fading and obvious triggers.
4, acute infectious diseases some acute infectious diseases of the respiratory tract such as measles, scarlet fever, whooping cough, etc. can appear early symptoms of acute rhinitis. In addition to the performance of acute rhinitis, these diseases also have their own disease manifestations, and the systemic symptoms are heavy, such as high fever, chills, headache, generalized muscle aches and pains. Through a detailed physical examination and close observation of the course of the disease can be identified.
5, nasal diphtheria child patients should pay attention to identify this disease. Nasal diphtheria with blood and heavy systemic symptoms is often complicated by pharyngeal diphtheria.
VI. Treatment
Support and symptomatic treatment is the main focus, while paying attention to the prevention of complications.
1. Systemic treatment: drink more water, soak feet in hot water, take a hot bath, etc. Diet is light, easy to digest and nutritious. Bed rest is recommended for those with severe symptoms.
(1) sweating early with can reduce symptoms and shorten the course of the disease. Such as ginger, brown sugar, white onion decoction hot water, oral antipyretic and analgesic drugs.
(2) Acute rhinitis can be used in a combination of Chinese and Western medicine Chinese medicine antiviral oral liquid, vitamin C silver warp tablets.
(3) systemic antibiotics combined with bacterial infection or suspected complications with. It can be administered orally, intramuscularly or intravenously.
(4) Other treatment light diet, loosen the bowels, pay attention to rest.
2.Local treatment
(1) Intranasal decongestant vasoconstrictor such as 1% (0.5% for children) ephedrine saline nasal drops to make the mucous membrane decongest and reduce nasal congestion, smooth drainage. Attention should be paid to the correct method of nasal drip, now introduced as follows: 1) supine method: supine, pillow under the shoulder; or supine, head as far back as possible and hanging outside the edge of the bed, the front nostril facing up. 2) sitting method: sitting position, back against the back of the chair, head as far back as possible. 3) lateral method: lying to the side of the disease, head down (for unilateral sinusitis or hypertensive patients). After the position is fixed, the medicine is dripped into the nasal cavity through the anterior nostril, 3 to 5 drops per side.
(2) acupuncture therapy for nasal congestion choose Yingxiang, Hall of Yin acupuncture points; headache choose Hegu, Sun, Fengchi and other points. Strong stimulation stay needles for 10 to 15 minutes.
(3) In addition, the correct nasal blowing method should be used to tightly press one side of the nose and gently blow the nasal mucus from the opposite nasal cavity; or inhale the nasal mucus into the pharynx and then spit it out.
Seven, prevention The onset of acute rhinitis is mostly due to the decline in body resistance to viral invasion. Therefore, you should often exercise, appropriate outdoor activities to enhance the body’s resistance. Advocate cold water washing, cold water bath, sunbathing. According to the seasonal climate change, increase or decrease clothing in time. Avoid close contact with patients during the “cold” epidemic, and keep the living room well ventilated. We can use ginger sugar and jujube soup (9g ginger, 9g jujube, 72g brown sugar) or 30g Kanzhu, decocted in water, to achieve the purpose of prevention. In addition, some vinegar water can be sprinkled in the living room to prevent the disease.