Chronic rhinitis is a chronic inflammatory disease of the mucous membrane and submucous layer of the nasal cavity and is a common disease. It manifests as chronic congestion and swelling of the nasal mucosa and is called chronic simple rhinitis. If it develops into hyperplasia and hypertrophy of the nasal mucosa and turbinate bone, it is called chronic hypertrophic rhinitis. The clinical manifestations are characterized by swelling of the nasal mucosa, increased secretions, no clear pathogenic microbial infection, and the disease lasts for more than several months or recurrent.
(A) Etiology and pathogenesis
It is not known. It is generally believed that this disease is not an infectious disease. Even if an infection is present, it is secondary. Currently, it is believed that the disease is associated with many factors.
1.Local factors
(1) Repeated attacks of acute rhinitis or not thoroughly treated and evolved into chronic rhinitis.
(2) Such as nasal septal deviation obstructs nasal ventilation and drainage, increasing the chances of recurrent infection of the nasal mucosa, and it is not easy to cure completely. Due to the long-term stimulation or deformity of the adjacent chronic inflammatory disease, resulting in nasal ventilation or drainage obstruction, such as chronic inflammatory sinus disease, secretions long-term irritation of the nasal mucosa, so chronic rhinitis often coexists with chronic inflammatory sinus disease, called chronic rhinosinusitis.
(3) adjacent infectious lesions: such as chronic tonsillitis, adenoid hypertrophy, etc.
(4) Inappropriate or prolonged nasal medication: such as intranasal abuse of nasal drops or ephedrine nasal drops, which can lead to drug rhinitis. Intranasal application of bupivacaine, lidocaine, etc. can damage the mucus cilia transport function of the nasal mucosa.
2.Occupational and environmental factors
Long-term or repeated inhalation of dust (such as cement, lime, tobacco, coal dust, flour, etc.) or harmful chemical gases (such as sulfur dioxide, formaldehyde, etc.), living or production environment, the temperature and rapid changes in temperature (such as steel, baking and melting, freezing operations), the nasal mucosa is stimulated and damaged by physical and chemical factors, can cause chronic rhinitis.
3, systemic factors
(1) systemic chronic diseases: such as anemia, diabetes, rheumatism, tuberculosis, heart, liver and kidney disease and autonomic nerve dysfunction and chronic constipation, etc., can cause long-term stasis or reflex congestion of the nasal mucosa blood vessels.
(2) Malnutrition: vitamin A and C deficiency.
(3) Endocrine diseases or disorders: such as hypothyroidism can cause nasal mucosal edema. In late pregnancy and adolescence, the nasal mucosa is often physiologically congested and swollen.
(4) Long-term use of antihypertensive drugs such as reserpine can cause nasal vasodilation and produce symptoms like rhinitis.
(5) Smoking and alcohol addiction: can affect the nasal mucosa vasodilation and disorders.
4.Other factors
Long-term overwork, immune dysfunction, allergic rhinitis, etc.
(2) There are mainly 2 types of pathology.
1, deep nasal mucosa arteries and veins, especially the spongy blood sinus of the inferior turbinate is chronically dilated and permeability is increased, there is inflammatory cell infiltration around the vessels and glands mainly lymphocytes and plasma cells, mucus glands are active and secretion is increased.
2, early manifestation of mucosal lamina propria arteriosus and venous dilation, lymphocyte infiltration around veins and lymphatic vessels, venous and lymphatic vessel reflux obstruction, increased venous permeability, and mucosal lamina propria edema. In the late stage, it develops into limited or diffuse fibrous tissue hyperplasia and hypertrophy of the mucosa, submucosa, and even periosteum and bone. The inferior turbinate is the most obvious, and its anterior, posterior and inferior edges may be nodular, mulberry-like or lobulated hypertrophy, or polypoid changes may occur. The anterior end of the middle turbinate and the mucosa of the nasal septum may also develop hyperplasia, hypertrophy or polypoid changes.
(C) Clinical types
Based on the above 2 pathological types and clinical manifestations, there are 2 clinical types. Chronic simple rhinitis: the pathology is mainly manifested as the first pathological type. Chronic hypertrophic rhinitis: the pathology is mainly manifested as the 2nd pathological type. Although the two clinical types differ pathologically, there is no clear line of demarcation in practice. Pathologically the former can develop and transform into the latter. However, the clinical manifestations of the two are different, and there are also differences in treatment.
Chronic simple rhinitis
1. Nasal congestion: intermittent or alternating.
(1) Intermittent nasal congestion: it is generally reduced during the day, labor or exercise, and aggravated at night, when sitting still or cold.
② alternating nasal congestion: the nasal cavity located on the lower side often becomes more obstructed when lying on the side, and after turning to the other side, the nasal cavity just located on the upper side without nasal congestion or with lighter nasal congestion appears nasal congestion or increased nasal congestion after turning to the lower side; while the nasal cavity just located on the lower side has reduced nasal congestion. In addition, the sense of smell may be diminished to different degrees, and the speech is occlusive nasal sound. Due to the long-term flow of nasal mucus through the nasal vestibule and the upper lip, it can cause dermatitis or eczema, mostly seen in children. The nasal mucus may flow backward into the pharyngeal cavity, resulting in cough and phlegm. Sometimes there may be headache, dizziness, dry throat and sore throat. Occlusive nasal sound, decreased sense of smell, tinnitus and sense of ear occlusion are not obvious.
2.Much runny nose: often mucous or mucopurulent, occasionally purulent, mainly located in the bottom of the nasal cavity, the lower nasal tract or the common nasal tract. Purulent ones mostly appear after secondary infection.
Examination: The nasal mucosa is swollen, with a smooth, moist, generally dark red surface. The turbinate mucosa is soft and elastic, and the probe can be depressed by light pressure, but the depression is quickly recovered by removing the probe, especially in the inferior turbinate. If the nasal mucosa is contracted with decongestant 1~2% ephedrine solution, the turbinates will shrink rapidly. There is mucous or purulent secretion from the common or inferior nasal passages.
Treatment principle: eradicate the cause, exclude the secretion, and restore the nasal ventilation function.
Etiological treatment to find out the systemic and local causes, timely treatment of systemic chronic diseases, sinusitis, adjacent infected lesions and deviated nasal septum. Improve the living and working environment, exercise, quit smoking and alcohol, and improve the body resistance.
Local treatment
(1) intranasal decongestant: hydroxyzoline hydrochloride spray can be chosen, continuous application should not exceed 7 days, if you need to continue to use intermittent 3-5 days. 0.5%-1% ephedrine or compound furacilin ephedrine liquid, chloramphenicol ephedrine liquid nasal drops, long-term application of 0.5%-1% ephedrine saline nasal drops may damage the nasal mucosa cilia structure, should be avoided, if you have to use should be intermittent Application should be intermittent. The use of nasal drops is prohibited because it has been proved that it can cause drug rhinitis.
(2) Intranasal glucocorticoids: They have good antibacterial effect and eventually produce decongestive effect. Longer-term application of nasal sprays such as Reynocort, Endosulfan, and Cozultan can be used as needed.
(3) Nasal lavage therapy: For those with more nasal secretions or sticky nasal secretions, saline can be used to cleanse the nasal cavity to remove nasal secretions and improve nasal ventilation.
(4) Mucus promoter: Oral administration of Genoton capsule or Mucosolvan to increase the oscillation of respiratory epithelial cilia and promote the discharge of mucus or purulent secretions.
(5) Closure therapy: 0.25%-0.5% procaine as Yingxiang, nasal pass point closure, or as nasal dike or inferior turbinate front submucosal injection, 1-1.5ml each time, once every other day, 5 times for a course of treatment. Note that individual patients may develop procaine allergy.
(6) Ultrashort wave or infrared physiotherapy can improve local blood circulation to reduce symptoms.
3. When the above therapies are not effective, sclerosing agents can be used for inferior turbinate injection, laser, freezing, electrocoagulation, microwave and low-temperature plasma radiofrequency ablation therapy.
Chronic hypertrophic rhinitis
Clinical manifestations
1. Heavy nasal congestion, unilateral or bilateral persistent nasal congestion, without alternation. Most of them are persistent, often open-mouth breathing, and the sense of smell is mostly diminished.
2, thick nasal discharge, mostly mucus or mucopurulent, not easy to blow out. Due to the backflow of nasal mucus, it stimulates the throat and causes cough and phlegm.
3.When the hypertrophied middle turbinate presses the nasal septum, it can cause the pressure or inflammation of the anterior sieve nerve which is divided by the ophthalmic branch of trigeminal nerve, resulting in irregular episodes of frontal pain and radiation to the nasal bridge and orbit, called anterior sieve neuralgia, also called anterior sieve nerve syndrome.
4.Other: There are often occlusive nasal sounds, tinnitus and ear occlusion as well as headache, dizziness, dry throat and sore throat. A small number of patients may have hyposmia.
Examination
1. The inferior turbinates are obviously enlarged, or both the inferior and middle turbinates are enlarged, often causing nasal blockage. There are mucous or mucopurulent secretions at the bottom of the nasal cavity or in the lower nasal passage.
2. The mucous membrane is swollen, pink or purplish red, with an uneven surface, or nodular or mulberry-shaped, especially the front of the inferior turbinate and its free edge are obvious. The depression is not obvious when the probe is lightly pressed, and there is a hard and solid feeling when touched. Mucosal contraction is not obvious after local use of vasoconstrictors.
Treatment
In mild cases, the symptoms can be controlled by regular exercise or medication; in more severe cases, surgery may be required to correct the overly curved septum and overly thickened turbinates.
1. Conservative treatment is limited to mild cases. If the inferior turbinate is sensitive to decongestants, the same treatment as for chronic simple rhinitis can be used. Those who are not sensitive can use inferior turbinate sclerosing agent injection. Commonly used sclerosing agents are 80% glycerin, 5% glycerol petrolatum, 5% sodium cod liver oil and 50% glucose, etc. The mechanism of action is that after sclerosing agent injection, it can cause local chemical inflammatory reaction, produce scar tissue, reduce the volume of turbinate and improve ventilation, once every 10 days, with 3-5 times as a course of treatment. In addition, laser, freezing, microwave or radiofrequency treatment can also be taken to solve nasal congestion.
2.Surgical treatment
(1) Partial mucosal resection of inferior turbinate: If the mucosa is seriously thickened and insensitive to decongestants, partial resection of inferior turbinate is feasible. There are mainly two ways to remove the thickened inferior turbinate: one is extra-mucosal resection, in which the thickened mucosa on the surface of inferior turbinate is removed directly with a cutting drill; the other is submucosal tissue resection, in which an incision is made at the front of the inferior turbinate, and then the cutting drill is transferred into the incision to remove the submucosal tissue. The advantage of the latter is that the mucosal surface of the inferior turbinate is not damaged. In principle, the resection should not exceed 1/3 of the inferior turbinate, and if too much is removed, secondary atrophic rhinitis can be caused.
(2) Inferior turbinate mucosal-subperiosteal resection: This procedure is suitable for those with enlarged inferior turbinate bones. It can improve nasal ventilation and drainage and preserve the integrity of the mucosa.
(3) For chronic systemic diseases or adjacent lesions such as deviated septum or sinusitis, appropriate treatment is also given.
Prevention
(1) Quit smoking and drinking, pay attention to dietary hygiene and environmental hygiene, and avoid long-term stimulation by dust.
2.Treatment process should be combined with sports therapy to enhance physical fitness and resistance to disease
3, avoid local long-term use of ephedrine nasal drops, chronic simple rhinitis nasal mucosa smooth, elastic, sensitive to vasoconstrictors; while chronic hypertrophic rhinitis is generally due to mucosal hypertrophy, insensitive to vasoconstrictors, so even after dropping ephedrine nasal congestion is not significantly reduced, and will cause olfactory disorders, headaches, memory loss, and may cause “drug rhinitis The “drug rhinitis”.
4, active treatment of acute rhinitis, whenever the cold nasal congestion aggravated, do not force digging nose, so as not to cause nasal infection. Pay attention to environmental hygiene, addicted to smoking and alcohol should be quit.