Rhinorrhea

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Rhinorrhea
Illu nose nasal cavities.jpg
Labeled cross section of the nasal cavities
Specialty Otorhinolaryngology

Rhinorrhea, rhinorrhoea, or informally runny nose is the free discharge of a thin mucus fluid from the nose; [1] it is a common condition. It is a common symptom of allergies (hay fever) or certain viral infections, such as the common cold or COVID-19. It can be a side effect of crying, exposure to cold temperatures, cocaine abuse, [2] or drug withdrawal, such as from methadone or other opioids. [3] Treatment for rhinorrhea may be aimed at reducing symptoms or treating underlying causes. Rhinorrhea usually resolves without intervention, but may require treatment by a doctor if symptoms last more than 10 days or if symptoms are the result of foreign bodies in the nose. [4]

Contents

The term rhinorrhea was coined in 1866 from the Greek rhino- ("of the nose") and -rhoia ("discharge" or "flow"). [5]

Signs and symptoms

Rhinorrhea Rhinorrhea nasal congestion.jpg
Rhinorrhea

Rhinorrhea is characterized by an excess amount of mucus produced by the mucous membranes that line the nasal cavities. The membranes create mucus faster than it can be processed, causing a backup of mucus in the nasal cavities. As the cavity fills up, it blocks off the air passageway, causing difficulty breathing through the nose. Air caught in nasal cavities – namely the sinus cavities, cannot be released and the resulting pressure may cause a headache or facial pain. If the sinus passage remains blocked, there is a chance that sinusitis may result. [6] If the mucus backs up through the Eustachian tube, it may result in ear pain or an ear infection. Excess mucus accumulating in the throat or back of the nose may cause a post-nasal drip, resulting in a sore throat or coughing. [6] Additional symptoms include sneezing, nosebleeds, and nasal discharge. [7]

Causes

A runny nose can be caused by anything that irritates or inflames the nasal tissues, including infections such as the common cold and influenza, and allergies and various irritants. Some people have a chronically runny nose for no apparent reason (non-allergic rhinitis or vasomotor rhinitis). Less common causes include polyps, a foreign body, a tumor or migraine-like headaches. Some causes of rhinorrhea include: acute sinusitis (nasal and sinus infection), allergies, chronic sinusitis, common cold, coronaviruses (COVID-19), decongestant nasal spray overuse, deviated septum, dry air, eosinophilic granulomatosis with polyangiitis, granulomatosis with polyangiitis, hormonal changes, influenza (flu), lodged object, medicines (such as those used to treat high blood pressure, erectile dysfunction, depression, seizures and other conditions), nasal polyps, non-allergic rhinitis (chronic congestion or sneezing not related to allergies), occupational asthma, pregnancy, respiratory syncytial virus (RSV), spinal fluid leak, and tobacco smoke. [8]

Cold temperatures

Rhinorrhea is especially common in cold weather. Cold-induced rhinorrhea occurs due to a combination of thermodynamics and the body's natural reactions to cold weather stimuli. One of the purposes of nasal mucus is to warm inhaled air to body temperature as it enters the body; this requires the nasal cavities to be constantly coated with liquid mucus. In cold weather the mucus lining nasal passages tends to dry out, so that mucous membranes must work harder, producing more mucus to keep the cavity lined. As a result, the nasal cavity can fill up with mucus. At the same time, when air is exhaled, water vapor in breath condenses as the warm air meets the colder outside temperature near the nostrils. This causes excess water to build up inside nasal cavities, spilling out through the nostrils. [9]

Inflammatory

Infection

Rhinorrhea can be a symptom of other diseases, such as the common cold or influenza. During these infections, the nasal mucous membranes produce excess mucus, filling the nasal cavities. This is to prevent infection from spreading to the lungs and respiratory tract, where it could cause far worse damage. [10] It has also been suggested that viral rhinorrhea is a result of viral evolution whereby virus variants that increase nasal secretion and are thus more resistant to the body's immune defenses are selected for. [11] Rhinorrhea caused by these infections usually occur on circadian rhythms. [12] Over the course of a viral infection, sinusitis (the inflammation of the nasal tissue) may occur, causing the mucous membranes to release more mucus. Acute sinusitis consists of the nasal passages swelling during a viral infection. Chronic sinusitis occurs when sinusitis continues for longer than three months. [13]

Allergies

Pollen grains from a variety of common plants can cause an allergic reaction. Misc pollen.jpg
Pollen grains from a variety of common plants can cause an allergic reaction.

Rhinorrhea can also occur when individuals with allergies to certain substances, such as pollen, dust, latex, soy, shellfish, or animal dander, are exposed to these allergens. In people with sensitized immune systems, the inhalation of one of these substances triggers the production of the antibody immunoglobulin E (IgE), which binds to mast cells and basophils. IgE bound to mast cells are stimulated by pollen and dust, causing the release of inflammatory mediators such as histamine. [14] In the nasal cavities, these inflammatory mediators cause inflammation and swelling of the tissue, as well as increased mucus production. Particulate matter in polluted air and chemicals such as chlorine and detergents, which can normally be tolerated, can make the condition considerably worse. [15]

Crying

Rhinorrhea is also associated with shedding tears (lacrimation), whether from emotional events or from eye irritation. When excess tears are produced, the liquid drains through the inner corner of the eyelids, through the nasolacrimal duct, and into the nasal cavities. As more tears are shed, more liquid flows into the nasal cavities, both stimulating mucus production and hydrating any dry mucus already present in the nasal cavity. The buildup of fluid is usually resolved via mucus expulsion through the nostrils. [10]

Non-inflammatory

Head trauma

Rhinorrhea can be caused by a head injury, a serious condition. A basilar skull fracture can result in a rupture of the barrier between the sinonasal cavity and the anterior cranial fossae or the middle cranial fossae. This can cause the nasal cavity to fill with cerebrospinal fluid (cerebrospinal fluid rhinorrhoea, CSF rhinorrhea), a condition that can lead to a number of serious complications, including death if not addressed properly. [16]

Other causes

Rhinorrhea can occur as a symptom of opioid withdrawal accompanied by lacrimation. [17] Other causes include cystic fibrosis, whooping cough, nasal tumors, hormonal changes, and cluster headaches. Rhinorrhea can also be the side effect of several genetic disorders, such as primary ciliary dyskinesia, as well as common irritants such as spicy foods, nail polish remover, or paint fumes. [18]

Treatment

In most cases, treatment for rhinorrhea is not necessary since it will clear up on its own, especially if it is the symptom of an infection. For general cases nose-blowing can get rid of the mucus buildup. Though blowing may be a quick-fix solution, it increases mucosal production in the sinuses, leading to frequent and higher mucus buildups in the nose in the medium term. Alternatively, saline or vasoconstrictor nasal sprays may be used, but may become counterproductive after several days of use, causing rhinitis medicamentosa. [19]

In some cases, such as those due to allergies or sinus infections, there are medicinal treatments available. Several types of antihistamines can be obtained relatively cheaply to treat cases caused by allergies; antibiotics may help in cases of bacterial sinus infections. [20]

See also

Related Research Articles

<span class="mw-page-title-main">Sinusitis</span> An inflammation of the mucous membrane that lines the sinuses resulting in symptoms

Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, a feeling that phlegm is oozing out from the back of the nose to the throat along with a necessity to clear the throat frequently and frequent attacks of cough.

<span class="mw-page-title-main">Respiratory tract</span> Organs involved in transmission of air to and from the point where gases diffuse into tissue

The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa.

<span class="mw-page-title-main">Allergic rhinitis</span> Nasal inflammation due to allergens in the air

Allergic rhinitis, of which the seasonal type is called hay fever, is a type of inflammation in the nose that occurs when the immune system overreacts to allergens in the air. Signs and symptoms include a runny or stuffy nose, sneezing, red, itchy, and watery eyes, and swelling around the eyes. The fluid from the nose is usually clear. Symptom onset is often within minutes following allergen exposure, and can affect sleep and the ability to work or study. Some people may develop symptoms only during specific times of the year, often as a result of pollen exposure. Many people with allergic rhinitis also have asthma, allergic conjunctivitis, or atopic dermatitis.

<span class="mw-page-title-main">Nasal cavity</span> Large, air-filled space above and behind the nose in the middle of the face

The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nasal cavity is the uppermost part of the respiratory system and provides the nasal passage for inhaled air from the nostrils to the nasopharynx and rest of the respiratory tract.

<span class="mw-page-title-main">Mucus</span> Secretion produced by mucous membranes

Mucus is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It is a viscous colloid containing inorganic salts, antimicrobial enzymes, immunoglobulins, and glycoproteins such as lactoferrin and mucins, which are produced by goblet cells in the mucous membranes and submucosal glands. Mucus serves to protect epithelial cells in the linings of the respiratory, digestive, and urogenital systems, and structures in the visual and auditory systems from pathogenic fungi, bacteria and viruses. Most of the mucus in the body is produced in the gastrointestinal tract.

<span class="mw-page-title-main">Rhinitis</span> Irritation and inflammation of the mucous membrane inside the nose

Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip.

<span class="mw-page-title-main">Upper respiratory tract infection</span> Medical condition

An upper respiratory tract infection (URTI) is an illness caused by an acute infection, which involves the upper respiratory tract, including the nose, sinuses, pharynx, larynx or trachea. This commonly includes nasal obstruction, sore throat, tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold. Most infections are viral in nature, and in other instances, the cause is bacterial. URTIs can also be fungal or helminthic in origin, but these are less common.

<span class="mw-page-title-main">Nasal polyp</span> Noncancerous growths within the nose or sinuses

Nasal polyps (NP) are noncancerous growths within the nose or sinuses. Symptoms include trouble breathing through the nose, loss of smell, decreased taste, post nasal drip, and a runny nose. The growths are sac-like, movable, and nontender, though face pain may occasionally occur. They typically occur in both nostrils in those who are affected. Complications may include sinusitis and broadening of the nose.

Catarrh is an inflammation of mucous membranes in one of the airways or cavities of the body, usually with reference to the throat and paranasal sinuses. It can result in a thick exudate of mucus and white blood cells caused by the swelling of the mucous membranes in the head in response to an infection. It is a symptom usually associated with the common cold, pharyngitis, and chesty coughs, but it can also be found in patients with adenoiditis, otitis media, sinusitis or tonsillitis. The phlegm produced by catarrh may either discharge or cause a blockage that may become chronic.

<span class="mw-page-title-main">Nasal spray</span> Spray that delivers medications locally in the nasal cavities or systemically

Nasal sprays are used to deliver medications locally in the nasal cavities or systemically. They are used locally for conditions such as nasal congestion and allergic rhinitis. In some situations, the nasal delivery route is preferred for systemic therapy because it provides an agreeable alternative to injection or pills. Substances can be assimilated extremely quickly and directly through the nose. Many pharmaceutical drugs exist as nasal sprays for systemic administration. Other applications include hormone replacement therapy, treatment of Alzheimer's disease and Parkinson's disease. Nasal sprays are seen as a more efficient way of transporting drugs with potential use in crossing the blood–brain barrier.

<span class="mw-page-title-main">Nasal irrigation</span> Personal hygiene practice for rinsing out nasal passages

Nasal irrigation is a personal hygiene practice in which the nasal cavity is washed to flush out mucus and debris from the nose and sinuses, in order to enhance nasal breathing. Nasal irrigation can also refer to the use of saline nasal spray or nebulizers to moisten the mucous membranes.

Nasal congestion is the partial or complete blockage of nasal passages, leading to impaired nasal breathing, usually due to membranes lining the nose becoming swollen from inflammation of blood vessels.

<span class="mw-page-title-main">Post-nasal drip</span> Medical condition

Post-nasal drip (PND), also known as upper airway cough syndrome (UACS), occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the back of the nose, and eventually in the throat once it drips down the back of the throat. It can be caused by rhinitis, sinusitis, gastroesophageal reflux disease (GERD), or by a disorder of swallowing. Other causes can be allergy, cold, flu, and side effects from medications.

<span class="mw-page-title-main">Maxillary sinus</span> Largest of the paranasal sinuses, and drains into the middle meatus of the nose

The pyramid-shaped maxillary sinus is the largest of the paranasal sinuses, located in the maxilla. It drains into the middle meatus of the nose through the semilunar hiatus. It is located to the side of the nasal cavity, and below the orbit.

<span class="mw-page-title-main">Mometasone</span> Steroid medication

Mometasone, also known as mometasone y 3 s, is a steroid medication used to treat certain skin conditions, hay fever, and asthma. Specifically it is used to prevent rather than treat asthma attacks. It can be applied to the skin, inhaled, or used in the nose. Mometasone furoate, not mometasone, is used in medical products.

Chronic atrophic rhinitis, or simply atrophic rhinitis, is a chronic inflammation of the nose characterised by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena. It can also be described as the empty nose syndrome.

A sinus is a sac or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue. In common usage, "sinus" usually refers to the paranasal sinuses, which are air cavities in the cranial bones, especially those near the nose and connecting to it. Most individuals have four paired cavities located in the cranial bone or skull.

<span class="mw-page-title-main">Adenoiditis</span> Medical condition

Adenoiditis is the inflammation of the adenoid tissue usually caused by an infection. Adenoiditis is treated using medication or surgical intervention.

Nonallergic rhinitis is rhinitis—inflammation of the inner part of the nose—not caused by an allergy. Nonallergic rhinitis displays symptoms including chronic sneezing or having a congested, drippy nose, without an identified allergic reaction. Other common terms for nonallergic rhinitis are vasomotor rhinitis and perennial rhinitis. The prevalence of nonallergic rhinitis in otolaryngology is 40%. Allergic rhinitis is more common than nonallergic rhinitis; however, both conditions have similar presentation, manifestation and treatment. Nasal itching and paroxysmal sneezing are usually associated with nonallergic rhinitis rather than allergic rhinitis.

<span class="mw-page-title-main">Fungal sinusitis</span> Inflammation of the paranasal sinuses due to fungal infection

Fungal sinusitis or fungal rhinosinusitis is the inflammation of the lining mucosa of the paranasal sinuses due to a fungal infection. It occurs in people with reduced immunity. The maxillary sinus is the most commonly involved. Fungi responsible for fungal sinusitis are Aspergillus fumigatus (90%), Aspergillus flavus, and Aspergillus niger. Fungal sinusitis occurs most commonly in middle-aged populations. Diabetes mellitus is the most common risk factor involved.

References

  1. ↑ Dorland's pocket medical dictionary. Elsevier. 10 November 2013. p. 660. ISBN   978-81-312-3501-0.
  2. ↑ Myon L, Delforge A, Raoul G, Ferri J (February 2010). "[Palatal necrosis due to cocaine abuse]". Rev Stomatol Chir Maxillofac (in French). 111 (1): 32–5. doi:10.1016/j.stomax.2009.01.009. PMID   20060991.
  3. ↑ Eileen Trigoboff; Kneisl, Carol Ren; Wilson, Holly Skodol (2004). Contemporary psychiatric-mental health nursing . Upper Saddle River, N.J: Pearson/Prentice Hall. p.  274. ISBN   978-0-13-041582-0.
  4. ↑ "Rhinorrhea (Runny Nose)". Cleveland Clinic. Retrieved 10 October 2023.
  5. ↑ "Rhinorrhea". Online Etymology Dictionary. Retrieved 21 September 2011.
  6. 1 2 "Nasal discharge". Medline Plus. United States National Library of Medicine, National Institutes of Health . Retrieved 1 November 2007.
  7. ↑ "Rhinorrhea Overview". FreeMd. Retrieved 21 September 2011.
  8. ↑ "Runny nose: causes". Mayo Clinic. 16 March 2021.
  9. ↑ "Why Does Cold Weather Cause Runny Noses?". NPR.org. NPR. Retrieved 22 September 2011.
  10. 1 2 "Why Does My Nose Run?". Kids Health. Retrieved 22 September 2011.
  11. ↑ Vareille M, Kieninger E, Edwards MR, Regamey N (January 2011). "The airway epithelium: soldier in the fight against respiratory viruses". Clin. Microbiol. Rev. 24 (1): 210–29. doi:10.1128/CMR.00014-10. PMC   3021210 . PMID   21233513.
  12. ↑ Smolensky MH, Reinberg A, Labrecque G (May 1995). "Twenty-four Hour Pattern in Symptom Intensity of Viral and Allergic Rhinitis: Treatment Implications". The Journal of Allergy and Clinical Immunology. 95 (5 Pt 2): 1084–96. doi:10.1016/s0091-6749(95)70212-1. PMC   7126948 . PMID   7751526.
  13. ↑ Kwon, Edward; O'Rourke, Maria C. (2023), "Chronic Sinusitis", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   28722963 , retrieved 10 October 2023
  14. ↑ Dipiro, J.T.; Talbert, R.L.; Yee, G.C. (2008). Pharmacotherapy: A Pathophysiologic Approach (7th ed.). New York, NY: The McGraw-Hill Companies, Inc. pp. 1565–1575. ISBN   978-0-07-147899-1.
  15. ↑ Wu, Jin-Zhun; Ge, Dan-Dan; Zhou, Lin-Fu; Hou, Ling-Yun; Zhou, Ying; Li, Qi-Yuan (1 June 2018). "Effects of particulate matter on allergic respiratory diseases". Chronic Diseases and Translational Medicine. Special Issue: Air Pollution and Chronic Respiratory Diseases. 4 (2): 95–102. doi:10.1016/j.cdtm.2018.04.001. ISSN   2095-882X. PMC   6034084 . PMID   29988900.
  16. ↑ Welch; et al. (22 July 2011). "CSF Rhinorrhea". Medscape. Retrieved 22 September 2011.
  17. ↑ Shah, Mansi; Huecker, Martin R. (2023), "Opioid Withdrawal", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30252268 , retrieved 10 October 2023
  18. ↑ "Rhinorrhea – Definition, Symptoms, Causes, Diagnosis and Treatment". Prime Health Channel. 30 August 2011. Retrieved 24 September 2011.
  19. ↑ Ramey JT, Bailen E, Lockey RF (2006). "Rhinitis medicamentosa" (PDF). Journal of Investigational Allergology and Clinical Immunology. 16 (3): 148–155. PMID   16784007 . Retrieved 29 April 2015.
  20. ↑ "Rhinorrhea (Runny Nose)". Cleveland Clinic. Retrieved 10 October 2023.
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