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Acute runny nose (acute rhinitis)

Acute rhinitis (rhinitis acuta) is an acute nonspecific inflammation of the nasal mucosa.

This disease is among the most common in both children and adults. The clinic distinguishes between:

• acute catarrhal rhinitis (rhinitis cataralis acuta);

• acute catarrhal rhinopharyngitis, usually in childhood (rhinitis cataralis neonatorum acuta);

• acute traumatic rhinitis (rhinitis traumatica acuta).

In etiology and acute catarrhal runny nose, the decrease in local and general reactivity of the body and the activation of microflora in the nasal cavity are of major importance. This usually occurs with general or local hypothermia, especially in contrast (drafts, wet clothes, etc.), which violates the protective neuro-reflex mechanisms. The weakening of local and general immunity during hypothermia (colds) of the whole body or its parts (legs, head, etc.) contributes to an increase in the pathogenicity of microbes saprophytic in the nasal cavity, in particular staphylococci, streptococci, etc., especially in people who are not seasoned for cold and sudden changes in temperature. The impact of the common cold is faster manifested in people with reduced resistance, especially in chronic diseases or weakened by acute diseases, etc.

Acute traumatic rhinitis is usually caused by trauma to the mucous membrane by foreign bodies or by manipulations, including surgical ones, in the nasal cavity (in this case it is one-sided). In some cases, the cause of an acute traumatic runny nose is a professional factor or environmental conditions: particles of mineral dust, coal, metal, chemical effects of smoke, gas, aerosols (with prolonged exposure, it becomes chronic).

Pathological changes in the nasal mucosa mainly correspond to the classical picture of the development of acute inflammation. In the first hours (rarely 1-2 days) of the disease, the mucous membrane is hyperemic and dry, then a profuse serous effusion forms and it becomes moist and swollen. The epithelium and submucous layer are saturated with lymphocytes, the cylindrical epithelium loses cilia, the amount of mucus increases in the exudate, the own layer of the mucous membrane is gradually infiltrated by leukocytes, the cavernous spaces are filled with blood; exudation collects in places under the epithelium and vesicles can form, desquamation of the epithelium and erosion of the mucous membrane are noted.

K l and n and with to and to kartin and. Acute catarrhal rhinitis is characterized by an acute sudden onset and damage to both halves of the nose. Only with traumatic acute rhinitis can the process be limited to one half of the nose.

In the clinic of acute catarrhal rhinitis, 3 stages of the course are distinguished, successively turning one into the other: 1) a dry stage of irritation; 2) stage of serous discharge; 3) stage of mucopurulent discharge (resolution).

• The dry stage of irritation usually lasts several hours, rarely lasts for 1-2 days, begins with a feeling of dryness, tension, burning, scratching, tickling in the nose, often in the throat and larynx, and sneezing is disturbing. At the same time, malaise, chills, heaviness and pain in the head, more often in the forehead, appear, body temperature can rise to subfebrile numbers, less often to febrile ones. At this stage, the mucous membrane is hyperemic, dry; it gradually swells, and the nasal passages narrow. Breathing through the nose is gradually disturbed, the sense of smell worsens (respiratory hyposmia), the taste decreases, and closed nasal arises.

• The stage of serous secretions is characterized by an increase in inflammation, a large amount of transparent watery fluid appears, sweating from the blood vessels, then the amount of mucus gradually increases due to increased function of goblet cells and mucous glands, therefore, the discharge becomes serous-mucous, contains sodium chloride and ammonia, which causes irritating effect on the skin and mucous membrane, especially in children. In this regard, redness and swelling of the skin of the entrance to the nose and upper lip are possible.

After the appearance of copious discharge from the nose, the symptoms of stage I disappear - a feeling of dryness, tension and burning in the nose, but lacrimation occurs, often conjunctivitis, breathing through the nose is sharply disturbed, sneezing continues, noise and tingling in the ears are disturbed. With anterior rhinoscopy, hyperemia of the mucous membrane is less pronounced than in stage I, but it is sharply swollen, with a cyanotic hue.

• The stage of mucopurulent discharge occurs on the 4th-5th day from the onset of the disease, characterized by the appearance of mucopurulent, first grayish, then yellowish and greenish discharge, which is due to the presence of blood cells in it - leukocytes, lymphocytes, and also rejected epithelial cells and mucin. These signs indicate the culmination of the development of acute catarrhal runny nose. In the next few days, the amount of discharge decreases, the swelling of the mucous membrane disappears, nasal breathing and the sense of smell are restored and after 8-14 days from the onset of the disease the acute runny nose stops (in rare cases, the duration of its course doubles).

In acute rhinitis, moderate irritation extends to the mucous membrane of the paranasal sinuses, as evidenced by pain in the forehead and nose, as well as a thickening of the mucous membrane of the sinuses, recorded on radiographs. Inflammation can also pass to the tear ducts, the auditory tube, and the underlying respiratory tract.

Sometimes, with a good immunobiological state of the body, acute catarrhal rhinitis occurs abortively for 2-3 days; with a weakened state of protective forces it can drag on up to 3-4 weeks with a tendency to transition to a chronic form. The course of acute rhinitis largely depends on the condition of the mucous membrane of the nasal cavity before the disease: if it is atrophic, then reactive phenomena (swelling, hyperemia, etc.) will be less pronounced, the acute period will be shorter; with hypertrophy of the mucous membrane, on the contrary, acute phenomena and the severity of symptoms will be expressed much sharper and longer.

In early childhood, the inflammatory process in acute catarrhal rhinitis usually extends to the pharynx, and acute rhinopharyngitis develops. Often in children, the inflammatory process extends to the larynx, trachea, bronchi, i.e. has the character of an acute respiratory infection. For acute rhinopharyngitis in early childhood, a number of features are characteristic that can aggravate the course of the disease. These include the narrowness of the nasal passages, which in conditions of inflammation contributes to an increase in nasal congestion, which does not allow the baby to suckle normally.

The newborn has reduced adaptability to breathing through the mouth, he cannot actively remove the nasal discharge. After a few sips of milk, the baby throws his chest to breathe air, so he quickly gets tired and stops sucking, is malnourished, loses weight, sleeps poorly. There may be signs of a violation of the function of the gastrointestinal tract (vomiting, flatulence, aerophagia, diarrhea). Due to the fact that breathing through the mouth with a stuffy nose is easier with the head thrown back, a false opisthotonus appears with tension of the fontanelles. In childhood, acute rhinopharyngitis is often complicated by acute otitis media, which is facilitated by the spread of inflammation from the nasopharynx to the auditory tube and the age-related anatomical feature - short and wide auditory tube.

Acute catarrhal rhinopharyngitis usually occurs in children with atrophy (hypotrophic). In both early and advanced childhood, acute catarrhal rhinitis can have a descending character, causing tracheitis, bronchitis and pneumonia.

D and a g n about with t and to and. Acute catarrhal rhinitis is recognized on the basis of these symptoms, but in each case it is necessary to differentiate it from acute specific rhinitis, which is a symptom of an infectious disease - influenza, diphtheria, measles, whooping cough, scarlet fever, as well as gonorrhea, syphilis, etc. In some cases, it is also necessary differentiate from vasomotor (neurovegetative or allergic) rhinitis. Each of the infectious diseases has its own clinical picture, which should be based on in diagnosis; acute rhinitis in these cases is a specific secondary symptom of the underlying disease. In the differential diagnosis, it must be borne in mind that exacerbations of chronic rhinitis and chronic inflammation of the paranasal sinuses have in many respects a common symptomatology with acute nonspecific catarrhal rhinitis. The history of the disease and its course in the patient in these cases will help to correctly diagnose.

Treatment is usually outpatient. In rare cases of severe runny nose, accompanied by high body temperature, bed rest is recommended. It is better for the patient to be in a room with warm and humidified air, which reduces the painful feeling of dryness, tension and burning in the nose. Diet should not be annoying. It is necessary to monitor the timeliness of physiological administration (stool, urination). During the blockage of the nasal passages, it is not recommended to forcefully breathe through the nose; blow your nose only after vasoconstrictor drops are injected into the nose without much effort and simultaneously only through one half of the nose so as not to throw pathological discharge through the auditory tubes into the middle ear.

The abortive course of acute catarrhal rhinitis in the first days can be caused by thermal distractions and diaphoretic procedures.
A hot general or foot (hand, lumbar) bath is prescribed, after which the patient immediately drinks hot tea, after which he takes inside 0.5-1.0 g of aspirin dissolved in water or 1.0 g of paracetamol and lays in a warm bed, wrapped up into the blanket. In order to influence the neuro-reflex reactions in the nose, ultraviolet irradiation of the soles of the feet (erythema dose), mustard plasters on the calf areas, UVD, UHF-therapy or diathermy on the nose, etc. are also prescribed. All these agents show their effect to a greater extent in I stages of acute catarrhal rhinitis, however, their beneficial effect can affect the II stage.

Drug therapy in children and adults is different.

In infants from the first day of acute rhinopharyngitis, the most important treatment factor is the restoration of nasal breathing during periods of breastfeeding, which not only ensures normal nutrition, but also prevents the spread of inflammation to the auditory tubes and middle ear, as well as the underlying airways.

For this purpose, before each feeding, it is necessary to suck out mucus from each half of the nose with a spray can; if there are crusts on its threshold, they are gently softened with sweet almond oil or olive oil and removed with a cotton ball. 5 minutes before feeding, 2 drops of a vasoconstrictor substance are poured into both halves of the nose - a solution of adrenaline at a dilution of 1: 5000 (or 1:10 000) and 2 drops of a 2% solution of boric acid (can be taken together). Between feedings, 4 drops of 2% solution of collargol (or protargol) are poured into each half of the nose 3 times a day for 3-4 days, but not more than a week. This substance, enveloping the nasal mucosa and partially the pharynx, has an astringent and antimicrobial effect, which reduces the amount of discharge and favorably affects the course of the disease. Alternatively, a 20% albucide solution can also be used. A good vasoconstrictor effect is given by children otrivin or 1% solution of ephedrine and other drugs of identical action.

In adults, the basis of drug therapy for acute catarrhal rhinitis is vasoconstrictor and antimicrobial agents. One of the most painful symptoms of the disease is stuffy nose. The restoration of nasal breathing significantly improves the well-being of the patient, reduces the amount of nasal discharge, and helps to reduce the effects of inflammation of the nasal mucosa. For this purpose, preparations of local symptomatic action are prescribed - adrenaline, ephedrine, but it is better to otrivin, sanorin, etc. - in all stages of an acute cold. Otrivin acts for a longer time - after infusion of 5 drops of the drug into each half of the nose, the vasoconstrictor effect lasts about 4-6 hours; the infusion of drops is repeated 2-3 times a day. Adrenaline and ephedrine act for a short time - 20-30 minutes.

In stage II of the disease, silver preparations are successfully used - 3-5% solution of collargol or protargol, and when crusts appear - irrigation with isotonic sodium chloride solution 3-4 times a day. With a pronounced inflammatory and microbial reaction, insufflation of a mixture of several sulfanilamide drugs is recommended, it is also possible to mix with an antibiotic powder (you should first determine the allergic background). A good vasoconstrictor and antimicrobial effect is provided by mixtures of several preparations packaged by the factory in the form of inhalers or aerosols. Along with the drug, it is also useful to prescribe physiotherapy - UV, UHF, helium-neon laser endonasally, microwave exposure, local heat on the nose.

It should be borne in mind that the infusion of any drops into the nose, aqueous or oily, the injection of powders, the use of inhalations should be limited to 8-10 days, in rare cases - 2 weeks. Longer use of these agents leads to the development of a number of pathological processes. Most often, there is a defeat of the vasomotor function of the nasal mucosa (as a result of which vasomotor rhinitis develops), the restoration of the function of the ciliated epithelium is disrupted, it dies, an allergic reaction to any drug used endonasally occurs; an atrophic or hypertrophic process of the mucous membrane may develop.

An effective tool in the treatment of acute rhinitis is bioparox - a local inhaled antibiotic with anti-inflammatory properties. The drug is active against most pathogenic microorganisms found in infections of the upper respiratory tract, the anti-inflammatory effect is due to the suppression of the release of inflammatory mediators. Bioparox has only a local effect, this in turn allows you to use it in those conditions when it is necessary to avoid a systemic effect, for example, in pregnant women. Bioparox is taken 4 times a day for 6-8 days. Children can be taken from the age of 2.5.

An effective role in the prevention of acute catarrhal rhinitis is played by the gradual hardening of the body to cooling and overheating, humidity and dryness of the air. The body should be trained systematically at all times of the year with the help of sports or outdoor walks, water procedures, etc., to strengthen the function of heat-regulating mechanisms, as well as the respiratory, cardiovascular and other systems. It is very important that the clothes match the weather at different times of the year. A good vasoconstrictor and antimicrobial effect gives the drug polydexas phenylephrine - drops for the nose. Along with the pronounced antimicrobial effect of polymyxin and neomycin, the drug also contains dexamethasone and phenylephrine, which have anti-inflammatory and hyposensitizing, as well as mild, vasoconstrictive prolonged action. Polydex with phenylephrine is applied topically - 1-2 instillations in each half of the nose 3 times in 1 day for 5-7 days. The drug is effective in stage II – III of catarrhal rhinitis, especially in those cases when the process acquires a manifesting or sluggish course. If it is undesirable to use sympathomimetics and it is necessary to achieve a pronounced antimicrobial effect, then isofra — drops for the nose are preferred. As an active ingredient, the isofra preparation contains the antibiotic framycin, which has a wide spectrum of antibacterial activity. The drug is prescribed 5 drops in both halves of the nose 4 times a day, the duration of treatment is 5-8 days.

The methods of immunoprophylaxis and immunotherapy of people who are often ill for a long time with colds are finding wider application. Active local immunization through the mucous membrane of the upper respiratory tract can be carried out using the drug IPC-19, which is a multivalent vaccine containing non-pathogenic polyvalent antigenic fractions of the 19 most common pathogens of the upper respiratory tract. Once on the mucous membrane, the drug causes protective immune responses similar to those that develop in response to the intervention of a real pathogen. Immunization is carried out in the period preceding the outbreak of colds - in the autumn (September - October) months, the drug is inhaled 1 time in each half of the nose 2 times a day (morning and evening) for 2 weeks. Considering that the effectiveness of immunization gradually decreases after 3-4 months, it is advisable to repeat it during this period.

By stimulating the system of specific and non-specific protection of the body against infections, IRS-19 is also effective in the treatment of patients with acute catarrhal rhinopharyngitis and rhinitis. For therapeutic purposes, the drug is instilled in both halves of the nose at a dose of 5 times a day in adults, and 3 times in children for 2-5 days. Taking the drug in the initial stage of the disease often allows you to achieve an abortive course of the pathological process.

Вакциной, обеспечивающей защиту от гриппа, является инфлювак, представляющий комплекс инактивированных антигенов вирусов гриппа А и В, выращенных на куриных эмбрионах. Антигенный состав антигриппозной вакцины ежегодно обновляется в соответствии с рекомендациями ВОЗ.

Очищенные антигены, содержащиеся в вакцине, повышают титр специфических антител и тем самым устойчивость к гриппозной инфекции. Защитный эффект наступает через 14 дней после однократной инъекции препарата и действует в течение 12 мес.

Прогноз при остром катаральном рините у взрослых, как правило, благоприятный, хотя в редких случаях возможен переход инфекции из носа в околоносовые пазухи или на нижние дыхательные пути, особенно у лиц, склонных к легочным заболеваниям. Часто повторяющийся острый процесс может перейти в хроническую форму. В грудном возрасте острый назофарингит всегда опасен, особенно для ослабленных детей, предрасположенных к различным легочным, аллергическим и другим осложнениям; в более старшем возрасте прогноз обычно благоприятен.

Больные острым ринитом должны быть признаны временно нетрудоспособными. При этом нужно учитывать профессию.Больные, работа которых связана со сферой обслуживания, пищевыми продуктами, а также с чтением лекций, пением или с неблагоприятными условиями труда, во время острого насморка обязательно освобождаются от работы.
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Острый насморк (острый ринит)

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