From Big Medical Encyclopedia

RHINITIS (rhinitis; Greek rhis, rhinos a nose + - itis; synonym cold) — inflammation of a mucous membrane of a nose. Is one of the most frequent diseases of upper respiratory tracts.

The river can be the noninfectious and infectious nature. The river of the noninfectious nature develops in connection with influence of various mechanical, thermal or chemical irritants. E.g., sharp change of air temperature, the general or local overcooling cause decrease in reactivity of an organism that leads to activation of the low-virulent microbic flora which is constantly living in a nasal cavity and causes R. Vozmozhna's development rhinitises at masons, workers of flour-grinding production and chemical industry. The river of the infectious nature arises at various inf. diseases, napr, flu, measles, scarlet fever, diphtheria, sapa, gonorrhea, etc.

On a wedge, to a current distinguish acute and chronic R. Vydelyayut also independent forms P. — vasculomotor and allergic.

Acute rhinitis

Acute R. can be primary at initial damage of a mucous membrane of a nose and secondary when contagiums get on a mucous membrane of a nose from adnexal bosoms of a nose (okolono-sovy bosoms, T.), drinks, tracheas, bronchial tubes, etc. at their primary defeat. At inf. diseases contagiums can get into a mucous membrane of a nose in the hematogenous way.

Patol. changes at acute R. are expressed by the signs characteristic of a catarrh of a mucous membrane: puffiness of fabrics, the greatest in area of nasal sinks. Microscopically from the very beginning of a disease partial rejection of an epithelium and disappearance of fibers are defined. In later terms in an epithelium and under it the kruglokletochny inflammatory infiltration which is especially expressed around glands and vessels is found.

At acute R. both half of a nose are always surprised. In its current allocate three stages. The first stage proceeding from several hours to 1 — 2 days is characterized by feeling of tension, dryness and an itch in a nasal cavity, reflex sneezing and to a lesser extent dacryagogue. The patient can complain also of a headache, a febricula, small fervescence. In the second stage liquid, transparent allocations from a nose, sometimes in very large number appear. The congestion of a nose, the complicated nasal breath, twang, decrease in sense of smell is noted. In the third stage there comes permission of inflammatory process: nasal breath improves, allocations from a nose accept slizistognoyny character, quantity them decreases.

In the first stage define a hyperemia of a mucous membrane of a nose, its small dryness by a rinoskopiya; in the second stage dryness decreases, the mucous membrane becomes wet and edematous; in a nasal cavity, preferential at the bottom, seroznoslizisty allocations accumulate. In the third stage hypostasis of nasal sinks decreases, the mucous membrane turns pale; in various sites of a nasal cavity mucopurulent allocations are visible.

Acute R. of an infectious origin can have specific characters. E.g., at flu (see) a current its more long, nasal bleedings, the expressed headache are noted, it is preferential in temples, in a forehead and eye-sockets; there are complications more often. At a rinoskopiya note an injection of vessels of a mucous membrane, hemorrhages are visible, is more often on a partition of a nose. At diphtheritic R. there are expressed symptoms of the general intoxication, high fever. The mucous membrane of a nose at the height of a disease is covered with fibrinous plaques. Allocations from a nose can be sanious, support Corynebacterium diphtheriae (see. Diphtheria ). River at to a sapa (see) it is characterized by sharp irritation of a mucous membrane, formation of ulcers or granulomas. For R. at to scarlet fever (see) plentiful allocations of wear, a sharp hyperemia of a mucous membrane, sometimes with a superficial necrosis of an epithelium and fibrinous and necrotic imposings are characteristic.

Acute R.'s duration on average 7 — 10 days. In nek-ry cases acute R. passes into chronic.

Among complications the dermatitis of a threshold of a nasal cavity caused by irritation of skin allocations from a nose, rich mineral salts meets more often. At the same time there is a reddening and swelling of wings of a nose, sometimes maceration of skin around nostrils. Complications can be connected also with distribution of contagiums on a mucous membrane of adnexal bosoms of a nose, a nasal duct, an eustachian pipe (an acoustical pipe, T.), to a drink and further in a throat, causing in them inflammatory processes.

At sharply expressed R.'s symptoms and elevated temperature of a body the bed rest is necessary. Also diaphoretics are applied febrifugal (acetilsalicylic to - that, acetphenetidiene, pyramidon, etc.) . From the distracting procedures recommend mustard plasters (see), mustard bathtubs (see. Bathtubs ), on a nose UVCh-therapy (see), uv radiation (see. Ultraviolet radiation ). These actions are more effective in the first stage of R., however use them in the second and third stages nevertheless accelerates treatment. The symptomatic treatment consists in topical administration for recovery of nasal breath of vasoconstrictors: adrenaline, ephedrine, menthol in the form of drops or ointments in a combination with the disinfecting, antihistaminic, antibacterial, knitting drugs (boric to - that, streptocides, Dimedrol). It is better to use ointments. since the medicinal substances which are contained in them gradually are soaked up by a mucous membrane of a nose and therefore work longer.

Acute R.'s treatment an infectious origin includes a complex of the events held concerning a basic disease.

Forecast, as a rule, favorable. At acute R. of the infectious nature the forecast is defined by a basic disease.

Acute R.'s prevention includes sanitation of a nasal cavity, a mouth (see. Sanitation of an oral cavity ) and drinks, recovery of nasal breath when it is broken, and a hardening of an organism.

Acute rhinitis at children of chest age proceeds more often as the nasopharyngitis, i.e. an inflammation at the same time extends to a nasal cavity, a nasopharynx, and sometimes to other parts of a throat and a throat. Especially hard acute R. can proceed at premature children and at a hypotrophy in connection with falloff of body resistance. Acute R., as a rule, affects the general condition of the child. The difficulty of nasal breath caused by swelling of a mucous membrane of a nose and a delay patol. separated, sometimes happens so strongly expressed that the child cannot breathe through a nose, and at breath through a mouth swallows air. The act of suction is violated. The child quickly is tired, undereats, loses flesh, sleeps badly. At considerable swelling of a mucous membrane of a nose for simplification of breath the child throws back the head back that creates a picture of a false opisthotonos, almost always with tension of fontanels. Body temperature usually in these cases happens high. There can be spasms. Eventually allocations from a nose become more dense, the quantity them decreases, nasal breath is recovered, and the child recovers. Quite often after acute R. develops bronchitis (see), bronchial pneumonia (see. Pneumonia ); most often there is an inflammation of a middle ear (see. Otitis ).

At differential diagnosis it is necessary to consider that acute R. at children of chest age can have a gonococcal etiology. The last begins with the birth of the child and matches gonorrheal damage of eyes (see. Blennorey ). The diagnosis is finalized at bacterial. research. Inborn syphilitic R. appears usually on 3 — to the 4th week of life of the child, at the same time note emergence a syphilide on skin of buttocks and around an anus, increase in a liver and spleen. The crucial role in diagnosis is played by serological tests (see. Syphilis ). At diphtheritic R. there are necrotic plaques, films, sanious allocations, lymphadenitis; at bacterial. a research of allocations from a nose sow Corynebacterium diphtheriae.

Acute R.'s treatment at children first of all is directed to recovery of nasal breath. For this purpose before feeding dig in 2 drops in each half of a nose of solution of adrenaline 1: 10 000 or 1% of solution of ephedrine with the subsequent injection of 1% r-raa colloid silver of a pla of protargol on 4 drops. Apply also 2 — 3 times a day 10 — 15% solution of a sulfacetamide sodium on 2 — 4 drops in each half of a nose. Recommend to grease an upper lip and an entrance to a threshold of a nasal cavity with vaseline or children's cream. Due to the danger laryngospasm (see) to children up to 5 years do not appoint menthol in drops or the drugs supporting him.

The forecast more often favorable, depends on virulence of an infection, a condition of the child and care of it.

Chronic rhinitis

Chronic R. is characterized by permanent dystrophic changes of a mucous membrane of a nose. Distinguish catarral, hypertrophic and atrophic chronic rhinitis. Development hron. By river it is, as a rule, connected with the long or often repeating hyperemia of the mucous membrane of a nose caused by its acute inflammations (including at various infections), influence of adverse environmental factors, nek-ry diseases of cardiovascular system, kidneys, a liver, atakzhedis-menorey, locks, alcoholism. Hron. The river can develop at adenoides, hron. purulent inflammation of adnexal bosoms of a nose, etc. In an etiology hron. Rubles can matter genetic predisposition, malformations and deformations of a nose, napr, a curvature of a partition of a nose, etc. In some cases hron. The river can be a symptom of chronic purulent sinusitis. At atrophic R. local, or limited, the mucosal atrophy arises most often as a result of an injury, a burn or a rough operative measure. The reasons of the general, or diffuse, atrophies, remain unknown. According to nek-ry researchers, it is a late stage hron. catarral R., others consider atrophic hron. Rubles an independent disease, a noticeable role in development to-rogo have hereditary and constitutional factors.

Chronic catarral rhinitis. Morphologically the phenomena of a metaplasia and proliferation of an epithelium of a mucous membrane of a nose prevail, is more often on the front ends of nasal sinks. The ciliate epithelium turns in cubic, and sometimes and in keratosic, to a greater or lesser extent loses cilia, to-rye can be recovered at improvement of a state. The reinforced epithelium has up to 10 — 12 rows of cells, instead of usual 4 — 6 rows. The amount of mucous glands and the slime emitted by them increases; channels of glands extend. The secret on the structure can be serous, mucous, mucopurulent. Further are involved in process and the lying fabrics are deeper, in to-rykh proliferation of connective tissue elements is observed, the number of vessels with a hypertrophy of a vascular wall and expansion of gleams increases. At the long course of a disease the periosteum and a bone are involved in process.

Clinically complicated nasal breath and allocations from a nose are expressed unsharply. These symptoms appear periodically, however a congestion of one half of a nose, usually alternate, is more constant. Allocations from a nose mucous in a small amount, but at an aggravation of process become slizistognoyny, plentiful. Determine by Rinoskopicheski a hyperemia of a mucous membrane, its thickening, is more often in the field of lower nasal and the front end of average nasal than sinks. Passing disturbances of sense of smell are noted.

Treatment is directed first of all to elimination of the reason which caused or supporting hron. inflammation. Locally apply astringents (2 — 5% solution of protargol or colloid silver) or cauterizing (2 — 5% solution of silver nitrate). For the purpose of reduction of swelling of a mucous membrane of a nose its 2 once a week grease 1 — 2% with solution iodine-glitse-rina.

Chronic hypertrophic rhinitis it is characterized by growth of fabric elements of a mucous membrane and its glands; the epithelium is loosened, cilia in places are absent. Most often growth of a mucous membrane and a submucosa is observed in the field of cavernous veniplexes in the front and back ends of the lower and average nasal sinks. At the same time hypertrophied nasal sinks can have a smooth, chicken or papillary surface, coloring varies a cut from gray-red to bright red or blue-crimson. The back end of a hypertrophied nasal sink can be given in the form of a tumor in nasopharyngeal pass.

Hypertrophic R.'s symptoms the same, as catarral, but the congestion of a nose happens almost constant character. Plentiful allocations from a nose are also almost constant. To establish the diagnosis usually easily. For the purpose of differential diagnosis of hypertrophic R. from catarral it is possible to grease a mucous membrane of a nose of 2 — 3% with solution of ephedrine or 1% solution of Dicainum or adrenaline. At hron. catarral R. the swelling of a mucous membrane after greasing disappears, lack of reduction or insignificant reduction of a swelling testifies to hypertrophic Ruble.

Treatment is directed to elimination of the reasons which caused River. Conservative treatment is ineffective. Apply cauterization of a hypertrophied mucous membrane of nasal sinks an electrocauter (see. Galvanocautery ) or lyapisy, trichloroacetic, chromic to-tami. Hypertrophied sites of nasal sinks after anesthesia can be removed with scissors or a conchotome, and in the field of the front and back ends of nasal sinks at a limited hypertrophy — a wire cutting loop (see. Turbinotomy ).

Chronic atrophic rhinitis it is characterized by a mucosal atrophy and rarely an atrophy of a bone skeleton of nasal sinks. The disease occurs at women twice more often than at men.

Morphologically process consists in a gradual atrophy of fabrics of a nasal cavity with thinning of a mucous membrane, a zapustevaniye of vessels, cavernous veniplexes of sinks and mucous glands; the ciliate epithelium turns into flat. The bony frame of nasal sinks can decrease in volume. At a limited atrophy in the field of defect of fabric the hem is formed that is followed by a zapustevaniye of glands, disappearance of a cavernous layer, a metaplasia of a ciliate epithelium in flat, formation of crusts.

At distribution of an atrophy on olfactory area easing gradually develops sense of smell (see), up to hypo - or anosmias (see).

Patients complain of dryness and a congestion of a nose, decrease or lack of sense of smell. At a rinoskopiya the nasal cavity is expanded, through a postnaris the nasopharynx can be visible.

In a nasal cavity — dry crusts, dense mucopurulent allocations. Often atrophic R. is combined with atrophic pharyngitis (see) and laryngitis (see). In these cases at patients bronchitis, pneumonia meet more often. Atrophic R. should be differentiated with ozena (see), atrophic form scleromas (see), syphilis (see).

Treatment is symptomatic, long, it is directed to elimination of dryness and crusts in a nasal cavity. Carry out 2 times to a week of greasing of a mucous membrane of a nose of 1% by solution iodine-glycerin, irrigation of a nasal cavity through an irrigator warm isotonic solution of sodium chloride, introduction to a nose a chlorophyll - carotene candles, diakhilny ointment, the vitaminized fish oil, etc. Operational treatment consists in narrowing of a nasal cavity by means of replanting under a mucous membrane of a partition of a nose and a bottom of a nose of various transplants.

Complications at chronic R. happen local and general character. More than in 90% of cases hron. The river is a cause of illness of the lacrimal ways. Quite often on this soil develop conjunctivitis (see). Sometimes hron. The river is followed by a headache with preferential localization in a forehead. It the irritation

of the first and second branches of a trifacial is the most probable cause. In developing of a headache contact of a mucous membrane of the front end of an average nasal sink with a nasal partition has a big role. It is known that quite often after removal of the front end of an average nasal sink the headache disappears. Disorders of nasal breath influence function of a brain that is expressed to hl. obr. in difficulty to concentrate the thoughts and perceptions, easing of memory. Owing to shallow breathing through a mouth lung ventilation is broken. The complicated nasal breath leads to changes of blood: the quantity of erythrocytes and content in blood of hemoglobin decreases, and the quantity of leukocytes increases. At recovery of nasal breath the composition of blood is normalized.

Chronic catarral or hypertrophic R.'s forecast at timely treatment rather favorable. The prevention of a recurrence is possible when it is possible to eliminate the factors influencing emergence hron. rhinitis.

At atrophic R. the forecast doubtful since it is not possible to recover completely function of a mucous membrane of a nose and sense of smell.

Prevention consists in a hardening of an organism, elimination of curvatures of a partition of a nose, a hypertrophy of a mucous membrane, adenoides (see) and others patol. changes.

Vasculomotor rhinitis

Is observed preferential at persons with the general vegetative frustration. Functional disturbance of vazomotor is its cornerstone. As a result the slightest irritation of nerve terminations of a mucous membrane of a nose or the remote reflexogenic zones (cooling, a pungent smell, etc.) leads to rough reaction in the form of the attacks which are characterized by a sudden congestion of a nose, plentiful watery and mucous allocations, sneezing, sometimes dacryagogue.

The mucous membrane of a nose is thickened with a metaplasia of an epithelium in multilayer flat. The abundance is characteristic scyphoid cells (see), accumulation of slime in cells; the stroma is edematous, the razvoloknena, is often collagenized.

At rinoskopiya (see), made during vasculomotor R.'s attack, find the expressed swelling of a mucous membrane of preferential lower nasal sinks and a large number of a watery and mucous secret. Sometimes on a mucous membrane the «gray-white spots of Voyachek» indicating dominance of a tone of a parasympathetic nervous system are visible. During the sounding of the nasal courses the bellied probe it it is free, without any resistance, it is pressed into soft tissues almost to a bone. After greasing of a mucous membrane vasoconstrictors (3% solution of ephedrine, 0,1% solution of adrenaline) the sizes of nasal sinks decrease to normal.

Treatment includes use of the hyposensibilizing means, physiotherapeutic procedures — diathermy (see), galvanization of an upper cervical node of a sympathetic trunk (see. Galvanization ), etc., prescription of medicines (drugs of bromine, a valerian) for decrease in the increased nervous irritability. In the absence of effect of conservative therapy resort to operational methods — a galvanocautery of the lower nasal sinks (see. Galvanocautery ), turbinotomies (see), it is desirable against the background of use of antihistaminic drugs (Dimedrol, Suprastinum, tavegil).

The forecast at timely diagnosis and the correct treatment favorable.

Prevention is generally directed to normalization of functional disturbances of a nervous system, a hardening of an organism.

Allergic rhinitis

Is one of the most widespread and represents the allergic reaction which is expressed in a considerable rhinedema, especially in the field of nasal sinks.

In an etiology the large role is played by allergens of inhalation type — pollen of plants (see. Pollinosis ), house, library, production dust, getting into an organism directly through a mucous membrane of a nose. Quite often the disease develops at hit of allergen through went. - kish. path or skin. In allergic R.'s emergence the bacterial allergy, generally to a streptococcus, staphylococcus and viruses has a certain value (see. Allergens ).

Frequent development of allergic process in a nasal cavity speaks fiziol. the conditions promoting long contact of allergen with fabrics, high-permeability of a mucous membrane, the slowed-down blood flow in cavernous veniplexes of nasal sinks, a delay of particles of various substances on their surface.

The cycling current with aggravations in the form of attacks is characteristic of allergic R. Typical symptoms are repeated sneezing, plentiful liquid allocations from a nose, paresthesias (itch) in this area and the complicated nasal breath.

Rinoskopicheski in the period of an attack note bilateral narrowing of the nasal courses due to increase in volume of the lower and average nasal sinks. The mucous membrane has pale or pale blue coloring with characteristic whitish or cyanochroic spottiness. The nasal courses are usually filled watery or a mucous consistence with allocations. At accession of consecutive infection of allocation accept purulent character. During the period between attacks the rinoskopichesky picture can be normal, however at the long course of a disease the mucous membrane remains edematous, and amount of slime in the nasal courses — raised.

In diagnosis, in addition to typical rinoskopichesky changes, an important role is played the allergological anamnesis, skin tests (see), an eosinophilia of blood, determination of content of eosinophils in a secret of a nasal cavity (reaches 80 — 100%). Local manifestations of allergic reactions reveal by means of provocative test (see. Allergy diagnostic tests , Provocative tests ).

In treatment use the general principles of therapy of allergic diseases (see. Desensitization ). Intranasal are locally most widespread novocainic blockade (see), cauterization of a mucous membrane, cryoinfluence (see. Cryosurgery )>, sclerosing therapy, physiotherapeutic treatment — an ionophoresis with Calcium chloratum, a hydrocortisone (see the Electrophoresis). Vasoconstrictors (ephedrine, sanorin, Naphthyzinum, etc.) at allergic R. are contraindicated since they lead to permanent vasculomotor disturbances. Sometimes resort to operational removal of thorns of a partition of a nose, hypertrophied sites of nasal sinks.

The forecast at timely and rational treatment good.

The same prevention, as at others allergic diseases (SEE).

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H. I. Kostrov, V. P. Fomina-Kosolapov; M. R. Bogomilsky (ave).