chronic rhinitis
Introduction
Introduction to chronic rhinitis Chronic rhinitis (chronicrhinitis) is a chronic inflammation of the nasal mucosa and submucosa, manifested as chronic congestion and swelling of the nasal mucosa, called chronic simple rhinitis (chronicsimplerhinitis), if developed into hypertrophy of the nasal mucosa and turbinate bone, called chronic hypertrophic rhinitis (chronichypertrophicrhinitis). 1. Chronic simple rhinitis: It is a chronic inflammation characterized by vasodilatation of the nasal mucosa and increased secretion of glands due to neuromodulation dysfunction of the nasal blood vessels. 2. Chronic hypertrophic rhinitis: chronic rhinitis characterized by nasal vascular neuromodulation dysfunction, allergic and hormonal effects or factors such as dust, climatic and occupational factors, such as nasal mucosal hypertrophy and turbinate swelling. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: Nasal polyps Otitis media Swelling Edema Eustachian tube obstruction Deafness Secretory otitis media Sinusitis
Cause
Causes of chronic rhinitis
Local cause (35%):
Acute rhinitis recurrent or incomplete treatment and evolved into chronic rhinitis; due to long-term stimulation or malformation of adjacent chronic inflammation, nasal ventilation or drainage obstruction, such as chronic sinusitis, nasal septum deviation, chronic tonsillitis or adenoids Hypertrophy, etc.; nasal cavity medication is inappropriate or excessively long to form rhinitis medicamentosa, which is common after long-term use of nasal drops.
Systemic cause (20%):
Long-term chronic diseases, such as endocrine disorders, long-term constipation, kidney disease and cardiovascular disease, cause long-term or repeated congestion or blood stasis of the nasal mucosa; vitamin deficiency, such as vitamin A or C; excessive alcohol and tobacco can affect the blood vessels of the nasal mucosa Obstruction and obstruction; long-term use of blood and blood equals antihypertensive drugs, can cause nasal vasodilatation and produce symptoms like rhinitis.
Environmental factors (15%):
In the environment of cement, tobacco, coal dust, flour or chemicals, the nasal mucosa is stimulated and damaged by physical and chemical factors, which can cause chronic rhinitis, environments with rapid changes in temperature and humidity, such as steelmaking, freezing, Workers in the workshop such as baking and melting are also more susceptible to this disease.
pathology:
Chronic simple rhinitis: Chronic dilatation of deep mucosa of the mucosa, especially the following changes in the cavernous sinusoids of the nasal sinus, the mucous gland is active, the secretion is increased, the nasal mucosa is swollen, but there is no obvious hyperplastic change in the submucosal tissue.
Chronic hypertrophic rhinitis: mucosal epithelial cilia shedding, becoming a stratified cubic epithelium, submucosal edema followed by fibrous tissue hyperplasia and mucosal hypertrophy, for a long time, may be mulberry-like or polypoid changes, periosteal and bone tissue hyperplasia, nasal bone The bone can also change in hypertrophy.
Chronic dry rhinitis: The reduction or disappearance of the goblet cells of the nasal mucosa causes the nasal mucosa to dry, but the nasal mucosa and the turbinates have no atrophy, and the nasal secretions are also odorless.
Prevention
Chronic rhinitis prevention
1, quit smoking and alcohol, pay attention to food hygiene and environmental hygiene, to avoid long-term stimulation of dust.
2, the treatment process should be combined with physical therapy to enhance physical fitness and disease resistance.
3, to avoid local long-term use of ephedrine nasal drops, chronic simple rhinitis nasal mucosa smooth, elastic, sensitive to vasoconstrictors; and chronic hypertrophic rhinitis generally due to mucosal hypertrophy, not sensitive to vasoconstrictors, so even if ephedrine There is no significant reduction in the posterior nasal congestion, and it can cause olfactory disturbance, headache, memory loss, and may cause "drug rhinitis."
4, active treatment of acute rhinitis, every time you have a cold nasal congestion, can not use force to nose, so as not to cause nasal infection, pay attention to environmental hygiene, smokers and alcohol should naturally quit.
Complication
Chronic rhinitis complications Complications, nasal polyps, otitis, swelling, edema, eustachian tube obstruction, deafness, secretory otitis, sinusitis
Chronic rhinitis series complications:
1, nasal polyps: one of the main complications of allergic rhinitis is nasal polyps, as well as changes in nasal polyps, these are manifested as nasal obstruction, lower nose and hypertrophy, you can take some conservative treatment.
2, bronchial asthma: less than half of patients with hay fever and some patients with perennial allergic rhinitis bronchial asthma, which is caused by allergic bronchial disease, its allergens are also consistent with allergic rhinitis, generally in the nose, eyes There are bronchial asthma only a few years after the onset of symptoms. Before the onset of asthma, there is a persistent, long-lasting cough. This is a prodromal symptom of asthma, caused by allergic bronchitis, and very few patients with asthma and nose, eye symptoms. At the same time, a small number of children have asthma first. It is often found that in young children, nasal symptoms appear only a few years later. At this time, asthma may still be in episodes, or there may be no clinical manifestations. The bronchial asthma attack mainly manifests as expiratory dyspnea and wheezing; serious With chest tightness, suffocation, can not sit flat. Often take the sitting position or the semi-sitting position to help the breathing, in order to eliminate the thick secretions in the bronchi, the patient often coughs hard, the child can cause vomiting, when the asthma begins to relieve, often a lot of white sticky out The difficulty of breathing is relieved. Long-term asthma can be complicated by emphysema and pulmonary heart disease, which seriously affects the health and quality of life of patients. This condition is only seen in perennial allergic rhinitis.
3, otitis media: due to swelling or edema of the nasal mucosa and eustachian tube mucosa continuous, eustachian tube mucosa can also occur the same lesions, when the eustachian membrane mucosal swelling and edema to a certain extent, can lead to obstruction of the eustachian tube, middle ear Cavity effusion, and there is a transmission of deafness, which is allergic otitis media, this disease does not purulent, it will not cause tympanic membrane perforation and ear pus, its allergens are consistent with allergic rhinitis, but allergic rhinitis complicated by allergies Otitis media is not common.
4, sinusitis: due to swelling or edema of the nasal mucosa blocked in the middle nasal passages and upper nasal sinus opening, almost all patients with allergic rhinitis have varying degrees of allergic sinusitis, the invaded sinus is often Bilateral, total sinus, allergic sinusitis often has no obvious clinical manifestations before secondary infection, and the diagnosis depends on sinus x-ray or cT scan.
5, allergic pharyngitis: nasal allergic reaction can spread to the throat, the patient has itchy throat, cough, mild hoarseness, severe cases may occur epiglottis, vocal cord mucosal edema and breathing difficulties, allergic rhinitis can cause the above A serious complication, it is necessary to pay attention to the active treatment of allergic rhinitis to avoid complications.
6, the relationship between allergic rhinitis and sleep disorders: patients with allergic rhinitis often due to the release of inflammatory mediators and the activation of inflammatory cells caused by nasal congestion and obstruction, seriously affecting the quality of sleep, resulting in daytime learning ability, work efficiency And the decline in quality of life, so medication for allergic rhinitis, improve nasal symptoms is very important.
7, children suffering from rhinitis can cause memory loss, mental decline, adult suffering from rhinitis affects work and life, nasal inflammation for a long time, there is a risk of nasal tumors.
Symptom
Chronic rhinitis symptoms Common symptoms Nasal mucosal ulcers and atrophy runny nose purulent secretions Nasal hypertrophy Nasal mucosa swelling Unilateral nasal obstruction Nodules Nasal mucosal hemorrhage
Chronic simple rhinitis:
The nasal mucosa is swollen, the surface is smooth and moist, generally dark red, the turbinate mucosa is soft and elastic, and the probe is lightly pressed to form a depression, but the removal of the probe will quickly restore the depression, especially in the inferior turbinate. 2% ephedrine solution for nasal mucosa contraction, the turbinate rapidly shrinks, there is mucous or purulent secretion in the total nasal passage or lower nasal passage.
Chronic hypertrophic rhinitis:
1 The lower turbinate is obviously hypertrophied, or the inferior turbinate and the middle turbinate are hypertrophied, often causing nasal congestion, mucus or mucopurulent secretions in the bottom of the nasal cavity or in the lower nasal passage.
2 mucous membrane swelling, pink or purple, uneven surface, or nodular or mulberry-like, especially the front end of the turbinate and its free edge is obvious, the probe light pressure depression is not obvious, the touch has a hard feeling.
3 After the local vasoconstrictor, the mucosal contraction was not obvious.
Examine
Chronic rhinitis examination
Chronic rhinitis often has nasal blockage, nasal turbidity, headache, and decreased sense of smell. First check the anterior nasal orifices for damage, crusting, foreign bodies or tumors. Because these diseases can also often appear the above symptoms. Follow the nasal septum to see if there are erosions, crusting or severe nasal septum deformity. The most important thing in nasal examination is to see if the nasal mucosa is hyperemia, hypertrophy, whether the nasal turbinates are congested, hypertrophy or polyps, whether there are secretions in the nasal passages, and the color, nature and location of the secretions.
Diagnosis
Diagnosis and diagnosis of chronic rhinitis
Generally not confused with other diseases, special circumstances are not excluded.
The symptoms are basically the same as chronic simple rhinitis, but the degree of nasal congestion is more serious and more persistent. The degree of occlusive nasal and olfactory dysfunction is also severe. The snot is usually not much, it is mucous or mucopurulent and is not easy to sputum.
The posterior end of the hypertrophic inferior turbinate presses the eustachian tube and can cause tinnitus and hearing loss. The mucosa of the inferior turbinate is thick, blocking the opening of the nasolacrimal duct, which can cause tears, or secondary dacryocystitis and conjunctivitis. Long-term nasal congestion, frequent mouth breathing, and long-term stimulation of nasal secretions, easy to secondary chronic sinusitis, pharyngitis, laryngitis. Headache, dizziness, memory loss, listlessness, insomnia and other symptoms are more serious than chronic simple rhinitis. When the hypertrophic middle turbinate presses the nasal septum, it can cause trigeminal neuralgia (the first branch), called "pre-screening neurological syndrome", and the headache can be alleviated by the anesthesia of the olfactory mucosa.
Check that the nasal cavity is blocked by the enlarged lower turbinate, and the bottom of the nose or the lower nasal passage is filled with mucus or pus. The mucous membrane is swollen, pale, pink or aubergine, with uneven surface, nodular or mulberry-like. The anterior, posterior and free rim of the nasal turbin are most obvious. When the turbinate is pressed with a probe, it has a hard feeling and is not easy to sag. , or it is not easy to recover after depression.
The hypertrophic nasal mucosa is not sensitive to vasoconstrictors, and after the local use of ephedrine drugs, the mucosal swelling does not significantly resolve. After nasal examination, the posterior turbinate hypertrophy can be seen. In severe cases, it is mulberry-like, which can protrude to the nasopharynx. The posterior end of the turbinate is grayish white, and some are polypoid. The mucosa on both sides of the nasal septum is symmetric and hypertrophic.
