Rhinitis
As a rhinitis ("nasal inflammation"; Greek artificial word ρινίτις from rhīs , " nose " and -itis , "inflammation") or a koryza (also in Latinized spelling Coryza ; learned Greek κόρυζα for " cold "; German also snot ) becomes an acute one or chronic inflammation of the mucous membrane ( inflammation of the mucous membrane of the nose ) by infectious , allergic and pseudoallergic mechanisms. It occurs most often as part of a cold and is then referred to as nasal catarrh or rhinitis ( acute rhinitis ).
Forms of rhinitis
| Classification according to ICD-10 | |
|---|---|
| J00 | Acute rhinopharyngitis [colds] |
| J30.- | Vasomotor and allergic rhinopathy |
| J31.0 | Chronic Rhinitis - Atrophic Rhinitis Hypertrophic Rhinitis |
| A36.1 | Nasopharyngeal diphtheria |
| ICD-10 online (WHO version 2019) | |
Acute rhinitis
In the acute rhinitis - the common cold - this is usually a harmless infection and thus an "infectious rhinitis" caused by a variety of viruses - especially rhinoviruses (a genus of picornaviruses ) and adenoviruses can be triggered - . The main characteristic is a runny nose ( rhinorrhea ) and the nasal congestion caused by the swelling of the mucous membranes .
In total, more than 200 "cold viruses" are possible triggers of a viral rhinitis, as it occurs in the context of a " cold ". This also includes pathogens such as the poliovirus and the three subtypes of the influenza virus .
It has not previously been possible to develop a vaccine against rhinitis. There are nasal sprays that briefly clear the airway (for example with the active ingredients tramazoline and xylometazoline ), but these only have a symptomatic effect. Nasal sprays with the active ingredient oxymetazoline have a direct antiviral effect by preventing the expression of ICAM-1 , a receptor for the human rhinovirus . With prolonged use of nasal sprays (use well beyond a week), a medical runny nose ( privinism ) is often developed, in which the nasal mucous membrane no longer swells at a normal level without the addition of active ingredients. These active ingredients are α-sympathomimetics , which can lead to a so-called rebound phenomenon after discontinuation . Inhalations of salt water vapor and sea water nasal sprays available in drug stores and pharmacies are used to relieve the symptoms.
The incubation period (time between infection and appearance of the first symptoms) is between a few hours and seven days, symptoms are:
- Sneeze or sneeze
- itching
- excessive secretion of thick or thin secretion (runny nose, catarrh , snot )
- Swelling of the nasal mucous membrane and thus hindrance to nasal breathing (common cold)
- burning pain
The swelling of the nasal mucosa and the tissue pain arise in the course of the immune reaction through the formation of various cytokines . Mucopolysaccharides are formed to cleanse the nasal mucosa .
Acute rhinitis usually disappears after a week.
Atrophic rhinitis
A disease of the nose, in which there is atrophy of the lining of the nose and mussels , is also known as ozaena . The common name for it is stinky nose , as the atrophic mucous membrane favors the colonization of germs, which give off an unpleasant, sweet and rotten smell. Since the mucous glands also atrophy, the inside of the nose can no longer be sufficiently moistened, which leads to dryness of the mucous membrane and thus to strong, black to yellow-green crust formation . The tough incrustations can result in headache and nose pain, nosebleeds and suppurations . Because of the smell of the nose, the sick often suffer from social exclusion. Due to anosmia (due to the atrophy of olfactory nerves) and because the olfactory nerves get used to their own odor, the patients do not perceive the smell themselves. The primary ozaena is presumably hereditary, occurs more frequently in females and usually begins with the age of puberty . The secondary ozaena can have various causes, such as: B .:
- Tumors of the nasopharynx
- Malformations of the nasal septum ( nasal septum )
- Abuse of xylometazoline (active ingredient in decongestant nasal drops, see drug rhinitis )
- Sequence of surgical interventions in the nasal cavity
There are different approaches to therapy for rhinitis atrophicans, but a complete cure is not expected:
- To keep the nasal mucous membranes moist, oily nasal drops and nasal ointments are recommended
- The bark can be removed mechanically or by means of nasal irrigation
- Highly dosed vitamins A and E help with regeneration and counteract atrophy
- The nasal cavity can be surgically narrowed by implanting pieces of cartilage , which can prevent drying out and thus the formation of crusts and the colonization of odor-causing germs. Thus an alleviation of the disease can often be achieved for a few years.
Allergic rhinitis
Hypertrophic rhinitis
Hypertrophic rhinitis is an increase in the volume of the lower and middle mussels, on which polyp-like thickenings often develop. The mussels lie close to the nasal septum so that only a narrow gap remains for air to pass through. Often there is a narrowing of the nose. Not only nasal breathing suffers, but also the sense of smell, language (stuffed nasal voice) and the singing voice. The result is irritation and catarrh of the mouth and throat, larynx and bronchi. Hypertrophic rhinitis is a very persistent and troublesome condition.
Rhinitis medicamentosa
Pseudomembranous rhinitis
When pseudomembranous rhinitis is today become rare appearance of diphtheria . Usually the front part of the nasal mucous membrane ( nasal septum or turbinates ) is affected in isolation. Characteristic is the formation of a so-called dummy membrane : The ectotoxin effect of the bacterium Corynebacterium diphtheriae damages the nasal mucosa and the formation of a tough, fibrin-rich , gray-white secretion with admixture of cell debris (dead epithelial cells of the nasal mucous membrane) and macrophages (white blood cells) as well as pathogens themselves. If the secretion dries up, it adheres so firmly to the surface that if you try to remove it, bleeding occurs.
Diphtheria, which is restricted to the nose, is next to skin diphtheria that form of the disease that leads to the least systemic effects (effects on the organism ).
Rhinitis sicca
Rhinitis sicca is characterized by dry mucous membrane and its crust. The atrophy of the mucous membrane and thus also its seromucosal glands can be caused by chronic inhalation of exogenous noxae such as B. cocaine, or as a result of autoimmune diseases such as Sjogren's syndrome . In this form of rhinitis there is a contraindication to the use of α-sympathomimetic nasal drops. Instead, preparations are used to moisten and care for the nasal mucosa, such as liposome sprays or nasal ointments .
Vasomotor rhinitis
In this inflammation of the nasal mucous membrane, also called NARE syndrome (from Non-Allergic Rhinitis with Eosinophilia Syndrome ), the regulation of the blood vessels of the nasal mucous membrane is disturbed. The cause of this has not yet been clarified and can lead to sleep apnea .
Although there are no verifiable allergic causes, doctors assume that extreme temperature changes (e.g. heated rooms and cold outside temperatures in winter), warm drinks, alcohol , stress , drug abuse or other psychological stress as well as the abuse of nasal drops or sprays can lead to a vasomotor rhinitis by increasing the blood flow to the nasal mucosal vessels. This causes the nasal mucous membrane to swell and, similar to an allergic runny nose , a watery nasal mucus develops, which causes a reduced sense of smell .
