What Are the Most Common Causes of Chronic Post-Nasal Drip?

Chronic rhinitis is a chronic inflammation of the nasal mucosa and submucosa. Its main characteristics are that the inflammation lasts for more than three months or recurs, it does not heal, and the intermittent period does not return to normal, and there are no clear pathogenic microorganisms, with varying degrees of nasal congestion, increased secretions, and swelling or thickening of the nasal mucosa And other obstacles. According to the pathological and functional disorders of chronic rhinitis, it can be divided into chronic simple rhinitis and chronic hypertrophic rhinitis. The former is chronic inflammation of the nasal mucosa characterized by swelling and increased secretion of the nasal mucosa, and the latter is mucosa and submucosa. There is even chronic inflammation of the nasal cavity characterized by localized bone mass or diffuse hypertrophy.

Basic Information

English name: chronic rhinitis
Visiting department: Otorhinolaryngology head and neck surgery

Common causes: Immune dysfunction, chronic inflammation of the nasal cavity and sinuses, etc.
Common symptoms: Nasal congestion, runny nose, intermittent diminished smell, headache, nasal sound
Contagious: no

Causes of chronic rhinitis

Pathogenic factors include: systemic factors, local factors, and occupational and environmental factors.

Systemic factors

(1) Chronic rhinitis is often a local manifestation of some systemic diseases, such as anemia, tuberculosis, diabetes, rheumatism, acute infectious diseases, and chronic heart, liver, and kidney diseases, which can cause long-term congestion or reflex congestion in the nasal mucosa. .

(2) Malnutrition, such as lack of vitamins A and C, can cause hypertrophy of the nasal mucosa and degeneration of the glands.

(3) Endocrine disorders, such as hypothyroidism, can cause nasal mucosal edema; nasal mucosa can become congested and swollen during adolescence, menstruation and pregnancy, and a few can cause nasal mucosal hypertrophy.

(4) Tobacco and alcohol addiction or long-term excessive fatigue can cause vasomotor dysfunction of the nasal mucosa.

(5) Immune dysfunction, such as autoimmune diseases, AIDS, vasculitis, cystic fibrosis, and organ transplantation or long-term use of immunosuppressants in tumor patients.

Local factors

(1) Repeated episodes of acute rhinitis or incomplete treatment, the nasal mucosa does not return to normal, but evolves into chronic rhinitis.

(2) Chronic inflammation of the nasal cavity and sinuses, or the influence of nearby infections, such as chronic tonsillitis, adenoid hypertrophy, etc., the nasal mucosa is stimulated by purulent secretions for a long time, which promotes chronic rhinitis.

(3) Deflection of the nasal septum, narrowing of the nasal cavity, foreign bodies and tumors hinder ventilation and drainage of the nasal cavity, making it easy for the pathogen to remain locally, resulting in repeated inflammation.

(4) The effects of improper nasal medication or systemic administration, such as dysfunction of nasal mucosa due to long-term infusion of vasoconstrictor, vasodilatation, and swelling of the mucosa.

3. Occupational and environmental factors

Long-term inhalation of various dusts in the professional or living environment, such as coal, rock, cement, flour, lime, etc. can damage the cilia of the nasal mucosa. A variety of chemicals and irritating gases (such as sulfur dioxide, formaldehyde, and ethanol) can cause chronic rhinitis. In addition, rapid changes in temperature and humidity in the environment can also cause the disease.

Clinical manifestations of chronic rhinitis

Chronic simple rhinitis

(1) The characteristics of nasal congestion are: intermittent: nasal congestion is reduced during the day, summer, labor or exercise, and the nasal congestion is worsened at night, meditation or cold; alternating: the lower nasal cavity is blocked when lying on the side, and the upper nasal cavity is better, When turning to the supine position on the other side, nasal congestion appeared on the other side.

(2) Mostly translucent mucus nasal discharge, pus may be present after secondary infection. Snot can flow back into the throat through the nostril, causing symptoms such as throat discomfort, "phlegm" and cough. Pediatric patients may have nasal vestibitis and eczema due to long-term nasal stimulation of the nasal vestibule and upper lip.

(3) Due to nasal congestion, there may be intermittent diminished smell, headache discomfort, and nasal sounds when speaking.

2. Chronic hypertrophic rhinitis

(1) The nasal congestion is heavy and mostly persistent. There are occlusive nasal sounds and hyposmia. The snot is not much, it is mucus or purulent, and it is difficult to exudate.

(2) Tinnitus and hearing loss may occur if the back of the inferior inferior turbinate compresses the eustachian tube.

(3) Chronic sore throat is prone to occur due to prolonged mouth breathing and stimulation of nasal secretions.

(4) Accompanied by symptoms such as headache, dizziness, insomnia, and malaise.

Chronic rhinitis examination

Chronic simple rhinitis

(1) Signs The nasal mucosa is swollen and the surface is smooth. The following turbinates are the most obvious. The turbinates are soft and elastic. They are gently pressed into a depression with a probe and recovered immediately after removal.

(2) The auxiliary examination of the nasal mucosa is sensitive to vasoconstrictor. The swelling of the lower turbinate can be resolved within 3 to 5 minutes after application. There are thick mucus secretions in the nasal cavity, which are mostly collected in the nasal floor, the common nasal passage or the lower nasal passage.

2. Chronic hypertrophic rhinitis

(1) Inflammation of signs for a long time can lead to hyperplasia and hypertrophy of the nasal mucosa, becoming dark red or lavender. The inferior turbinate mucosa is hypertrophic, and the inferior turbinate bones may also be enlarged. The surface of the inferior turbinate is uneven and nodular or mulberry-shaped. The light pressure of the probe on the turbinate has a hard and firm feel and is not prone to dents, or the dents appear but are not easy to recover.

(2) The auxiliary examination responds poorly to the vasoconstrictor, and the nasal mucosa does not contract or contracts slightly. Sometimes mucous or purulent discharge is seen on the bottom or lower nasal passages.

Diagnosis of chronic rhinitis

Diagnosed based on symptoms, rhinoscopy and nasal mucosa response to vasoconstrictors such as ephedrine.

Differential diagnosis of chronic rhinitis

However, attention should be paid to the identification of structural rhinitis. Structural rhinitis is the anatomical abnormality of one or more nasal structures in the nasal cavity, such as structural deviations of the nasal septum, reverse bending of the middle turbinate, and abduction of the inferior turbinate. Malfunction.

Chronic rhinitis treatment

Cause treatment

Find out the cause of systemic, local and environmental causes, and actively treat or eliminate systemic diseases. Corrective surgery is performed on those with deviated nasal septum to actively treat chronic sinusitis. Strengthen physical exercise, improve nutritional status, treat chronic diseases throughout the body, and improve body resistance.

Local treatment

(1) Local glucocorticoid nasal spray can exert powerful anti-inflammatory and anti-edema effects in all stages of inflammation, and can promote the repair of damaged ciliated epithelium. It is currently the first-line drug for nasal inflammatory diseases. For patients with "pregnancy rhinitis", decongestants should not be used, and glucocorticoid nasal sprays should be used with caution. Rhinitis symptoms will be relieved within 2 to 4 weeks after termination of pregnancy.

(2) Decongestants can be used only when chronic rhinitis is accompanied by an acute infection, nasal drops are used once or twice a day, and the general application time should not exceed 7 to 10 days. Long-term use of such drugs can cause drugs Rhinitis. Children can use these drugs for a short period of time.

(3) Sealing therapy can be used to close Yingxiang and Bitong points; it can also be used as a submucosal injection of the nasal mound or bilateral lower turbinates. But this method has been rarely applied.

(4) Those with severe nasal congestion can massage Yingxiang and Bitong acupoints, and can also use fresh saline or seawater to rinse the nasal cavity.

3. Systemic drug treatment

(1) If the inflammation is more obvious and there is more reflux of secretions, consider taking small doses of macrolide antibiotics orally.

(2) Chinese medicine treatment can be considered.

4. Surgery

For patients who are ineffective with drugs and other treatments and who have significant persistent nasal congestion, surgical treatment is feasible. At present, the surgery is mostly performed under the sinus endoscope, which can improve the safety and accuracy of the surgery.

(1) Inferior turbinate resection removes a part of the inferior turbinate by surgery to make the turbinate tissue smaller, which can reduce nasal resistance and improve the state of nasal ventilation. Dilation and contraction of the inferior turbinate cause great changes in nasal resistance. The front end of the inferior turbinate is close to the nasal valve area (the site with the highest resistance in the nasal cavity). Therefore, when performing inferior turbinate surgery, care should be taken to properly retain the front end of the inferior turbinate to avoid side effects.

(2) Low temperature plasma, laser (CO ₂ laser, YAG laser, etc.), and microwave inferior turbinate surgery can reduce the turbinate tissue by ablating the hypertrophic inferior turbinate mucosa or submucosal tissue, thereby improving the symptoms of congestion. This method is simple and easy to perform, but may cause dryness of the nasal cavity after surgery.

(3) This surgery can be performed for patients with inferior turbinate fractures who underwent local hypertrophy or inward extension of the turbinate bone . This method generally does not damage the inferior turbinate mucosa, has no obvious effect on the physiological function of the nasal cavity, and has less intraoperative and postoperative bleeding, which is a minimally invasive operation. The disadvantage is that the volume reduction effect is limited, and it is not good for heavier chronic rhinitis. ^[1-4]

Chronic rhinitis prevention

1. Quit smoking and drinking, pay attention to food hygiene and environmental hygiene, and avoid long-term stimulation of dust.

2. Avoid long-term use of nasal decongestants, which may cause "drug-induced rhinitis".

3. Actively treat acute rhinitis. Whenever a nasal congestion worsens, do not pull the nose with force to avoid causing nasal infection.

4. Pay attention to exercise and participate in appropriate physical activities.

5. Pay attention to climate change and add or remove clothes in a timely manner.

6. Avoid entering and exiting crowded places as much as possible, and pay attention to wearing masks.

References

1. Huang Xuanzhao, Wang Jibao, editor of Kong Weijia. Practical Otolaryngology Head and Neck Surgery. Beijing: People's Medical Publishing House, 2011: 109-119.

2. Edited by Li Xuepei. Otorhinolaryngology. Beijing: Peking University Medical Press, 2003: 36-39.

3. Xu Geng. New concept of local glucocorticoid therapy for non-allergic persistent rhinitis (chronic rhinitis): Clinical Journal of Otorhinolaryngology Head and Neck Surgery, 2007: 636-638.

4. Editor of Kong Weijia. Otorhinolaryngology Head and Neck Surgery. Beijing: People's Medical Publishing House, 2010: 265-266.