Runny nose: Diagnosis, treatment and Prevention

A runny nose is an inflammation of the mucous membrane of the nose, which is most often associated with an acute respiratory viral infection (ARVI). In medical literature, a runny nose is understood as rhinitis. But since rhinitis and sinusitis usually occur simultaneously, European countries have come to a consensus on the final term – rhinosinusitis. This is an inflammation of the mucous membrane of the nose and paranasal sinuses. In common parlance – a cold that occurs against the background of a viral (less often bacterial) infection.

When we talk about a runny nose, we mean acute rhinosinusitis. This is a common cold that lasts no more than 10 days. As a rule, a cold goes away on its own, provided that you stay in bed or at home and drink plenty of fluids. If the symptoms persist for more than 10 days, then we talk about acute post-viral rhinosinusitis, which can last up to 12 weeks. If the symptoms of the disease persist for more than 12 weeks, then this is already chronic rhinosinusitis.

How does a runny nose manifest itself?

Rhinosinusitis is characterized by so-called major and minor symptoms. Major symptoms include nasal congestion and nasal discharge. Minor symptoms include headache, pressure in a certain part of the face, and impaired sense of smell. These are the first diagnostic criteria for rhinosinusitis that the doctor pays attention to when making a diagnosis.

Acute rhinosinusitis is often accompanied by sneezing and watery eyes in addition to nasal congestion. Nasal discharge may be mucous or mucopurulent.

Headache with a runny nose

Headache with a runny nose – at first glance, it is a fairly common symptom. However, according to statistics, only 1 out of 8 patients who consult a doctor have a headache that is actually caused by rhinosinusitis.

Most often, headaches occur with acute frontal rhinosinusitis (frontal sinusitis), when the frontal paranasal sinus becomes inflamed. This type of sinusitis is more severe than others. Headaches can also be a problem with sphenoiditis, an inflammation of the mucous membrane lining the sphenoid sinus. In other cases, headaches are not caused by inflammation in the sinuses, but arise due to neurological or vascular causes.

If you have a runny nose with blood

The mucous membrane of the nose contains a large number of capillaries, and if they are damaged, the blood contained in them comes out. In the vast majority of cases, blood during a runny nose appears due to mechanical damage to the vessels. This is facilitated by excessive dryness of the mucous membrane and vascular spasms, which are observed with excessive physical exertion, climate change or a sharp jump in ambient temperatures.

Important! How to distinguish a runny nose from allergies

There is such a disease as allergic rhinitis, the symptoms of which are in many ways similar to a cold. However, allergic rhinitis has its own differences. Firstly, with allergic rhinitis, the patient does not feel pain in the nasal sinuses. Secondly, with allergies, nasal discharge is watery, not mucopurulent. In addition, allergic rhinitis is often accompanied by itching in the eyes, nose and ears.

Diagnostics

Diagnosis of rhinosinusitis is mainly based on the patient’s complaints, anamnesis and clinical picture of the disease [1].

During the examination, the doctor examines and palpates the maxillofacial area, examines the oropharynx and teeth. In some cases, anterior rhinoscopy is performed – examination of the nasal cavity using nasal mirrors.

Severe cases (extremely rare), there is a need for additional instrumental studies, such as computed tomography and magnetic resonance imaging.

In order to identify the infectious agent in rhinosinusitis, bacteriological studies are carried out – bacteriological culture of the taken smear or wash.

Treatment of a runny nose

The European Rhinosinusitis Guidelines (EPOS) clearly state that rhinosinusitis often does not require any specific treatment. However, a simple treatment algorithm has been developed for doctors, and here are its main points:

• When treating rhinosinusitis, it is recommended to drink plenty of fluids and stay in bed.
• For headaches and body aches, it is permissible to take non-steroidal anti-inflammatory drugs (for example, ibuprofen) and analgesics (paracetamol).
• It is possible to take some herbal preparations (more about them later).

If after 36-48 hours of such treatment the patient does not show positive dynamics, then he should consult an otolaryngologist.

Runny nose and antibiotics

Unfortunately, in our country you can still buy antibiotics without a prescription. Only this year the Cabinet of Ministers approved the National Action Plan to Combat Antimicrobial Resistance, one of the points of which provides for the sale of antibacterial drugs only upon prescription. However, in practice this does not always work.

Banning the over-the-counter sale of antibiotics is a necessary measure, but what to do if doctors themselves often prescribe antibiotics without reason. And a runny nose is no exception. The main reason for the unjustified prescription of antibiotics for a runny nose is the complications that may arise. Antibiotics are often prescribed to prevent complications. However, in reality, complications with a runny nose occur extremely rarely – only once in every 32 thousand cases in adults and 12 thousand cases in children.

General practitioners believe that purulent nasal discharge is a sign of bacterial infection, which requires immediate use of antibiotics. However, pus is not a specific sign of bacterial infection, so even in this case, antibiotics are not prescribed [2].

Recurrent acute rhinosinusitis and headache or toothache when bending over are also not grounds for prescribing antibiotics.

A natural question arises: when are antibiotics appropriate? There are criteria for acute bacterial rhinosinusitis that require antibiotics. These criteria include:

• High temperature – above 38 degrees.
• Increased levels of C-reactive protein in the blood.
• Increased erythrocyte sedimentation rate (ESR).

Each of the above criteria should not be considered separately. Antibiotics should be prescribed based on a combination of criteria and an assessment of the clinical picture of the disease.

Decongestants and other mistakes for a runny nose

Rarely do any medications give an immediate effect. Decongestants are among them. That is why they are so often used for a runny nose. These are well-known nasal drops and sprays that help to immediately relieve nasal congestion and breathe freely. Agree, instant relief from nasal congestion looks too tempting, especially since such medications are sold without a prescription and are inexpensive. But there is a fly in the ointment, and not even one.

According to EPOS recommendations, decongestant therapy for rhinitis is NOT RECOMMENDED for either children or adults. The problem is that clinical studies have not confirmed that decongestants speed up the patient’s recovery. In addition, vascular spasm caused by decongestants can cause damage to the vessel and the appearance of blood in the nasal cavity, as discussed above.

Another common mistake in treating a runny nose is steam inhalation, be it a decoction of potatoes, eucalyptus or other plants. As studies show, heated steam does not affect the recovery process in any way with a runny nose. Moreover, in some cases, such treatment is dangerous, since you can get a burn of the mucous membrane, especially if you do steam inhalation for children. Due to its ineffectiveness, EPOS experts definitely DO NOT RECOMMEND steam inhalation for treating a runny nose.

Paradoxically, another mistake in treating a runny nose is excessive enthusiasm for folk remedies. Instillation of onion juice, milk, oil drops and other folk remedies often complicates the recovery process. Moreover, there is not a single scientific proof of the effectiveness of such remedies for a runny nose.

Herbal remedies for runny nose

As for herbal remedies for rhinitis, some of them have been clinically studied and shown to be effective in treating rhinosinusitis using extracts of some medicinal plants.

EPOS experts, having analyzed the data of numerous studies, came to the conclusion that effective herbal preparations for rhinosinusitis are standardized myrtol (a mixture of essential oils of plant origin), preparations based on extracts of European cyclamen (alpine violet) and pelargonium (geranium) stonecrop. But as for the effectiveness of garlic, which is so often used by people to treat and prevent colds, experts have not yet found convincing evidence in its favor.

Prevention of runny nose

Unfortunately, it is impossible to completely protect yourself from viruses that cause a runny nose. However, you can significantly reduce the risk of developing a runny nose with the following recommendations:

• Maintain good hygiene – wash your hands with soap, especially after returning from the street. According to the results of randomized trials, hand washing significantly reduces the spread of respiratory viruses, especially among children.

• Take probiotics . As shown by Cochrane* studies*, regular intake of probiotics reduces the risk of developing upper respiratory tract infections [3].
• Take vitamin C. It should be noted that the preventive effect of vitamin C will only be for those people who have heavy physical activity or are in low temperatures for a short period of time. In other cases, the effectiveness of vitamin C for preventive purposes is not confirmed.