Chronic rhinitis is a chronic inflammation of the nasal mucosa mainly caused by nasal congestion. It includes chronic simple rhinitis and chronic hypertrophic rhinitis.

Chronic rhinitis can be caused by various factors that continue to irritate the nasal mucosa, affect the mucociliary clearance function of the nasal cavity, and increase nasal respiratory resistance. Chronic rhinitis can be caused by working in a polluted environment for a long time, being exposed to harmful gases, dust, etc.; or by incomplete treatment due to repeated episodes of acute rhinitis; or by improper use of nose and eye net for a long time.

Chronic rhinitis is not difficult to diagnose. In terms of treatment, attention should be paid to avoiding harmful factors that cause the disease, improving physical fitness, and choosing suitable nasal drops. For chronic hypertrophic rhinitis, sclerosing agent can be injected under the hypertrophied inferior turbinate mucosa, or laser or cryotherapy can be used to shrink the inferior turbinate to facilitate nasal ventilation and drainage.

Prescription

1. Strengthen labor protection and avoid or reduce exposure to harmful gases and dust.

2. When suffering from acute rhinitis, you should pay attention to rest and take active treatment. Pay attention to strengthening physical exercise at ordinary times.

3. Chronic simple rhinitis can be treated with 1% ephedrine intranasally. Pay attention to the nasal instillation method.

4. Do not use nose and eye cleanser for a long time.

5. Surgery on the inferior turbinate should be performed with caution, as excessive resection can induce atrophic rhinitis.

Chronic rhinitis is a chronic inflammation of the nasal mucosa and submucosa caused by systemic, local or occupational environmental factors. It usually includes two types: chronic simple rhinitis and chronic hypertrophic rhinitis. The clinical characteristics of chronic simple rhinitis are alternating and intermittent nasal congestion, excessive rhinorrhea, often mucus. The clinical characteristics of chronic hypertrophic rhinitis are severe nasal congestion, which is often persistent, and there is not much nasal mucus, which is thick and difficult to blow out. When chronic rhinitis is severe, it can affect the olfactory function.

Health Preservation Guide:

1. Increase physical exercise, choose medical exercises, Tai Chi, Wu Qin Xi, table tennis, sword dancing and other projects, and persist in it, which can enhance physical fitness and improve the body's ability to function. Disease resistance. Starting from summer, insist on washing your face and nose with cold water to increase your cold tolerance. When it is cold or the weather changes drastically, you should avoid catching a cold to prevent colds, and wear a mask when going out. Try to find out the causative factors and prevent and treat them in time.

2. Do not blow your nose forcefully when you have a stuffy nose to avoid causing nasal capillary rupture and causing nosebleeds. It also prevents bacterial mucus from backflowing into the nasopharynx and causing otitis media.

3. Using self-nasal massage technique, use the index and middle fingers of both hands to massage the inner corners of the eyes and the bridge of the nose at the same time, 1 time from top to bottom, 80 times maximum; use the middle finger to massage on both sides of the nose for about 1 Centimeters, make a rotating massage, massage 70 times; massage the center of the eyebrows with the index, middle and ring fingers of both hands at the same time, then massage outward along the eyebrows to the temples on both sides, massage 60 times. Massage can be repeated, once in the morning, noon and night. It can effectively prevent the occurrence of rhinitis and improve the condition of chronic rhinitis.

4. Wash the scabs in the nasal cavity with warm water, then dip a cotton swab in raw honey and apply it to the affected area of ??the nasal cavity, once a day, until the nasal cavity is free of pain and itching, no secretions are scabbed, and the sense of smell is restored.

5. The diet should be easy to digest and absorb. Avoid eating raw or cold foods, tobacco, alcohol, and pungent and irritating foods.

6. Actively and thoroughly treat acute rhinitis.

Chronic rhinitis is a common disease, with symptoms such as nasal congestion and runny nose. If your nose is blocked, breathe through your mouth. The door to your respiratory tract will be open, making it easy to contract diseases. Therefore, chronic rhinitis should also be taken seriously and actively treated.

Chronic rhinitis gradually evolves due to repeated attacks of acute rhinitis and improper treatment.

People with local lesions such as deviated nasal septum, turbinate hypertrophy, nasal polyps, and chronic lesions in adjacent organs, such as chronic tonsillitis and sinusitis, are prone to chronic rhinitis. In addition, people who work in dusty, high-temperature, dry environments for a long time, or are exposed to harmful gases for a long time, as well as people who lack exercise, have poor adaptability to climate change, and are prone to colds and colds, are prone to chronic rhinitis.

There are also patients suffering from certain chronic diseases, such as heart disease, liver disease, tuberculosis, kidney disease, severe anemia, vitamin deficiency, etc. Because the nasal mucosa is often in a state of congestion or malnutrition, it is also easy to Combined with chronic rhinitis.

Chronic rhinitis usually includes chronic simple rhinitis and chronic hypertrophic rhinitis.

The most obvious symptoms of chronic simple rhinitis are nasal congestion and increased nasal discharge, which are often accompanied by olfactory impairment and headache. Nasal congestion is mostly intermittent and alternating on both sides. The symptoms of chronic hypertrophic rhinitis are more severe than those of simple rhinitis. Nasal obstruction is often persistent and the sense of smell is significantly reduced. The thickening of the posterior end of the inferior turbinate can compress the pharyngeal opening of the Eustachian tube, causing tinnitus and hearing loss. Due to frequent mouth breathing and irritation from secretions, throat inflammation is prone to occur, with symptoms such as dryness and coughing. In addition, headache, insomnia, memory loss, listlessness, etc. are also common symptoms.

To treat chronic rhinitis, we should first find out the relevant pathogenic factors in the whole body, local area and environment, and treat or eliminate them in time. Local vasoconstrictors, such as 0.5-1% ephedrine saline, can be used for intranasal instillation, or short-term intranasal instillation of Noshinjing can be used. Acupuncture therapy can be performed on acupoints such as Yingxiang and Hegu. For sealing therapy, 0.25% to 0.5% procaine can be used to seal the above-mentioned acupoints, or it can be used to seal the nasal mound or the front end of the inferior turbinate within the mucosa. If the secretion is too thick and difficult to remove, you can rinse the nasal cavity with warm salt water. For patients with inferior turbinate hypertrophy who cannot be treated with topical medication, cryotherapy or carbon dioxide laser vaporization treatment can be used. If it is still ineffective, partial resection of the middle and inferior turbinates may be considered.

To prevent chronic rhinitis, you need to exercise and enhance the body’s defense capabilities. At the same time, you should pay attention to diet and environmental hygiene, quit smoking and alcohol, treat systemic diseases, correct nasal deformities, and remove lesions near the nasal cavity. Some drugs, such as reserpine and estrogen-containing contraceptive pills, can cause congestion of the nasal mucosa, so other drugs should be used instead.

During treatment, do not abuse nasal vasoconstrictors. Generally, the drug should be dropped 2 to 3 times a day. The principle is to use it as little as possible, especially for young children. If used in large quantities for a long time, it can cause drug-induced rhinitis. Once this occurs, the drug should be stopped immediately and switched to normal saline nasal drops, or 25% hydrocortisone acetate nasal drops. The condition is expected to gradually alleviate.

What is the concept and cause of chronic rhinitis?

Chronic rhinitis refers to inflammation under the nasal mucosa that lasts for more than several months, or the inflammation recurs and does not return to normal within an interval. , and there are no obvious pathogenic microorganism infections. Clinically, chronic rhinitis is divided into two types: chronic simple rhinitis and chronic hypertrophic rhinitis. However, the two types cannot be completely separated histologically. There are often transitional types, and chronic hypertrophic rhinitis mostly develops from chronic simple rhinitis. .

The exact cause of chronic rhinitis is unknown, but it is related to the following factors:

1. Local factors

(1) Acute rhinitis recurs or is not completely treated ;

(2) Long-term effects of chronic nasal cavity and sinus diseases: For example, in patients with chronic suppurative sinusitis, the nasal mucosa is irritated by pus for a long time; severe nasal septum deviation hinders nasal ventilation and drainage, causing the nasal mucosa to deteriorate. It is prone to recurring infections and difficult to completely recover;

(3) The influence of adjacent lesions: mainly inflammatory lesions, such as chronic tonsillitis, adenoid hypertrophy, etc.;

(4) Improper or prolonged use of nasal medications: long-term use of nasal drops or ephedrine can cause dilation of blood vessels, swelling of mucous membranes, and drug-induced rhinitis; lidocaine and dicaine can damage the mucociliary transport function of the nasal mucosa.

2. Systemic factors

(1) Systemic chronic diseases: such as anemia, diabetes, rheumatism, tuberculosis, heart, liver, kidney disease, autonomic nerve dysfunction and chronic constipation, etc. All can cause long-term blood stasis or reflex congestion in the nasal mucosa blood vessels;

(2) Malnutrition: such as lack of vitamin A and vitamin C;

(3) Endocrine disorders: such as Hypothyroidism can cause edema of the nasal mucosa; physiological congestion and swelling of the nasal mucosa often occur during pregnancy and lactation;

(4) Such as tobacco and alcohol addiction

3. Occupation and environment Factors: long-term or repeated inhalation of dust (such as cement, coal dust, flour, etc.) or harmful chemical gases (such as SO2, formaldehyde, etc.), rapid changes in temperature and humidity in living or production environments (such as steelmaking, baking, melting, and freezing operations) ) can lead to the occurrence of this disease.

4. The occurrence of this disease is also related to individual immune dysfunction and allergic reactions.

What are the main symptoms and signs of chronic simple rhinitis?

The most obvious symptoms of chronic simple rhinitis are nasal congestion and increased nasal discharge. Olfactory disorders and headaches are also common. Nasal congestion is mostly intermittent and alternating, sometimes continuous, and is heavier on the lower side when lying on the side.

Nasal congestion is often relieved after exercise or in fresh air, and worsened when sitting quietly reading, doing calculations or performing manual operations. Severe nasal congestion can lead to obliterative nasal sounds, loss of smell and headaches, and sometimes causes inability to concentrate for a long time and insomnia. The secretion increases, usually in the form of thick translucent mucus, sometimes accompanied by a little pus. Long-term nasal mucus irritation of the nasal vestibule and upper lip skin can cause nasal vestibulitis, eczema or folliculitis, which is more common in children. Mucus flowing backward into the throat can cause nasopharyngitis and otitis media. Patients may experience suction expectoration and hearing loss.

Examination showed swelling of the inferior turbinates on both sides, with a smooth, moist surface and dark red color. The elderly, frail, anemic, and hypothyroid patients will only see swelling but no congestion. The mucosa of the inferior turbinate is soft and elastic, and appears depressed when touched with a probe. It can immediately return to its original shape after the probe is removed. It is difficult to see the entire nasal cavity due to swelling of the mucous membrane. Only thick secretions can be seen attached between the inferior turbinate, nasal septum and nasal base. The nasal mucosa responds well to vasoconstrictors.

Chronic simple rhinitis is bilateral, without ulcers, granulation, necrosis, foul odor, paroxysmal sneezing or watery secretions, and can be distinguished from other rhinitis. The prognosis is generally good and with appropriate treatment the disease can recover and the nasal mucosa can return to normal. However, if the causative factors are not removed or treated improperly, the disease can also evolve into hypertrophic rhinitis.

How should chronic simple rhinitis be treated?

The treatment principle of chronic simple rhinitis is to eradicate the cause and restore the nasal ventilation function. The following treatment measures can be mainly taken.

(1) Treatment according to the cause: Carefully find out the systemic or local cause of the disease, and provide timely treatment. At the same time, attention must be paid to protecting the environment, improving working conditions, strengthening physical exercise, strengthening physical fitness, and improving the body's resistance. force.

(2) Local treatment:

① For those with thick nasal secretions, 9% saline can be used to flush the nasal cavity to avoid infection due to long-term accumulation of secretions.

② Use vasoconstrictor nasal drops: usually 0.5% to 1% ephedrine saline can be used, or nasal drops can be used, but it can cause drug-induced rhinitis and aggravate nasal congestion, so it must be considered.

③ Blocking therapy: 0.25% to 0.5% procaine can be used to seal the Yingxiang and Bitong acupoints, or submucosal injection can be done into the nasal embankment or the front end of the inferior turbinate, 1 to 1.5ml each time. Once every other day, 5 times constitute a course of treatment.

(3) Syndrome differentiation and treatment with traditional Chinese medicine: Traditional Chinese medicine calls this disease "nasal suffocation" and believes that the condition is caused by heat accumulation in the lung meridian and deficiency of lung-spleen and spleen. The syndrome and treatment are as follows: ① The syndrome of accumulation of heat in the lung meridian: nasal congestion may be mild or severe, or alternately blocked, yellow and sticky mucus, small amount, hot nasal air, turbinate swelling, good contraction reaction, yellow sticky mucus in the nasal passages; tongue Red coating and yellow pulse. Treatment should be to clear away lung heat, activate blood circulation and clear the orifices. Recipe: Scutellaria baicalensis decoction combined with Xanthium seed powder and flavored: 30g Scutellaria baicalensis, 10g Atractylodes macrocephala, 15g Morus alba, 15g Gardenia, 12g Forsythia, 10g light tempeh, 15g red peony root, 10g Platycodon 10g, 10g mint, 12g Schizonepeta, 15g Xinyi , Angelica dahurica 15g, Digupi 15g, licorice 3g. Decoction in water and take orally. ②Syndrome of lung and spleen deficiency: nasal congestion may be mild or severe or occur alternately, and runny nose may be white and sticky, or may be thin, aggravated by wind and cold. Examination shows that the nasal mucosa is pale white or reddish and swollen, the turbinates are enlarged, and the sense of smell is reduced. It may be accompanied by dizziness, bad wind, and easy to catch a cold; the tongue is pale with white coating and the pulse is thin. The treatment is suitable for replenishing the lungs and spleen, dispersing cold and clearing the orifices. Addition and subtraction of Buzhong Yiqi Decoction and Xanthium Seed Powder: Astragalus 30g, Codonopsis pilosula 15g, Atractylodes 12g, Danggui 12g, Bupleurum 10g, Cimicifuga 10g, Tangerine Peel 12g, Poria 20g, Guizhi 10g, Xanthium Seed 10g, Xinyi 10g, Angelica dahurica 20g, Mint 12g, Platycodon 10g, Licorice 6g. Decoction in water and take orally. Topical Biyanling nasal drops (see question 108), 2 drops each time, 3 times a day. You can also use 50g of goose grass, 6g of camphor, ground into fine flour, sealed in a bottle, wrapped in cotton wool to plug the nose, and change the dressing once a day.

(4) Acupuncture: Use Yingxiang, Hegu, and Shangxing points; for headaches, use Fengchi, Taiyang, and Yintang, moderate stimulation, and leave the needle for 15 minutes, once a day or every other day.

What are the clinical manifestations and treatments of chronic hypertrophic rhinitis?

Chronic hypertrophic rhinitis is a nasal cavity characterized by localized or diffuse hypertrophy of the mucosa, submucosa and even bone. Chronic inflammation. The nasal mucosa suffers from long-term congestion and edema, followed by fibrous tissue hyperplasia, mucosal hypertrophy, and sometimes periosteum proliferation, and substantial turbinate bone hyperplasia.

Generally, the inferior turbinate is the heaviest. The anterior, posterior and lower edges of the inferior turbinate, as well as the anterior end of the middle turbinate, may be nodular or mulberry-shaped hypertrophy or polypoid.

The clinical manifestations of chronic hypertrophic rhinitis are: severe nasal obstruction, mostly persistent, obliterative nasal sound, and decreased sense of smell. There is not much nasal discharge, which is mucus and mucopurulent. If the posterior end of the hypertrophic inferior turbinate compresses the pharyngeal opening of the Eustachian tube, tinnitus and hearing loss may occur. Due to mouth breathing and long-term irritation from secretions, chronic pharyngitis, headache, dizziness, insomnia, dreaminess, and listlessness are prone to occur. Examination revealed hypertrophy of the mucous membrane and turbinate bones, uneven nasal mucosa surface, nodular or mulberry shape, pale, light red or purplish red color. It feels firm to palpation, and no depression appears when pressed. Or although it is dented, it is not easy to recover immediately. With ephedrine, the mucosa does not shrink or shrinks very little.

For the treatment of chronic hypertrophic rhinitis, in addition to treating the cause, the following methods should be used to reduce the size of the turbinates and relieve symptoms such as nasal congestion.

(1) Inferior turbinate submucosal sclerotherapy injection.

Suitable for early stage hypertrophic rhinitis. Commonly used drugs include 80% glycerol or 20% sulfathiazonat, or 50% glucose solution, or 5% cod liver oleate sodium. After topical anesthesia, insert the injection needle into the submucosal membrane from the front end of the inferior turbinate back to close to the back end of the inferior turbinate. Then slowly withdraw the needle and inject the sclerosing agent while withdrawing the needle. The injection volume is about 1 ml. The injection can be repeated after 2 to 10 days depending on the contraction of the inferior turbinate. Generally, 3 times constitute a course of treatment.

Attention should be paid when injecting sclerosing agent: ① The thickness of the injection needle should be appropriate. If it is too thick, it will easily cause bleeding. If it is too thin, it will be difficult to inject oil medicine. If there is blood during injection, the injection site should be changed. ② The amount of injection should not be too much at one time, so as to make the mucosa white to avoid causing mucosal necrosis. ③ If a systemic reaction occurs during injection, the injection should be stopped immediately and the patient should lie down with his head slightly lowered. ④ To prevent blindness or visual impairment caused by retinal artery spasm, rapid vasodilators such as amyl nitrite should be prepared.

(2) Inferior turbinate submucosal electrocoagulation: Use high-frequency current to coagulate hypertrophic tissue and cause scar contraction. After topical anesthesia, use a fine needle to pierce the mucosa several times at the front end of the inferior turbinate, from front to back to the back end of the inferior turbinate without touching the bone, and then withdraw the needle while solidifying.

(3) Cryotherapy: Place the head end of the hyperbaric oxygen freezer (-50℃~-60℃) on the thick part of the inferior turbinate for about 2 minutes; if a liquid nitrogen freezer is used, the temperature can If it drops lower, the time should be shortened accordingly. Pay attention to complications such as pain, swelling, adhesions, etc. when freezing.

(4) Simple inferior turbinate mucosal resection: The patient takes a sitting or semi-recumbent position, uses 1% dicaine for nasal surface anesthesia, and injects 1% containing a small amount of 1‰ epinephrine under the inferior turbinate mucosa. Lidocaine 1~2ml, use turbinate scissors to remove the diseased mucosa of the inferior turbinate according to the predetermined range. Remove the resected hyperplastic tissue, use epinephrine cotton pads to stop bleeding, and then fill the nasal cavity with Vaseline gauze strips.

(5) Resection of hypertrophic mucosa together with bone: The method is roughly the same as the resection of simple mucosal lesions, except that part of the turbinate bone is removed.

In principle, the scope of resection should not exceed 1/3 of the inferior turbinate. If too much is resected, secondary atrophic rhinitis may occur. When performing partial resection of the inferior turbinate, attention should be paid to the contraindications: ① Acute inflammation of the upper respiratory tract; ② People with bleeding diseases or hemorrhagic diathesis; ③ Menstrual period; ④ People with hypertension, heart disease, liver cirrhosis, chronic nephritis, etc. Those with serious systemic diseases.

Traditional Chinese medicine believes that this disease belongs to the category of "nasal suffocation". Its pathogenesis is mostly related to long-term retention of evil poisons and qi stagnation and blood stasis. Symptoms include swelling and hypertrophy of the turbinate, hard and dark color, or mulberry-like or nodular shape, continuous aggravation of nasal congestion, yellow and thick or white sticky mucus, decreased sense of smell, poor speech, cough with phlegm, tinnitus and deafness; tongue texture Red with ecchymoses, stringy and thin pulse. Treatment should be to harmonize Qi and blood, promote stagnation and remove blood stasis. Recipe: Xuefu Zhuyu Decoction: 12g Angelica sinensis, 15g red peony root, 15g raw rehmannia glutinosa, 15g chuanxiong rhizome, 10g peach kernel, 10g safflower, 10g bupleurum, 10g platycodon, 10g aurantium, 10g magnolia, 15g curcuma, 15g turtle shell. , Patchouli 12g. Decoction in water and take orally. External rhinyanling nasal drops are used for long-term nasal drip. Compound Salvia Injection or Angelicae Injection can also be used for submucosal injection into the inferior turbinate. After conventional topical anesthesia, take 2ml of Angelicae Injection and inject into the inferior turbinate once every 2 days, 3 times as a course of treatment.

Why does chronic hypertrophic rhinitis cause hearing loss?

From an anatomical point of view, the nose and ears are connected through the Eustachian tube. The pharyngeal opening of the Eustachian tube is located on the lateral wall of the nasopharynx, about 1 to 1.5 cm from the posterior end of the inferior turbinate. Therefore, swelling or hypertrophy of the inferior turbinate often causes nasal congestion, which in turn affects Eustachian tube ventilation and drainage, leading to ear symptoms such as tinnitus and hearing loss.

Under normal circumstances, the Eustachian tube has the function of adjusting the air pressure in the middle ear through the opening and closing of the lumen of its cartilage segment to basically maintain a balance with the external atmospheric pressure. At the same time, through the ciliary movement of the Eustachian tube mucosa, secretions can be discharged from the middle ear to the nasopharynx, thereby draining the middle ear.

When chronic hypertrophic rhinitis causes turbinate hypertrophy, the pharyngeal opening of the Eustachian tube is blocked, and external air cannot enter the middle ear. The original gas in the middle ear is gradually absorbed by the mucosa, forming a negative pressure in the cavity, and the middle ear The mucous membrane swells, capillary permeability increases, and a series of pathological changes occur in the middle ear mucosa. Goblet cells increase and secretion increases, forming tympanic effusion, which hinders the conduction of sound waves and causes gradual hearing loss.

So, chronic hypertrophic rhinitis can cause hearing loss.

Chronic rhinitis

Chronic rhinitis is a chronic inflammation of the nasal mucosa and submucosa. Chronic congestion and swelling of the nasal mucosa is called chronic simple rhinitis. If it develops into hyperplasia and hypertrophy of the nasal mucosa and turbinate bones, it is called chronic hypertrophic rhinitis. The main causes include acute rhinitis that evolves into chronic rhinitis due to repeated attacks or incomplete treatment, long-term irritation or deformity caused by adjacent chronic inflammation such as sinusitis, tonsillitis, and drug-induced rhinitis caused by improper nasal medication (common after long-term use of nasal drops). etc. In addition, systemic causes such as long-term chronic diseases, lack of vitamin A or C, excessive smoking and alcohol, long-term use of antihypertensive drugs such as reserpine and environmental pollution can cause this disease. The main symptoms include nasal congestion and excessive nasal discharge. Hypertrophic rhinitis can manifest as persistent nasal congestion, and simple rhinitis can manifest as intermittent nasal congestion.

Medical guide:

1. Pay attention to self-treatment and health care according to the cause of your disease.

2. To solve the problem of nasal congestion, you can use 1% ephedrine or nitrofuracillin ephedrine solution or chloramphenicol ephedrine solution for nasal drops, 3 times a day.

3. 0.25~0.5% procaine can be used for nasal hillock sealing or inferior turbinate submucosal sealing, 1~1.5ml each time, once every other day, or twice a week, 5 times a day. Treatment course.

4. When nasal congestion is severe, sclerosing agent can be used for inferior turbinate injection treatment, or laser microwave coagulation treatment can be used. Microwave and laser treatments are commonly used clinically.

5. Surgical therapy, mainly for bony hypertrophic rhinitis, partial resection of the inferior turbinate can be performed.

6. Intranasal drip method: The patient lies on the bed. Place your head on the edge of the bed and hang down, at a 90-degree angle to the body, and drip it into the nose, 2-3 drops on each side, and wait for about 3 minutes before getting up. This can prevent the medicine in the nasal cavity from entering the pharynx. This method should not be used by the elderly.

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