Rhinorrhea

Rhinorrhea, rhinorrhoea, or informally runny nose is the free discharge of a thin mucus fluid from the nose;[1] it is a common condition. It is a common symptom of allergies (hay fever) or certain viral infections, such as the common cold or COVID-19. It can be a side effect of crying, exposure to cold temperatures, cocaine abuse,[2] or drug withdrawal, such as from methadone or other opioids.[3] Treatment for rhinorrhea is not usually undertaken, but there are a number of medical treatments and preventive techniques.

Rhinorrhea
Labeled cross section of the nasal cavities
SpecialtyOtorhinolaryngology

The term was coined in 1866 from the Greek rhino- ("of the nose") and -rhoia ("discharge" or "flow").[4]

Signs and symptoms
Rhinorrhea

Rhinorrhea is characterized by an excess amount of mucus produced by the mucous membranes that line the nasal cavities. The membranes create mucus faster than it can be processed, causing a backup of mucus in the nasal cavities. As the cavity fills up, it blocks off the air passageway, causing difficulty breathing through the nose. Air caught in nasal cavities, namely the sinus cavities, cannot be released and the resulting pressure may cause a headache or facial pain. If the sinus passage remains blocked, there is a chance that sinusitis may result.[5] If the mucus backs up through the Eustachian tube, it may result in ear pain or an ear infection. Excess mucus accumulating in the throat or back of the nose may cause a post-nasal drip, resulting in a sore throat or coughing.[5] Additional symptoms include sneezing, nosebleeds, and nasal discharge.[6]

Causes

The Mayo Clinic says that a runny nose can be caused by anything that irritates or inflames the nasal tissues, including infections such as the common cold and influenza, and allergies and various irritants. Some people have a chronically runny nose for no apparent reason (non-allergic rhinitis or vasomotor rhinitis). Less common causes include polyps, a foreign body, a tumor or migraine-like headaches. Causes listed (alphabetically) and discussed are: acute sinusitis (nasal and sinus infection), allergies, chronic sinusitis, Churg-Strauss syndrome, common cold, coronavirus disease 2019 (COVID-19), decongestant nasal spray overuse, deviated septum, dry air, granulomatosis with polyangiitis (Wegener's granulomatosis), hormonal changes, influenza (flu), lodged object, medicines (such as those used to treat high blood pressure, erectile dysfunction, depression, seizures and other conditions), nasal polyps, non-allergic rhinitis (chronic congestion or sneezing not related to allergies), occupational asthma, pregnancy, respiratory syncytial virus (RSV), spinal fluid leak, and tobacco smoke.[7]

Cold temperatures

Rhinorrhea is especially common in cold weather. Cold-induced rhinorrhea occurs due to a combination of thermodynamics and the body's natural reactions to cold weather stimuli. One of the purposes of nasal mucus is to warm inhaled air to body temperature as it enters the body; this requires the nasal cavities to be constantly coated with liquid mucus. In cold weather the mucus lining nasal passages tends to dry out, do that mucous membranes must work harder, producing more mucus to keep the cavity lined. As a result, the nasal cavity can fill up with mucus. At the same time, when air is exhaled, water vapor in breath condenses as the warm air meets the colder outside temperature near the nostrils. This causes excess water to build up inside nasal cavities, spilling out through the nostrils.[8]

Infection

Rhinorrhea can be a symptom of other diseases, such as the common cold or influenza. During these infections, the nasal mucous membranes produce excess mucus, filling the nasal cavities. This is to prevent infection from spreading to the lungs and respiratory tract, where it could cause far worse damage.[9] It has also been suggested that rhinorrhea is a result of viral evolution whereby virus variants that increase nasal secretion are selected for.[10] Rhinorrhea caused by these infections usually occur on circadian rhythms.[11] Over the course of a viral infection, sinusitis (the inflammation of the nasal tissue) may occur, causing the mucous membranes to release more mucus. Acute sinusitis consists of the nasal passages swelling during a viral infection. Chronic sinusitis occurs when one or more nasal polyps appear. This can be caused by a deviated septum as well as a viral infection.[12]

Allergies
Pollen grains from a variety of common plants can cause an allergic reaction.

Rhinorrhea can also occur when individuals with allergies to certain substances, such as pollen, dust, latex, soy, shellfish, or animal dander, are exposed to these allergens. In people with sensitized immune systems, the inhalation of one of these substances triggers the production of the antibody immunoglobulin E (IgE), which binds to mast cells and basophils. IgE bound to mast cells are stimulated by pollen and dust, causing the release of inflammatory mediators such as histamine.[13] In turn, this causes, among other things, inflammation and swelling of the tissue of the nasal cavities as well as increased mucus production. Particulate matter in polluted air and chemicals such as chlorine and detergents, which can normally be tolerated, can make the condition considerably worse.

Crying

Rhinorrhea is also associated with shedding tears (lacrimation), whether from emotional events or from eye irritation. When excess tears are produced, the liquid drains through the inner corner of the eyelids, through the nasolacrimal duct, and into the nasal cavities. As more tears are shed, more liquid flows into the nasal cavities, both stimulating mucus production and hydrating any dry mucus already present in the nasal cavity. The buildup of fluid is usually resolved via mucus expulsion through the nostrils.[9]

Head trauma
Main article: Cerebrospinal fluid rhinorrhoea

Rhinorrhea can be caused by a head injury, a serious condition. A basilar skull fracture can result in a rupture of the barrier between the sinonasal cavity and the anterior cranial fossae or the middle cranial fossae. This can cause the nasal cavity to fill with cerebrospinal fluid (cerebrospinal fluid rhinorrhoea, CSF rhinorrhea), a condition that can lead to a number of serious complications, including death if not addressed properly.[14]

Other causes

Rhinorrhea can occur as a symptom of opioid withdrawal accompanied by lacrimation.[15] When it occurs due to exercise, it is described as exercise-induced rhinitis.[16][17][18] Other causes include cystic fibrosis, whooping cough, nasal tumors, hormonal changes, and cluster headaches. Due to changes in clinical practice, rhinorrhea is now reported as a frequent side effect of oxygen-intubation during colonoscopy procedures.[19] Rhinorrhea can also be the side effect of several genetic disorders, such as primary ciliary dyskinesia.[12]

Treatment

In most cases, treatment for rhinorrhea is not necessary since it will clear up on its own—especially if it is the symptom of an infection. For general cases nose-blowing can get rid of the mucus buildup. Though blowing may be a quick-fix solution, it would likely proliferate mucosal production in the sinuses, leading to frequent and higher mucus buildups in the nose. Alternatively, saline nasal sprays and vasoconstrictor nasal sprays may also be used, but may become counterproductive after several days of use, causing rhinitis medicamentosa.

In recurring cases, such as those due to allergies, there are medicinal treatments available. For cases caused by histamine buildup, several types of antihistamines can be obtained relatively cheaply from drugstores.

References
  1. Dorland's pocket medical dictionary. Elsevier. p. 660. ISBN 978-81-312-3501-0.
  2. Myon L, Delforge A, Raoul G, Ferri J (February 2010). "[Palatal necrosis due to cocaine abuse]". Rev Stomatol Chir Maxillofac (in French). 111 (1): 32–5. doi:10.1016/j.stomax.2009.01.009. PMID 20060991.
  3. Eileen Trigoboff; Kneisl, Carol Ren; Wilson, Holly Skodol (2004). Contemporary psychiatric-mental health nursing. Upper Saddle River, N.J: Pearson/Prentice Hall. p. 274. ISBN 978-0-13-041582-0.
  4. "Rhinorrhea". Online Etymology Dictionary. Retrieved 21 September 2011.
  5. "Nasal discharge". Medline Plus. United States National Library of Medicine, National Institutes of Health. Retrieved 1 November 2007.
  6. "Rhinorrhea Overview". FreeMd. Retrieved 21 September 2011.
  7. "Runny nose: causes". Mayo Clinic. 16 March 2021.
  8. "Why Does Cold Weather Cause Runny Noses?". NPR. Retrieved 22 September 2011.
  9. "Why Does My Nose Run?". Kids Health. Retrieved 22 September 2011.
  10. Vareille M, Kieninger E, Edwards MR, Regamey N (January 2011). "The airway epithelium: soldier in the fight against respiratory viruses". Clin. Microbiol. Rev. 24 (1): 210–29. doi:10.1128/CMR.00014-10. PMC 3021210. PMID 21233513.
  11. Smolensky MH, Reinberg A, Labrecque G (May 1995). "Twenty-four Hour Pattern in Symptom Intensity of Viral and Allergic Rhinitis: Treatment Implications". The Journal of Allergy and Clinical Immunology. 95 (5 Pt 2): 1084–96. doi:10.1016/s0091-6749(95)70212-1. PMC 7126948. PMID 7751526.
  12. "Rhinorrhea – Definition, Symptoms, Causes, Diagnosis and Treatment". Prime Health Channel. 30 August 2011. Retrieved 24 September 2011.
  13. Dipiro, J.T.; Talbert, R.L.; Yee, G.C. (2008). Pharmacotherapy: A Pathophysiologic Approach (7th ed.). New York, NY: The McGraw-Hill Companies, Inc. pp. 1565–1575. ISBN 978-0-07-147899-1.
  14. Welch; et al. (22 July 2011). "CSF Rhinorrhea". Medscape. Retrieved 22 September 2011.
  15. "Opioid Withdrawal Protocol" (PDF). Mental Health and Addiction Services. Retrieved 24 September 2011.
  16. Silvers, William S; Poole, Jill A (February 2006). "Exercise-induced rhinitis: a common disorder that adversely affects allergic and nonallergic athletes". Annals of Allergy, Asthma & Immunology. 96 (2): 334–40. doi:10.1016/S1081-1206(10)61244-6. PMID 16498856. Retrieved 21 August 2020.
  17. Hope, M. ten; Yao, L. (1 November 2018). "Exercise Induced Rhinitis: A Prevalent But Elusive Disease". Annals of Allergy, Asthma & Immunology. 121 (5). doi:10.1016/j.anai.2018.09.424. Retrieved 21 August 2020.
  18. Groves, Michael. "Non-Allergic Perennial Rhinitis: A Family of Disorders". bcm.edu. Baylor College of Medicine. Retrieved 21 August 2020.
  19. Li, Nai-Liang; Tseng, Shiang-Chung; Hsu, Che-Chang; Lai, Wei-Ju; Su, Hung-Chang; Cheng, Tsun-I; Chen, Wei-Chun; Peng, Wen-Ling (2011). "A Simple, Innovative Way to Reduce Rhinitis Symptoms After Sedation during Endoscopy". Canadian Journal of Gastroenterology. 25 (2): 68–72. ISSN 0835-7900. PMC 3043006.
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