Congestion is not mucus, but blood
The main misunderstanding around a runny nose is that congestion is equated with the amount of mucus. In fact, it is not she who is preventing her from breathing. In the inferior nasal concha there is a special tissue arranged like a sponge of small vascular cavities. When the vessels fill with blood, the concha swells and the lumen of the nasal passage narrows almost to zero - this is what is felt as congestion. In this case, there may be no mucus at all: the person says “the nose is clogged, but there is nothing to blow the nose,” and this is an accurate description of vascular edema. Understanding the mechanism immediately explains why vasoconstrictor drops work instantly: they cause the vessels to contract, the sponge collapses, and air passes through. And it also explains why these drops do not cure anything - the cause of the swelling remains in place.
The second thing you should know: the nose is normal and should not breathe symmetrically. There is a nasal cycle - alternating swelling of the mucous membrane, first on the right, then on the left, changing every few hours. One half works, the second rests and restores the mucous membrane. A healthy person does not notice this, because the total air flow is enough. But as soon as a slight swelling or deviated septum appears, the cycle becomes obvious: “first one nostril is blocked, then the other.” This is not a wandering infection or a sign of a tumor, but normal physiology that has become noticeable.
Different rhinitis is treated differently
The word "runny nose" conflates conditions with completely different mechanisms, and this is the main reason why hit-and-miss treatments don't work. Drops that help with one type of rhinitis are useless with another, and harmful with a third. Therefore, the doctor’s first question is not “what were you treated with,” but “how long ago, what provoked it, and what happened.”
- Acute infectious rhinitis - a common cold: sneezing and thin discharge, then thick, spontaneous recovery in about 7-10 days
- Allergic rhinitis - attacks of sneezing, watery discharge, itching in the nose and eyes, a clear connection with the season, dust, animals
- Vasomotor rhinitis - a reaction to cold, strong odor, spicy food, temperature changes; congestion prevails, no allergies during examination
- Drug-induced rhinitis is a consequence of long-term use of vasoconstrictor drops
- Chronic hypertrophic rhinitis - the shells have grown irreversibly, the spray no longer has an effect
- Atrophic rhinitis - the mucous membrane, on the contrary, is thinned and dry, crusts form, the nose is “free”, but breathing is uncomfortable
- Rhinitis in pregnant women - congestion due to hormonal changes, disappears after childbirth
A separate and very common situation is the so-called rhinitis with a deviated septum. Here the mucous membrane can be almost healthy, but a mechanical obstacle interferes with breathing. No amount of sprays will remove such an obstacle, and months of drops in this case are wasted time. A simple test helps differentiate between edema and anatomy: the doctor instills a vasoconstrictor and after a few minutes looks to see if breathing has resumed. If the nose starts to breathe, the problem is swelling of the mucous membrane and it can be treated therapeutically. If not, the obstacle is structural, and another solution is being discussed.
Dependence on vasoconstrictor drops: how it happens
This is the most important section for most readers, because a person gets drug-induced rhinitis not from the disease, but from the method of treating it. The mechanism looks like this. The vasoconstrictor substance causes the vessels of the conchae to contract, and after a minute the nose breathes freely. But as the drug stops working, the vessels dilate more than they were before instillation - so-called recoil edema occurs. The man is dripping again. After a few days, the receptors of the vascular wall lose sensitivity: the previous dose no longer lasts eight hours, but four, then two. There is a need to drip at night, take a bottle on the go, keep a spare one in your bag. At the same time, the mucous membrane itself suffers: blood supply is disrupted, eyelashes stop moving, glands work worse.
The time frame during which this develops is shorter than is commonly thought. The first signs of addiction appear after approximately 5-7 days of continuous use, and in sensitive people even earlier. After a few weeks, a full-fledged dependence is formed, and after months, an irreversible growth of shells occurs, in which stopping the drops is no longer enough. A separate problem is that the condition is not perceived as a disease: a person does not consider himself sick, he simply “uses the drops,” sometimes for ten or fifteen years in a row, and comes to the doctor only when the drops stop helping completely.
- Считайте дни. Пять дней — ориентир, семь — предел. Не «пока не пройдёт», а по календарю.
- Не капайте «профилактически» перед сном при свободном носе — так формируется привычка, а не лечение.
- Не увеличивайте дозу и не переходите на более концентрированный флакон при снижении эффекта: это прямой путь к зависимости.
- Одновременно с каплями с первого дня используйте промывание солевым раствором — оно уменьшает потребность в них.
- Если срок уже превышен, не отменяйте резко «на силе воли»: несколько бессонных ночей обычно заканчиваются возвратом к флакону.
- Выход of зависимости строится на замене: врач назначает топический гормональный спрей, который снимает отёк без привыкания, и постепенно убирает сосудосуживающее средство, часто по одной половине носа за раз.
- Срок отвыкания обычно составляет от двух недель до полутора-двух месяцев, в зависимости от стажа.
Allergic or vasomotor: what's the difference?
The two conditions are similar in appearance and are constantly confused, but are treated differently, so differentiating them is important. In allergic rhinitis, the immune system reacts to a specific substance - pollen, house dust mites, wool, mold. With vasomotor there is no allergy: the autonomic regulation of the nasal vessels is unbalanced, and they expand in response to nonspecific irritants.
- Allergic: attacks of repeated sneezing in a row, profuse watery discharge, itching in the nose, palate, eyes, lacrimation
- Allergic: a clear pattern - flowering season, cleaning, contact with animals, night on an old pillow
- Allergic: often combined with conjunctivitis, skin manifestations, and in some people with bronchial asthma
- Vasomotor: congestion, not sneezing, is in the foreground; there is usually no itching
- Vasomotor: provoke exposure to the cold, hot and spicy foods, strong odors, stuffiness, alcohol, stress
- Vasomotor: allergy examination is negative, there are no eosinophils in the nasal smear
- General: both last for months and years, both noticeably impair sleep and performance
The practical significance of this difference is great. In allergic rhinitis, the key role is played by reducing contact with the causative substance and basic therapy prescribed by the doctor, and in some cases, allergen-specific immunotherapy is also discussed - the only method that affects the reaction itself, and not the symptoms. For vasomotor rhinitis, antihistamines work poorly, but avoidance of provocateurs, air humidification, physical activity and, if ineffective, minimally invasive interventions on the lower turbinates help. Prescribing yourself antiallergic pills for vasomotor rhinitis is a typical mistake, because of which people conclude “nothing helps me.”
Rinse with saline solution: how to do it correctly
Nasal rinsing is the most underrated method for any rhinitis. It mechanically removes mucus, crusts, dust, pollen and some pathogens, moisturizes the mucous membrane and helps the epithelial cilia to work again. For allergic rhinitis, rinsing in the evening washes away the pollen that has settled during the day and makes the night much easier. In case of acute runny nose, it reduces the need for vasoconstrictor drops. It has virtually no side effects, but technique matters—improper rinsing can push fluid into the middle ear.
- Раствор должен быть тёплым, близким к температуре тела: холодный вызывает спазм и неприятные ощущения.
- Наклоните голову над раковиной вперёд и вбок, чтобы одна ноздря была выше другой; жидкость вливается в верхнюю и вытекает of нижней.
- Рот держите открытым и дышите через него — так мягкое нёбо перекрывает вход в носоглотку.
- Не глотайте и не разговаривайте во время процедуры.
- Не создавайте сильное давление: при использовании флакона или спринцовки нажим должен быть мягким.
- После промывания высмаркивайтесь без усилия и по одной ноздре, не зажимая обе сразу.
- Не выходите на холод сразу после процедуры — дайте 20-30 минут.
When it's no longer just a runny nose
A common cold causes a runny nose for 7-10 days with gradual improvement. Anything that stands out from this picture requires inspection. The most common complication is sinusitis, inflammation of the paranasal sinuses: it is manifested by pain and swelling in the forehead, cheeks or bridge of the nose, increased pain when bending forward, return of temperature after improvement and a prolonged course of more than ten days without positive dynamics.
- Examination by an ENT doctor with anterior rhinoscopy - basic stage
- Endoscopy of the nasal cavity - a thin endoscope allows you to see the posterior sections, sinus anastomosis, polyps, adenoids in a child; a regular inspection does not show them
- Computed tomography of the paranasal sinuses is the main method for suspected chronic sinusitis and before surgery; A survey image of the sinuses is much less informative
- Allergy testing - skin tests or blood tests for specific antibodies
- A smear from the nasal cavity for cellular composition - helps to suspect an allergic nature
- Assessment of nasal breathing and examination of the septum, if necessary, consultation on its correction
It is worth mentioning separately about a child’s chronic runny nose. A constantly open mouth, snoring during sleep, a nasal voice and frequent otitis media are most often not “weak immunity”, but enlarged adenoids, which are visible only during endoscopy. Another situation that parents should remember: a one-sided runny nose with an unpleasant odor in a child 2-5 years old is almost always a foreign body in the nose, and not an infection. Both can be resolved quickly if you see a doctor, rather than treating with drops for months.
