Causes of chronic rhinitis
In principle, infections and the rhinitis that may be associated with them can become chronic or recur repeatedly in the case of a permanently weakened immune system (e.g. in the context of an HIV infection). In addition, there are many other different causes of chronic rhinitis, some of which have their own names. The allergic rhinitis (Rhinitis allergica) is particularly common.
This includes above all the so-called hay fever, which only occurs seasonally during the spring, summer and (depending on the region) autumn months and can be triggered by various grass and flower pollen. Many other allergens such as animal hair, house dust mites, molds, certain foods or occupational different working materials such as wood dust or hair dyes can also cause rhinitis, but it persists throughout the year (perennial). Similar to the allergic rhinitis is the vasomotoric rhinitis (Rhinitis vasomotorica), but with the difference that no allergy or other cause is detectable, which is why the term NARE syndrome (Non-Allergic Rhinits with Eosinophilia Syndrome) is also used in this context.
In this syndrome, a misregulation of blood vessels leads to an inflammation of the nasal mucosa, which can apparently be promoted by factors that promote blood circulation, such as extreme temperature changes, stress or alcohol. Various medications, such as the contraceptive pill, beta blockers or ACE inhibitors can also cause a cold (especially the drying and swelling of the nasal mucosa), but by far the most common is rhinitis medicamentosa caused by prolonged use (> 10 days) of decongestant nasal sprays. Due to a so-called rebound effect, the nasal mucosa swells automatically after the spray is discontinued, as the nasal mucosa has “accustomed” to the effect of the drug.
Rhinitis sicca, on the other hand, is a chronic rhinitis with particularly dry, thinned mucous membrane, which is triggered by mechanical or toxic effects (e.g. chronic cocaine consumption or certain toxic/irritating substances at the workplace). A further form is rhinitis atrophicans (ozaena or “stinky nose“), in which tissue shrinkage of the nasal mucosa favors germ colonization and thus leads to unpleasant odors, dehydration and bark formation.In addition to the hereditary form, there are other causes for such a disease, such as tumors of the nasopharynx, malformations of the nasal septum or surgical interventions. Sometimes, however, an increase in the volume of the lower and middle nasal conchae (rhinitis hypertrophica) or polyps developing on them are also the cause of chronic complaints.
Changes in hormonal balance, e.g. during pregnancy or hyperthyroidism, or systemic diseases such as Wegener’s granulomatosis or sarcoidosis are also conceivable causes. If the nasal secretions become mixed with blood during a cold, this is usually only a sign of severe irritation of the mucous membrane. Infections, allergies or other triggers of a cold can attack the mucous membrane in such a way that slight superficial bleeding occurs.
A dry nasal mucosa (e.g. due to dry room air) and mechanical stress such as a fall, the introduction of foreign bodies, “nose-picking” or frequent blowing have a beneficial effect, but high blood pressure and disorders of blood clotting also increase the risk. Long-term use of decongestant nasal sprays or chronic cocaine consumption can also damage the mucous membrane. In a few infectious diseases, a bloody nose is even a specific symptom in its own right. For example, congenital syphilis in children causes a bloody rhinitis, while diphtheria can cause a bloody, fluid rhinitis (Rhinitis pseudomembranacea), in which the mucous membrane is damaged by the formation of a pseudomembrane. Purulent blood discharge, especially in connection with obstructed nasal breathing, bad smell from the nose and other complaints, can also be an indication of a tumor of the nose or paranasal sinuses.
