Introduction
A nasal mucosa inflammation occurs in most cases in the context of a cold and is also called rhinitis or colloquially rhinitis. This is generally used to describe an inflammation of the mucous membrane, which can be acute or chronic and is caused by an infection with pathogens, allergic reactions or so-called pseudoallergic mechanisms. The inflammation of the nasal mucosa is usually accompanied by a narrowing or obstruction of the upper respiratory tract. Frequently, there is nasal discharge on one or both sides, which can be mucusy (serous) to bloody. A common symptom of nasal mucosa inflammation is sneezing, a rapid, reflexive and involuntary expulsion of air through the nose triggered by the sneezing reflex, which removes nasal secretions including dust and other foreign bodies from the nose.
Anatomy of the nasal mucosa
The entire nasal cavity including the paranasal sinuses is equipped with the so-called nasal mucosa. This mucous membrane forms special cilia on the surface (multi-rowed ciliated epithelium), in which mucus-producing cells (goblet cells) are located, which ensure constant moistening of the nasal mucous membrane. The cilia move rhythmically in the direction of the nasopharyngeal space, which causes the excretion of dust particles, foreign bodies and pathogens. The nasal mucosa can become inflamed by various causes. Depending on its severity, a distinction is then made between acute nasal mucosa inflammation in the form of a rhinitis and chronic sinusitis, the so-called sinusitis.
Acute nasal mucosa inflammation
Acute nasal mucosa inflammation, commonly known as “common cold“, is mostly caused by viruses and is a harmless infection. There is a large variety of viruses that can cause such nasal mucosa inflammations, it is estimated that up to 200 different types of viruses can cause a “cold” of the upper respiratory tract. Typically, acute rhinitis is accompanied by a runny nose and nasal congestion due to swelling of the nasal mucosa.
As a rule, the inflammation of the nasal mucous membranes as part of a cold lasts about a week. It is currently impossible to develop a vaccination against acute rhinitis, as there are too many different viruses that can cause the disease. The treatment of acute sinusitis aims to relieve the symptoms and discomfort.
For example, nasal sprays or drops and inhalations of salt water vapour can temporarily clear the airway. The typical symptoms of an acute nasal mucosa inflammation are sneezing, itching, secretion of thick or thin nasal secretions (catarrh), burning pain due to the irritation of the nasal mucosa, and swelling of the nasal mucosa, which can hinder nasal breathing. The reason for your nasal mucosa inflammation can also be a foreign body.
Active ingredients such as tramazolin and xylometazolin can be used very effectively against the symptoms of nasal mucosa inflammation. These active ingredients lead to a reduction in swelling of the mucous membrane when they are introduced into the nose with the aid of a spray (e.g. Nasic®) or in drop form, thus clearing the airways for a certain period of time. The active ingredient oxymetazoline also has a second mechanism of action that prevents certain viruses (rhinoviruses) from penetrating the nasal mucosa.
In this way, the active ingredient Oxymetazoline can reduce the duration of an acute nasal mucosa inflammation by about one third of the time. However, the therapy duration of seven days should not be exceeded for any of the above-mentioned active ingredients in nasal spray or nasal drop form, as this can lead to drying of the nasal mucous membranes and increased blood flow to the blood vessels in the nose. This can lead to the development of a so-called medical cold (privinism), in which the nasal mucous membranes become accustomed to the cold and do not swell to a normal level without the active ingredients.
This medical rhinitis is caused by the fact that the active ingredients at certain receptors (alpha-adrenoreceptors) cause a narrowing of the blood vessels of the nasal mucosa and thus have a decongesting effect. If the active ingredients are used for a longer period of time (beyond a ten-day application), the number of these receptors in the blood vessels decreases. At these receptors, however, the body’s own messenger substance adrenaline naturally regulates the dilation and constriction of the vessels.Due to the reduction of the constrictive effect, the vasodilating influences now predominate without stimulation by the drug and the nasal mucosa swells.
The therapy of such a privinism usually consists of simply discontinuing the nasal spray. This causes the chronic swelling of the nasal mucous membrane to subside after some time. In some cases, an underlying problem still needs to be treated, which was the reason why the nasal spray was used at all.
For example, in the case of generally poor nasal breathing, surgery of the nasal septum can be performed to relieve the symptoms. During pregnancy and lactation, nasal sprays containing the above-mentioned active ingredients are only recommended after medical advice, as they can also act systemically in the body and are not limited to the nasal mucous membrane. For babies and small children, the active ingredients in dosages appropriate to their age, for example Nasic® Nasal Spray for Children, are usually well tolerated, but their use should be discussed with a doctor beforehand.
Inflammation of the nasal mucosa can be caused by allergies and is often accompanied by other respiratory diseases such as inflammation of the paranasal sinuses (sinusitis) and asthma. The onset of allergic rhinitis is usually in early childhood. A distinction is made between seasonal rhinitis (e.g.
hay fever), which only occurs in certain seasons, year-round allergic rhinitis of the nasal mucous membrane (e.g. house dust allergy) and occupational allergic rhinitis. Allergic rhinitis has many different causes. The tendency to get an allergy (allergic diathesis) is inherited.
One theory says that the increasing number of diseases is due to the increase in hygiene and the aggressiveness of allergens caused by pollutants. This theory is supported by the fact that children from the countryside, who have had much contact with animals and flowers, suffer less often from allergies than city children. An allergy arises (in simplified terms) when the body’s own defense system recognizes a foreign substance (allergen) as a supposed enemy on first contact and then tries to fight it with each new contact.
Redness, itching, sneezing and a runny nose are the typical symptoms caused by this reaction. The diagnosis of an allergic nasal mucosa inflammation can be made by means of a prick test. In this test, various solutions containing allergens are drizzled onto the skin of the person affected and the skin is scratched with a needle.
If there is hypersensitivity (sensitization) to one or more substances, this is indicated by a reddening of the skin with wheals. In small children, a blood test can also be performed to identify the allergen. The therapy of an allergic nasal mucosa inflammation consists of avoiding the allergen (maternity leave), drug therapy (treatment of the symptoms) and a specific immunotherapy to eliminate the allergic reaction in the long term.
In the case of animal hair, the elimination of the allergen can already be achieved by avoiding the animals. In the case of a house dust mite allergy, special covers and frequent cleaning and ventilation of the sleeping room often help. Pollen allergy sufferers are recommended to change their clothes and wash their hair after spending time outdoors.
A specific immunotherapy (hyposensitization) should be started as early as possible to achieve a permanent insensitivity to the allergy trigger. This therapy is usually carried out over three years and usually consists of a monthly injection of the allergen into the back of the upper arm. Consistent application over the entire therapy period results in a significant improvement of the symptoms.
Drugs with the active ingredient cromoglicic acid are applied locally in the nose, where they inhibit the release of inflammatory mediators such as histamine, which play an important role in the allergic reaction. However, the effect is delayed, so that these drugs must be applied one week before the first pollen flight. Another group of substances is the so-called antihistamines.
These active ingredients (e.g. levocabastine, loratadine, cetericine) also prevent the symptom-initiating effect of the messenger substance histamine. Antihistamines can be applied locally with nasal sprays or systemically as tablets. Older generations of this substance class had a tiring (sedative) effect, which is why modern antihistamines are preferable, especially for children, drivers, workers, etc.A very effective treatment of allergic nasal mucosa inflammation can be achieved with the help of topical glucocorticoids (cortisone, e.g. budenoside, fluticasone).
Glucocorticoids suppress the allergic reactions in the nose, especially the constipation (obstruction), which is hardly influenced by antihistamines, for example. Systemically acting cortisone can be useful at the beginning of treatment, but should only be given for a short time to avoid side effects (e.g. diabetes). These side effects are not to be feared with local treatment with cortisone. Nasal sprays with active substances that have a sympathomimetic effect will relieve the congestion of the nose, as they have a decongesting effect, but this does not reduce the other symptoms. They should only be used for a short time.
