Rhinorrhea [Neurosurgery Wiki]

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====== Rhinorrhea ====== 
Rhinorrhea or rhinorrhoea is a condition where the nasal cavity is filled with a significant amount of mucus fluid. The condition, commonly known as a "runny nose", occurs relatively frequently. Rhinorrhea is a common symptom of allergies or certain diseases, such as the common cold or hay fever. It can be a side effect of crying, exposure to cold temperatures, cocaine abuse or withdrawal, such as from opioids like methadone.e.

The term Rhinorrhea was coined in [[1866]] and is a combination of the Greek terms "rhino-" meaning "of the nose" and "-rhoia" meaning "discharge or flow".

===== Classification =====

Rhinorrhea Classification can be categorized based on its cause, duration, and characteristics of nasal discharge. Below is a comprehensive classification:

1. Based on Etiology
a. Infectious Rhinorrhea:
Caused by viral, bacterial, or fungal infections.
Common examples:
Viral rhinitis (e.g., common cold).
Bacterial sinusitis.
Fungal sinusitis (less common, e.g., in immunocompromised patients).
b. Non-Infectious Rhinorrhea:
Allergic Rhinorrhea:
Triggered by allergens like pollen, dust mites, or animal dander.
Often associated with sneezing, itching, and nasal congestion.
Non-Allergic, Non-Infectious Rhinorrhea:
Vasomotor rhinitis: Triggered by irritants like smoke, weather changes, or strong odors.
Drug-induced rhinitis: Due to medications like nasal decongestant overuse (rhinitis medicamentosa) or certain antihypertensives (e.g., beta-blockers).
Hormonal rhinitis: Seen in pregnancy or hypothyroidism.
Cerebrospinal Fluid (CSF) Rhinorrhea:
Caused by a breach in the dura mater, leading to leakage of CSF into the nasal cavity.
Often occurs after trauma, surgery, or spontaneously.
Structural Abnormalities:
Nasal polyps or deviated septum causing chronic nasal discharge.
c. Trauma or Post-Surgical Rhinorrhea:
May result from nasal fractures, endoscopic sinus surgery, or skull base surgery.
d. Idiopathic Rhinorrhea:
No identifiable cause even after thorough evaluation.
2. Based on Duration
Acute Rhinorrhea:
Lasts less than 4 weeks.
Common in viral infections or acute allergic responses.
Chronic Rhinorrhea:
Persists for more than 12 weeks.
Often linked to chronic conditions like allergic rhinitis, chronic sinusitis, or structural abnormalities.
Recurrent Rhinorrhea:
Episodic, recurring symptoms with symptom-free intervals.
3. Based on Characteristics of Discharge
a. Clear, Watery Discharge:
Associated with:
Allergic rhinitis.
Vasomotor rhinitis.
CSF leak (may have salty taste).
Viral infections (initial phase).
b. Thick, Mucopurulent Discharge:
Suggestive of:
Bacterial sinusitis.
Advanced viral infections.
Fungal infections (especially in immunocompromised patients).
c. Bloody Discharge (Epistaxis-associated Rhinorrhea):
Seen with:
Trauma.
Neoplasms.
Vasculitis (e.g., granulomatosis with polyangiitis).
d. Unilateral Discharge:
Suggestive of:
Foreign body in children.
CSF leak.
Tumors or nasal polyps.
4. Based on Pathophysiology
a. Hypersecretion:
Due to overactive nasal glands, often in response to parasympathetic stimulation.
Seen in allergic or vasomotor rhinitis.
b. Reduced Clearance:
Impaired mucociliary clearance leads to accumulation of secretions.
Associated with conditions like cystic fibrosis or chronic sinusitis.
c. Leakage:
Loss of barrier integrity (e.g., CSF rhinorrhea due to trauma).
5. Special Subtypes
Honeymoon Rhinorrhea:
Triggered by autonomic activation during sexual activity or orgasm.
Cold-induced Rhinorrhea:
Occurs in response to cold temperatures (gustatory or vasomotor rhinitis).
Conclusion
Classifying rhinorrhea is essential for accurate diagnosis and treatment. A detailed history, clinical examination, and appropriate investigations (e.g., imaging, allergy testing, beta-trace test for CSF rhinorrhea) help identify the underlying cause and guide management.
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see [[Cerebrospinal fluid rhinorrhea]]