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.