Doctors explained the dangers of a common runny nose: difficulty breathing, sinusitis and apnea

Rhinitis

The most common diseases of the upper respiratory tract are rhinitis, sinusitis and inflammation of the adenoids. Any season of rising incidence of acute respiratory infections becomes a time of exacerbation. After all, local immunity (and it is no coincidence that the nose is called the entry gate of infection) reacts sharply to a high viral load.

Rhinitis, sinusitis, hypertrophy or inflammation of the pharyngeal tonsil (adenoiditis) are diagnosed today in every second child. Up to 10 million people in Russia today suffer from rhinitis or diseases of the paranasal sinuses (sinusitis), which seriously reduce the quality of life. And in about 12% of the population, rhinitis became chronic.

As the chief pediatric otorhinolaryngologist of the North-Western Administrative District of Moscow, Daria Kharina, says, difficulty in nasal breathing is a very acute problem today: “Rhinitis is a disease that has been well studied, but the question of whether to treat it or not and if treated, then how, does not lose its relevance. There are two camps of parents: some believe that it will go away on its own, while others believe that it needs to be treated, and as aggressively as possible, and they take everything that grows on windowsills and lies in refrigerators. Some begin to treat a runny nose immediately with antibiotics. But both approaches have consequences. Therefore, we need a golden mean.”

In the nasal cavity, the specialist says, there are ciliated cells that filter viruses and bacteria, and cells that produce mucus with immunological cells, which does not allow viruses (bacteria) to attach. It is most difficult for pathogenic agents to break into the body if the air temperature is 28–33 degrees under normal pH conditions. When rinsing the nose (especially with soap), the barrier is broken. Dry indoor air contributes to the accumulation of mucus. Low ambient temperature, insufficient air humidification, poor immunity, and the presence of chronic diseases – all this creates conditions for the proliferation of viruses and bacteria. Redness, soreness and swelling are the first symptoms of rhinitis. Then discomfort, dryness, a runny nose, and then a thick runny nose appear.

Daria Kharina gives some tips on how to behave during a runny nose.

It is necessary to ensure air humidification outside and on the mucous membrane (isotonic solutions of sea water, which need to be used to cleanse the nasal cavity, can handle this).

For swelling, you can use symptomatic medications, vasoconstrictor drops in doses. If a person uses drops frequently and for a long time, an addiction syndrome may develop, which can lead to atrophy of the mucosa. However, it is also impossible to completely abandon drops for edema: this can lead to swelling of the auditory tube, otitis media, rhinosinusitis, inflammation of the pharynx, tonsils, and pharyngitis. Immunological drugs are used only under the supervision of a physician.

Herbal preparations can be used, but they have limitations (they often cause allergic reactions). “It turned out that homeopathy works well. There are complex drugs that act on all parts of the pathological process, and for a runny nose they can be safely used by children as young as one and a half years old. This therapy reduces the need for vasoconstrictors and helps relieve symptoms of rhinitis,” continues the expert.

If a bacterial infection develops against the background of a runny nose, antibiotics are needed (only a doctor prescribes them). “I remind you that viral infections cannot be treated with antibiotics. The need for them is determined by the doctor, but it is important not to bring it to this stage,” says Daria Kharina.

Adenoiditis – size does not matter

Adenoids are a proliferation of lymphoid tissue of the pharyngeal tonsil, which is located in the vault of the nasopharynx. It is quite difficult to see adenoids during a routine ENT examination; this will require a special examination using a mirror or, more often, endoscopy, x-rays, and in some cases MRI or CT. The method is determined by a specialist.

“Any child should have adenoids,” says Elena Radzig, MD, professor, pediatric otorhinolaryngologist. – At a certain age, especially in preschoolers, they exist and can be of different sizes. Moreover, even if these are third-degree adenoids, for many children they do not cause problems, since they do not interfere with breathing through the nose and playing sports. On the other hand, even small adenoids can create problems when inflamed.”

Adenoiditis (acute or chronic) affects up to 70% of frequently ill children with respiratory diseases. And adenotomy (surgery to remove the adenoids) is the most common planned pediatric operation. And it also has consequences. For example, if it is performed on a child under 7 years of age, it is highly likely to lead to weight gain. But adenoiditis is not always a childhood problem; in recent years, it has been increasingly diagnosed in adults. “The reasons are chronic infections, allergic rhinitis, ordinary rhinitis, air pollution,” says general practitioner Irina Nikulina.

Unfortunately, there are still specialists who tell parents to cut to hell without waiting for peritonitis. And yet most doctors are in no hurry on this issue. First, conservative treatment of adenoiditis is prescribed. But there are not many therapeutic options. “Often steroids are poured into children’s noses. But now our capabilities are wider, there are more quality medicines, and they are available at any pharmacy. In addition, gymnastics for nasal breathing works well. It is important to support the child’s nose breathing skills: some children breathe through their mouths, imitating others.”

“The role of adenoids in immunity and the effect of their removal on the immune system is a constant subject of research and concern for parents,” says allergist-immunologist, pediatrician, expert of the ANO “Culture of Health” Natalya Lozko.

Adenoiditis can result in very serious complications: from serious difficulty in nasal breathing, hearing loss, sleep problems, sleep apnea and fatigue to loss of concentration and even problems with the formation of the facial skeleton (bite). Another problem that adenoid hypertrophy entails: in most cases, the disease is associated with nasal breathing disorders. “Sports with adenoiditis lead to increased fatigue and become a test for the cardiovascular system,” continues Irina Nikulina. – At the same time, muscle mass gain slows down. And very often today, for adenoiditis, analgesics, antibiotics and, ultimately, surgery are prescribed.”

Sometimes even after adenotomy, children continue to get sick often, and hearing, like breathing through the nose, is not always successfully restored. Why is the problem often not resolved after surgery? Unfortunately, in some children, lymphoid tissue begins to re-grow. Dr. Radzig gives the example of his young patient who underwent 7 adenotomies. In addition, after surgery, breathing may not be restored due to allergic rhinitis. It is, of course, worth considering that the operation is beneficial in a number of cases, for example in the case of chronic inflammation of the middle ear or pathological proliferation of the adenoids. By the way, in the indications for adenotomy there is no word “size” at all: the general condition of the patient is taken into account.

But research also suggests that adenotomy is not always effective in simpler cases – with recurrent acute respiratory infections without complications and more serious pathologies. However, the decision to undergo surgery should always be made by a specialist only after a thorough diagnosis.

Doctors note that complications and surgical intervention can be avoided if timely treatment is carried out with complex conservative (drug) treatment regimens. Doctors have developed a new ENT protocol for the treatment of adenoids, which provides for an integral approach to therapy and the use of various conservative techniques. “An open comparative observational study involving 154 children with symptoms of adenoiditis showed that the inclusion of a special protocol of homeopathic monomedicines in the standard treatment regimen for adenoiditis reduces the need for adenotomy by 66%. And this is twice as much as when using only standard therapy,” says Elena Radzig.

And adults too

If previously adenoids were considered a childhood problem, today adenoiditis is increasingly common in adolescents and even adults. Although adenoids should undergo reverse development (involution) by the age of 14–16 years, sometimes adenoid vegetations can bother adults, which is the cause of persistent difficulty breathing, snoring, sinusitis and apnea (holding your breath during sleep). “In 53% of cases, the cause is chronic infections of the ENT organs, in 30% – allergic rhinitis, as well as genetic predisposition, environmental conditions and smoking,” adds Daria Kharina.

“Children and adults with adenoids experience changes in the immune system,” says Natalya Lozko. – For example, the concentration of immunoglobulins decreases. And these are proteins that bind pathogens and prevent them from spreading. In addition, incomplete phagocytosis develops – thanks to this, microbes survive and can spread. The amount of lysocine, a defense protein against bacterial agents, also decreases. Removing the adenoids leads to disruption of the immune defense system.”

Experts note that a stereotype has formed in society: the population goes to the doctor for medicine, and if it is not prescribed, it means that the visit was in vain. Children have never received as many medications as are prescribed today in the entire history of mankind. Antiviral, antibacterial, for correcting immunity, antipyretics – this is the pool of drugs that are used today to treat ARVI. 80% of our children used antibiotics to treat colds by the age of three. And among children under three years of age, 96% (!) were given immunocorrective drugs. In recent years, a new trend has been noticeable in world medicine – the use of regulatory therapy drugs, which allows the body to mobilize to fight infections.

In the fight against a runny nose, of course, lifestyle is also important: regular walks in the fresh air, physical activity, proper nutrition. Today, conservative treatment of adenoiditis is widespread. We are talking about breathing exercises, regular rinsing of the nose with isotonic or hypertonic saline solutions. Additionally, lozenges can be used to relieve nasal congestion and reduce swelling. Patients may also be prescribed antibiotic therapy and mucolytic drugs to help reduce the severity of postnasal drip. Treatment of any health problem always requires special care and attention. Therefore, after consulting with a specialist, try to make a choice in favor of reducing risks to the body and using safe and at the same time effective treatment regimens.