Rhinitis- A major disease of the upper respiratory tract
Inflammation of the nasal mucosa is called rhinitis
. The most frequent cause is allergy to inhaled substances such as pollen, dust or hair. Sometimes ingested allergens may also lead to rhinitis. Sneezing, nasal obstruction, and watery nasal discharge are the early symptoms, Rhinitis may be a predominant symptom in coryza and other respiratory viral infections. Drugs like reserpine may cause troublesome nasal stuffiness and obstruction. Edema of the mucosa occurring in rhinitis may lead to obstruction and infection of the paranasal sinuses.
Treatment
Allergic rhinitis responds to antihistamines like diphenhydramine 25 mg orally like 1% ephedrine solution or xylometazoline 0.1% promptly relieve the obstruction. Continued use of nasal drops containing disodium cromoglycate may help to desensitize the nasal mucosa.
Epistaxis
Epistaxis is bleeding from the nose. The unsupported blood vessels over the anterior part of the nasal septum and anterior nares are the usual sites of bleeding and these can be identified by speculum examination. Epistaxis may result from local or systemic causes. Local causes include rhinitis, foreign bodies within the nose, sinusitis, nasal diphtheria, rhinosporidiosis, carcinoma or trauma. Several systemic infections such as typhoid, pertussis, malaria, influenza and rheumatic fever may have their onset with epistaxis. Other systemic diseases like hypertension and hemorrhagic disorders may give rise to epistaxis. In cirrhosis, liver with hepatic failure, spider naevi may develop in the nose and these may bleed.
Epistaxis frightens the patient though it is self-limiting in the majority. Treatment consists of sedation, rest in bed and packing the nose with gauze soaked in adrenaline solution. Local vasoconstriction arrests the bleeding. If bleeding tends to be recurrent, the bleeding spot can be cauterized. In all cases the underlying systemic disorders should receive prompt attention.
Pharyngitis
Pharyngitis is the commonest cause of simple "sore throat". It may be due to infective or other causes. Viral infections include coryza, influenza, adenovirus, herpes simplex, measles, rubella, chickenpox, Coxsackie and echoviruses. Bacterial pathogens such as streptococci, Staphylococci, Penumococci, H. Influenzae, C. diphtheriae, fusobacterium, gonococci and T. Pallidum and fungi such as Candida albicans may lead to pharyngitis. In agranulocytosis and acute leukemia, necrotic ulceration of the tonsils and pharynx may be the presenting symptom. Excessive smoking, noxious fumes, corrosive and unaccustomed spicy foods are common irritants. Pharyngitis may also be caused by allergy to inhaled or ingested allergens.
Clinical features
Pharyngitis gives rise to sore throat and dysphagia. The posterior and upper cervical lymph nodes may be enlarged and tender. Inspection reveals redness and edema over the pharynx and adjoining areas.
Treatment
In infective cases appropriate antimicrobial drugs are indicated. Most cases respond to penicillin. Rest, steam inhalation, and analgesics give rapid symptomatic improvement. Throat lozenges containing menthol or eucalyptus give considerable relief to the pain and discomfort.
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