The nasal mucosa is sensitive to changes in air temperature and humidity levels. Even such factors alone can cause slight congestion and discharge in the nose. Viruses are among the most common causes of runny nose in adults and children. These infections caused by viruses can also reduce normal nasal resistance to bacterial invasion and pave the way for the development of secondary bacterial infections. When a runny nose lasts longer than 1week, allergic rhinitis, structural anomalies (septum deviation, choanal atresia, adenotonsillar hypertrophy, etc.) and mucosal anomalies, cystic fibrosis come to mind. The infection in the nasal cavity is likely to reach the sinuses and lead to persistent sinusitis.
A unilateral purulent discharge is considered a foreign body until proven otherwise. In the nose and nasal sinuses, 1 litter of mucus is made per day, and most of it goes down to the stomach spontaneously through the nasopharynx. Slight changes in the airway in the nose and the realization of the passage of the patient's mucus through the nasopharynx are mistakenly considered chronic sinusitis. These symptoms are noticeable in the late stages of the common cold.
It should not be forgotten that oedema and breathing in the nasal mucosa, especially in the turbinate, sneezing, clear nasal discharge and itching can also be caused by many drugs such as birth control pills, vasomotor drugs, iodides, etc. Oral contraceptives can cause a runny nose by disrupting the vasomotor effect of oestrogen, and anti-inflammatory analgesic drugs such as aspirin disrupting prostaglandin metabolism and causing degranulation of mast cells.
In runny nose due to colds, dripping 0.9% NaCl into the nose may help decongestion. Nasal drops containing corticosteroids reduce discharge by shrinking nasal polyps. Nasal drops containing ephedrine can also relieve discharge by reducing nasal congestion. In addition to these drugs, topical xylometazoline, oxymetazoline, phenylephrine, indazoline benefit the patient in relieving symptoms. However, it should not be used together with monoamine oxidase inhibitor drugs. Non-allergenic aqueous nose discharge responds well to ipratropium bromide. In acute cases due to infections, menthol and eucalyptus vapor provide relief to the patient.
Bleeding from the nose, which is generally seen due to trauma or mucosal damage. The reason why the patient's nose bleeds should be well evaluated. Treatment differs accordingly. Bilateral bleeding is usually suggestive of a systemic disease, while unilateral bleeding is more due to an anatomical disorder. Blood thinners, anti-inflammatory and pain medications, various mucous membrane damage can lead to nosebleeds. Traumas such as nasal fracture, surgical intervention or nose picking in children are also among the causes of nosebleeds.
Determining the exact bleeding site is important in determining the appropriate approach. If the bleeding area is in the anterior part of the cartilage tissue separating the nose, it is sufficient to press lightly until the bleeding stops. However, if the patient has a systemic disease, there is bleeding from the back cartilage part of the nose and it is often seen in old age and is considered as a sign of hypertension or atherosclerosis. Diffuse bleeding should be considered to be due to a systemic disease until proven otherwise. In this case, it is a strong haematological disease and detailed blood tests are performed.
Another nasal area where bleeding is common is the posterior end of the inferior turbinate, and bleeding from both nostrils equally suggests a trauma on the roof of the pharynx. If nosebleeds are accompanied by nasal congestion, it should be kept in mind that there may be a mass in the nose (angiofibroma). In addition, bacterial or viral infections can also cause nosebleeds. Primary treatment should be directed at systemic disease if it exists. If the bleeding is due to an anatomical disorder, surgical correction, if it is due to vascular damage, cautery application or cotton tampon impregnated with adrenaline helps to stop the bleeding.
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