Fact-checked by Grok 2 weeks ago

Rhinorrhea

Rhinorrhea, commonly known as a runny nose, is the medical term for the excessive discharge of thin, mostly clear mucus from the nasal passages, often resulting from irritation or inflammation of the nasal mucosa.^[1] This condition can manifest as fluid dripping from the nostrils or draining down the back of the throat, known as postnasal drip, and is a hallmark symptom of various underlying issues including allergic and non-allergic rhinitis.^[2]^[1] Rhinorrhea arises from multiple causes, broadly categorized into infectious, allergic, and non-allergic origins. Viral infections, such as the common cold or influenza, frequently trigger acute rhinorrhea by inflaming the nasal lining and stimulating mucus production.^[2] Allergic rhinitis, an IgE-mediated response to airborne allergens like pollen or dust mites, leads to clear rhinorrhea through histamine release and subsequent mucous gland stimulation.^[3] Non-allergic factors include exposure to cold or dry air, irritants such as smoke, certain medications, hormonal changes during pregnancy, or even gustatory rhinitis triggered by spicy foods.^[2] In rare cases, persistent unilateral rhinorrhea may indicate a cerebrospinal fluid leak, particularly following head trauma.^[2] Symptoms of rhinorrhea typically include watery or thick nasal discharge that may vary in color—clear in allergic cases, and may become yellow or green as an infection progresses, though color alone does not distinguish viral from bacterial causes—often accompanied by nasal congestion, sneezing, or itchy eyes.^[2]^[3] While usually self-limiting, chronic rhinorrhea lasting more than 10 days warrants medical evaluation to rule out complications like sinusitis or structural issues such as nasal polyps.^[2] Diagnosis generally involves a clinical history and physical exam, with further tests like allergy testing or imaging if needed.^[2] Treatment focuses on addressing the underlying cause and alleviating symptoms. For viral or allergic rhinorrhea, over-the-counter remedies such as saline nasal sprays, decongestants, and antihistamines provide relief by reducing inflammation and thinning mucus.^[4] Home measures like steam inhalation, humidifiers, and staying hydrated are recommended to soothe nasal passages.^[4] In cases of allergic rhinitis, intranasal corticosteroids or immunotherapy may be prescribed for long-term management.^[3] Bacterial infections require antibiotics, while surgical intervention is reserved for structural abnormalities.^[2] Prevention strategies include avoiding known allergens and irritants, practicing good hand hygiene to reduce infection risk, and maintaining indoor humidity.^[2]^[4]

Overview

Definition

Rhinorrhea, commonly referred to as a runny nose, is a medical condition characterized by the excessive production and discharge of thin mucus from the nasal passages. This discharge typically appears as a clear or watery fluid that drips from the nostrils, often in response to irritation or inflammation of the nasal mucosa.^[2]^[1]^[5] Unlike the normal nasal secretion, which produces approximately 1-2 liters of mucus daily to humidify inhaled air, trap particles, and protect against pathogens without noticeable outflow, rhinorrhea involves a pathological increase in volume, frequency, or duration of this discharge. This excess often persists beyond typical physiological responses and may indicate an underlying disorder, such as a viral infection like the common cold.^[2]^[6] The term "rhinorrhea" derives from the Ancient Greek roots "rhino-" (ῥίς, rhís, meaning "nose") and "-rhea" (ῥοία, rhoía, meaning "flow"), reflecting its literal description as nasal flow. It was first documented in English medical literature in the 1840s, with the modern form coined around 1866 to denote this specific symptom.^[7]^[8] Rhinorrhea is often subclassified by the nature of the mucus, including serous (clear, watery discharge) and mucoid (thicker, more viscous mucus). Serous rhinorrhea is commonly associated with conditions like vasomotor rhinitis, triggered by non-allergic irritants, or allergic rhinitis, resulting from immune responses to allergens, whereas mucoid forms may appear in other inflammatory states.^[6]^[9]

Epidemiology

Rhinorrhea is a highly prevalent condition globally, primarily driven by upper respiratory infections such as the common cold. Rhinorrhea is a hallmark symptom of the common cold, occurring in nearly all cases. In adults, these infections occur at an average rate of 2 to 3 episodes per year, leading to rhinorrhea in nearly all cases and affecting a large proportion of the population annually due to the widespread nature of viral etiologies like rhinovirus.^[10] Children experience even higher rates, with 6 to 10 infections per year in preschool-aged individuals, resulting in up to 50% affected multiple times annually and contributing to its status as one of the most common pediatric complaints.^[11] For chronic forms linked to rhinitis, global median prevalence stands at approximately 29% for unspecified cases, underscoring its public health burden.^[12] Seasonal patterns significantly influence rhinorrhea incidence, with peaks occurring in winter due to heightened viral transmission and cold-induced mucosal irritation. Although rhinovirus activity is prominent in fall and spring, overall respiratory infections, including those causing rhinorrhea, surge during colder months across temperate regions.^[13] This seasonality amplifies exposure risks, particularly in indoor environments where viruses spread more readily. Demographic factors play a key role in rhinorrhea distribution, with higher prevalence in temperate climates where distinct pollen seasons exacerbate allergic triggers. Allergic rhinitis, affecting 10-30% of individuals worldwide, frequently manifests with rhinorrhea as a primary symptom in the majority of affected patients, particularly those with perennial symptoms.^[14] Risk factors include smoking, which increases nasal symptoms through irritant effects (odds ratio up to 2.76 for perennial rhinitis), and urban air pollution exposure, linked to elevated rhinitis rates via particulate matter and NO2.^[15] Age-related susceptibility is notable, with infants facing 4-fold higher infection rates than adults and the elderly more prone due to mucosal atrophy and immunosenescence.^[16] ^[17] Post-2020 data indicate an elevated incidence of rhinorrhea tied to COVID-19 variants, where it appears as a symptom in 10-20% of cases, especially milder Omicron infections characterized by upper respiratory features like runny nose.^[18] This has broadened the condition's epidemiological profile amid ongoing viral dynamics.

Pathophysiology

Mechanisms of Nasal Secretion

The nasal mucosa, lining the respiratory epithelium of the nasal cavity, is primarily responsible for mucus production through specialized cellular components. Goblet cells, comprising 5–15% of the epithelial cells, secrete mucins that form the gel-like mucus layer, while seromucinous glands in the submucosa produce a mixture of serous and mucous secretions to contribute to the overall mucus volume.^[19]^[20] The submucosal vascular plexus, consisting of a rich network of capillaries beneath the epithelium, facilitates plasma transudation into the mucus, adding an aqueous component to nasal secretions.^[21] These structures collectively maintain mucociliary clearance and humidification under normal conditions but can lead to hypersecretion in rhinorrhea.^[22] Hypersecretion in rhinorrhea is predominantly triggered by parasympathetic nervous system stimulation, which activates glandular activity through neurotransmitter release. Acetylcholine, released from postganglionic parasympathetic fibers, binds to muscarinic M3 receptors on seromucinous glands and goblet cells, promoting exocytosis of secretory granules and increased mucus production.^[23] This cholinergic pathway results in a rapid, watery-to-mucoid discharge as a protective reflex, enhancing mucosal defense against irritants.^[24] Parasympathetic efferents also induce mild vasodilation, further contributing to secretion volume.^[25] Nasal secretions in rhinorrhea can be classified into aqueous and glandular types based on their origin and composition. Aqueous secretion arises from plasma leakage across epithelial tight junctions due to increased vascular permeability, forming a thin, watery fluid rich in electrolytes and proteins like immunoglobulins.^[22] In contrast, glandular secretion involves mucin production from goblet cells and seromucinous glands, yielding a viscous mucus that traps particulates.^[19] Aquaporins, particularly AQP5 expressed on the apical membrane of nasal epithelial cells, play a crucial role in watery rhinorrhea by facilitating rapid water transport across the epithelium, amplifying fluid secretion in response to stimuli. Additionally, hormonal influences, such as estrogen, can upregulate AQP5 expression, contributing to increased nasal secretion in conditions like pregnancy rhinitis.^[26]^[27]^[28] Inflammatory processes exacerbate nasal secretion through the action of key mediators that enhance vascular permeability and glandular output. Histamine, released from degranulating mast cells, binds to H1 receptors on endothelial cells and glands, causing immediate plasma extravasation and stimulating mucous gland secretion.^[29] Leukotrienes, such as cysteinyl leukotrienes (CysLTs), act via CysLT1 receptors to promote vasodilation, increase vascular leakage, and boost mucus production, contributing to sustained rhinorrhea.^[30] Cytokines, including interleukin-4 (IL-4) and IL-13 from Th2 cells, upregulate goblet cell hyperplasia and mucin gene expression (e.g., MUC5AC), while also recruiting inflammatory cells that amplify mediator release.^[31] These mediators collectively shift secretion toward a hypersecretory state during inflammation.^[32] Neural regulation of nasal secretion involves sensory afferents that trigger reflex pathways. Irritation of trigeminal nerve endings (cranial nerve V branches V1 and V2) in the nasal mucosa detects chemical, mechanical, or thermal stimuli, activating nociceptive neurons that relay signals to the brainstem.^[33] This leads to a reflex parasympathetic outflow via the greater superficial petrosal nerve, resulting in glandular hypersecretion and watery rhinorrhea as a defensive response.^[24] Trigeminal stimulation also induces sneezing and itch, integrating sensory detection with efferent secretory control.^[34] For instance, cold temperatures can briefly activate this reflex, increasing secretion to warm and humidify inspired air.^[35]

Classification of Rhinorrhea

Rhinorrhea is commonly classified by duration to guide diagnostic and therapeutic approaches. Acute rhinorrhea typically lasts less than 4 weeks and is often associated with infectious causes, such as viral upper respiratory infections.^[36] In contrast, chronic rhinorrhea persists for more than 12 weeks and may stem from allergic, non-allergic, or structural etiologies, requiring further evaluation to identify underlying triggers.^[36] Classification by the characteristics of the nasal discharge provides additional diagnostic insight. Clear, serous rhinorrhea suggests non-infectious processes, such as cerebrospinal fluid (CSF) leaks, particularly if unilateral and watery.^[6] Purulent discharge indicates bacterial infection, often seen in acute bacterial rhinosinusitis, while mucopurulent rhinorrhea reflects a mixed inflammatory response.^[37] The laterality of rhinorrhea—unilateral versus bilateral—further refines the differential diagnosis. Unilateral rhinorrhea raises suspicion for local structural abnormalities, such as nasal polyps, foreign bodies, or CSF leaks, necessitating imaging or endoscopy.^[38] Bilateral rhinorrhea is more indicative of systemic or diffuse processes, including allergic or vasomotor responses.^[38] Specific physiological subtypes of rhinorrhea, particularly within non-allergic rhinitis, highlight targeted triggers. Gustatory rhinorrhea, a cholinergic subtype, occurs shortly after ingesting spicy foods or alcohol, resulting in profuse watery discharge due to autonomic nerve stimulation.^[39] Other non-allergic forms include cold air-induced rhinorrhea, triggered by environmental irritants via nociceptor activation.^[40] These subtypes fall under non-allergic rhinopathy (also known as vasomotor rhinitis), involving autonomic dysregulation.^[39]^[40]

Causes

Environmental and Physiological Causes

Rhinorrhea can arise from environmental and physiological triggers that provoke non-pathological nasal responses, distinct from inflammatory or infectious etiologies. These causes often involve reflexive hypersecretion of nasal mucus to protect or adapt the nasal mucosa, mediated by neural or hormonal mechanisms.^[9] Exposure to cold temperatures induces rhinorrhea through a vasomotor response, where cold air stimulates sensory nerves in the nasal passages, triggering a cholinergic reflex that promotes glandular secretion to warm and humidify inhaled air. This phenomenon, sometimes termed "skier's rhinitis," results in copious watery discharge and nasal congestion, particularly in susceptible individuals with heightened neural sensitivity.^[41]^[42] Anticholinergic agents effectively mitigate this reflex by blocking the neural pathway.^[41] Crying elicits rhinorrhea via the lacrimal-nasal reflex, where excess tears produced by lacrimal glands drain through the nasolacrimal duct into the nasal cavity, mixing with mucus to produce a runny nose. This overflow occurs due to the anatomical connection between the ocular and nasal systems, leading to bilateral nasal discharge during emotional or irritant-induced tearing.^[2]^[43] Environmental irritants such as dust, smoke, and strong odors provoke rhinorrhea by activating trigeminal nerve endings in the nasal mucosa, initiating a non-allergic sensory response that increases vascular permeability and glandular secretion. These triggers, common in vasomotor rhinitis, cause immediate watery rhinorrhea without immune-mediated inflammation, often exacerbated by airborne particles or chemical vapors.^[44]^[45]^[46] Physiological states like pregnancy can induce rhinorrhea due to hormonal fluctuations, particularly elevated estrogen and progesterone levels, which increase nasal mucosal blood flow and edema, leading to congestion and discharge in up to 20-30% of pregnancies. This gestational rhinitis typically emerges in the second or third trimester and resolves postpartum, reflecting the impact of placental hormones on nasal vasculature.^[47]^[48]^[49] Exercise-induced rhinorrhea occurs in some individuals as a physiological adaptation to heightened airflow and oxygen demand, resulting in nasal irritation, sneezing, and watery discharge during or after physical activity. This response may stem from rapid changes in nasal airflow dynamics or transient mucosal cooling, affecting athletes in sports like running or swimming.^[50]^[51] Dietary triggers, particularly capsaicin in spicy foods, cause gustatory rhinorrhea through stimulation of cholinergic pathways in the nasal submucosal glands, leading to profuse, watery discharge shortly after ingestion. This non-allergic reaction, mediated by muscarinic receptors, is atropine-sensitive and commonly affects those consuming hot peppers or related spices.^[52]^[39]^[53]

Inflammatory Causes

Inflammatory causes of rhinorrhea primarily involve immune-mediated responses in the nasal mucosa, leading to increased secretion through cytokine release and vascular permeability. Viral infections represent the most common etiology, accounting for the majority of acute cases. Among these, the common cold, caused predominantly by rhinoviruses and coronaviruses, triggers rhinorrhea in 80-90% of acute upper respiratory tract infections.^[54]^[13] Symptoms typically emerge 1-3 days after exposure, beginning with clear nasal discharge that may progress to thicker mucus as inflammation intensifies.^[55]^[56] Bacterial infections are less frequent as a primary cause of rhinorrhea but often arise secondarily following viral upper respiratory infections, complicating approximately 0.5-2% of cases in adults. These secondary infections, such as acute bacterial rhinosinusitis, are characterized by purulent nasal discharge due to bacterial overgrowth in the sinuses, commonly involving pathogens like Streptococcus pneumoniae or Haemophilus influenzae.^[57]^[58] The inflammatory response in these instances involves neutrophil recruitment, leading to persistent, discolored rhinorrhea that differentiates it from viral etiologies.^[59] Allergic rhinitis stands as a leading chronic inflammatory cause, driven by an IgE-mediated type I hypersensitivity reaction to environmental allergens. Common triggers include pollen from trees, grasses, and weeds in seasonal forms (often termed hay fever), as well as perennial allergens such as dust mites, animal dander, and mold.^[3]^[60] Upon re-exposure, allergen binding to IgE on mast cells releases histamine and other mediators, resulting in watery rhinorrhea, sneezing, and nasal itching that can persist year-round in perennial cases or flare seasonally.^[61] Other inflammatory conditions include non-allergic rhinitis with eosinophilia syndrome (NARES), a subset of non-allergic rhinitis marked by chronic eosinophilic inflammation without identifiable allergens. In NARES, eosinophils comprise 10-20% or more of nasal secretions, contributing to persistent rhinorrhea through ongoing mucosal damage and hyperreactivity.^[53]^[39] This eosinophil-driven process may predispose individuals to nasal polyposis or aspirin sensitivity, highlighting its role in chronic inflammatory rhinorrhea.^[62] Recent developments have identified post-viral inflammatory syndromes as emerging causes, particularly following SARS-CoV-2 infection. In long COVID, persistent rhinorrhea affects approximately 8% of individuals two years post-infection, linked to lingering mucosal inflammation and immune dysregulation.^[63] This manifestation underscores the potential for acute viral insults to evolve into prolonged inflammatory states.^[64]

Non-Inflammatory Causes

Non-inflammatory causes of rhinorrhea encompass structural, traumatic, and systemic factors that disrupt normal nasal physiology without involving immune-mediated inflammation. One critical traumatic etiology is cerebrospinal fluid (CSF) rhinorrhea arising from head trauma, especially skull base fractures, which create a fistula allowing CSF to leak into the nasal cavity. This presents as persistent, unilateral clear discharge that may worsen with positional changes, such as leaning forward, and is distinguished from other nasal secretions by its watery consistency and lack of odor. Diagnosis relies on biochemical confirmation via beta-2 transferrin testing of the nasal fluid, which exhibits nearly 100% specificity for CSF due to its unique desialylated form absent in serum or other nasal fluids.^[65]^[66]^[67]^[68] Structural abnormalities, such as nasal polyps or tumors, can mechanically obstruct nasal passages, leading to post-obstructive rhinorrhea characterized by accumulated mucus drainage distal to the blockage. Nasal polyps, benign growths arising from the sinonasal mucosa, may cause chronic unilateral or bilateral discharge by impeding normal mucociliary clearance, even in the absence of active inflammation. Similarly, nasal tumors, including benign neoplasms like inverted papillomas or malignant ones such as squamous cell carcinomas, can produce obstructive rhinorrhea through mass effect, often accompanied by unilateral symptoms like epistaxis or anosmia, though the discharge itself stems from stasis rather than inflammatory response.^[69]^[70]^[71]^[72] Foreign bodies lodged in the nasal cavity represent another common non-inflammatory cause, particularly in pediatric populations where curiosity leads to self-insertion of objects like beads, food particles, or toy parts. This typically results in unilateral, foul-smelling purulent rhinorrhea due to local mucosal irritation, secondary infection, or biofilm formation on the object, with symptoms persisting until removal. In children, this is a common cause of unilateral nasal discharge presenting to emergency departments, highlighting the need for prompt endoscopic extraction to prevent complications like septal perforation.^[73]^[74]^[75] Systemic conditions and iatrogenic factors further contribute to non-inflammatory rhinorrhea through hormonal dysregulation or procedural trauma. Hypothyroidism, a hormonal imbalance reducing thyroid hormone production, can trigger nonallergic rhinitis with symptoms including rhinorrhea and nasal congestion, attributed to altered mucociliary function and increased vascular permeability in the nasal mucosa. Certain medications, such as angiotensin-converting enzyme (ACE) inhibitors used for hypertension, induce upper airway irritation, such as cough and, less commonly, watery rhinorrhea (cough-variant symptoms), via bradykinin accumulation; cough affects up to 10-20% of users, predominantly women.^[44]^[76]^[77]^[78] Iatrogenically, procedures like septoplasty may cause transient postoperative rhinorrhea from mucosal edema and disrupted nasal epithelium, while nasal intubation during anesthesia can provoke nonallergic rhinitis through mechanical impingement on the nasal mucosa, resulting in clear, profuse discharge shortly after the intervention.^[79]^[80]

Clinical Presentation

Symptoms

Rhinorrhea, commonly known as a runny nose, is characterized by the excessive production and drainage of nasal secretions, typically presenting as a thin, watery discharge that is mostly clear in noninfectious cases. In acute viral infections, such as the common cold, the discharge often begins as clear and profuse but may progress to become thicker and colored yellow or green due to secondary bacterial involvement or increased inflammatory cells. Allergic causes, like pollen exposure, typically result in clear, watery rhinorrhea without coloration, while nonallergic irritants can produce similar transparent mucus.^[81]^[3]^[82] Patients often report a constant or intermittent drip from the nostrils, which can worsen with changes in head position, such as leaning forward, or upon exposure to specific triggers like allergens, dust, cold air, or spicy foods. In allergic rhinitis, symptoms like clear rhinorrhea are frequently triggered by environmental factors such as pollens, animal dander, or mold, leading to episodic exacerbations. Nonallergic forms may be provoked by irritants including tobacco smoke, perfumes, or weather fluctuations, resulting in unpredictable frequency.^[44]^[3] The duration of rhinorrhea varies by underlying mechanism, with episodic patterns seen in physiological responses, such as during crying or emotional stress, where discharge is transient and self-resolving. In contrast, chronic rhinitis leads to persistent symptoms lasting more than three months, often year-round in perennial allergic or nonallergic variants, while seasonal allergies cause intermittent bouts aligned with pollen seasons.^[3]^[83] Rhinorrhea significantly impacts quality of life, frequently causing postnasal drip that results in sleep disruption from nighttime coughing or throat irritation, as well as voice changes including hoarseness or vocal fatigue due to constant throat clearing. These effects can lead to reduced productivity, with approximately 36% of affected adults reporting impaired work performance and occasional missed days. In colds, such symptoms contribute to overall discomfort but are referenced briefly as common acute triggers.^[84]^[3]^[85] In pediatric patients, rhinorrhea often manifests with nasal obstruction that complicates feeding, particularly in infants who are obligate nose breathers, leading to difficulties latching during breastfeeding or bottle-feeding and potential weight gain issues. Young children may also experience irritability or disrupted sleep from persistent discharge.^[86]

Associated Findings

On physical examination, rhinorrhea is often accompanied by nasal congestion, which manifests as swelling and obstruction of the nasal passages due to vascular engorgement and edema of the nasal mucosa.^[3] Mucosal erythema, indicating inflammation, is commonly observed in infectious or allergic etiologies, presenting as redness of the nasal lining.^[87] Turbinate hypertrophy, an enlargement of the nasal turbinates, may also be evident, contributing to persistent blockage and is particularly noted in chronic cases of allergic or vasomotor rhinitis.^[88] Post-nasal drip, a frequent secondary effect of rhinorrhea, can lead to throat irritation due to the constant drainage of mucus onto the pharyngeal mucosa, often resulting in a sensation of discomfort or globus.^[89] This drip is also associated with chronic cough, as the mucus stimulates the cough reflex, and may cause halitosis from bacterial overgrowth in the stagnant secretions.^[90]^[91] In allergic rhinorrhea, conjunctivitis is a common comorbidity, characterized by ocular redness, itching, and tearing due to shared IgE-mediated pathways affecting both nasal and conjunctival mucosa.^[92] For rhinorrhea secondary to sinusitis, facial pain or pressure is often present, arising from inflammation and obstruction in the paranasal sinuses.^[93] Systemic signs accompanying rhinorrhea include fever, which signals an underlying infectious process such as acute bacterial rhinosinusitis, typically with temperatures exceeding 38°C.^[57] In cases of traumatic origin, unilateral epistaxis may occur alongside rhinorrhea, resulting from mucosal vessel rupture due to injury.^[94] Red flags for rhinorrhea include persistent unilateral discharge, which raises suspicion for serious conditions such as nasal tumors or cerebrospinal fluid (CSF) leaks; in the latter, the discharge is often clear and watery, potentially confirmed by beta-2 transferrin testing.^[65]^[95]

Diagnosis

Clinical Evaluation

The clinical evaluation of rhinorrhea begins with a detailed history to characterize the condition and guide differential diagnosis. Key elements include the onset and duration of symptoms, which may be acute (e.g., sudden following a viral upper respiratory infection) or chronic (persisting beyond 12 weeks), helping to distinguish infectious from persistent noninfectious causes.^[6] Triggers such as seasonal allergens, environmental irritants like smoke or dust, or specific exposures (e.g., spicy foods in gustatory rhinitis) are assessed to identify potential etiologies.^[96] The characteristics of the nasal discharge—color (clear, mucoid, purulent, or bloody), volume (profuse or scant), and laterality (unilateral versus bilateral)—provide critical clues; for instance, clear unilateral discharge may suggest cerebrospinal fluid leak post-trauma, while bilateral purulent discharge raises concern for bacterial sinusitis.^[3] Associated symptoms, such as sneezing, nasal itching (suggestive of allergic rhinitis), postnasal drip, facial pain, or systemic features like fever and cough, further refine the assessment.^[97] Risk factor assessment is integral to the history, evaluating personal and family history of atopy, recent trauma or surgery, medication use (e.g., topical decongestants risking rebound congestion), and occupational or environmental exposures.^[6] This helps identify predispositions, such as allergies exacerbating inflammatory responses or anatomical issues from prior injury. The history also facilitates a differential diagnosis framework, ruling out mimics like epistaxis (distinguished by bloody discharge without clear rhinorrhea) or otorrhea (ear discharge misidentified as nasal) through targeted questioning on source and context.^[96] Physical examination focuses on direct inspection and palpation to corroborate historical findings. Anterior rhinoscopy, using a nasal speculum and light, evaluates the nasal mucosa for edema, pallor (as in allergic rhinitis), erythema, polyps, or secretions, while palpation assesses for sinus tenderness over the maxillary or frontal areas.^[3] Vital signs, including temperature, are reviewed for fever indicating infection, and the face is inspected for swelling or allergic shiners (periorbital darkening).^[6] In pediatric patients, clinical evaluation presents unique challenges due to limited verbal communication, particularly in preschool-aged children, necessitating reliance on parental reports for symptom description, timing, and triggers.^[98] Physical examination emphasizes gentle inspection for unilateral foul-smelling discharge (suggesting foreign body) or mucopurulent rhinorrhea, with anterior rhinoscopy adapted for cooperation and endoscopy considered in older children.^[6]

Laboratory and Imaging Tests

Nasal cytology involves the microscopic examination of cells obtained via scraping or smearing from the nasal mucosa, providing insights into the underlying inflammatory processes contributing to rhinorrhea. In cases of suspected allergic rhinitis, an elevated presence of eosinophils in the nasal cytology sample indicates an allergic etiology, as these cells are characteristically increased in allergic nasal inflammation. Conversely, a predominance of neutrophils suggests an infectious cause, such as acute bacterial or viral rhinosinusitis, helping to differentiate inflammatory patterns when clinical history is ambiguous.90178-3/fulltext)^[99] For suspected cerebrospinal fluid (CSF) rhinorrhea, particularly following trauma or in cases of unilateral clear discharge, the beta-2 transferrin immunoassay on collected nasal fluid serves as the gold standard confirmatory test due to its high specificity for CSF. This test detects the unique beta-2 transferrin isoform present almost exclusively in CSF, with a sensitivity exceeding 95% and specificity approaching 100%, enabling accurate distinction from other nasal secretions.^[100]^[68] Imaging modalities are employed when structural abnormalities are suspected as contributors to persistent or atypical rhinorrhea. Computed tomography (CT) scans of the paranasal sinuses are preferred for evaluating bony structures, identifying nasal polyps as soft-tissue opacifications within the sinuses, or detecting fractures and skull base defects that may lead to CSF leakage.^[101]^[67] Magnetic resonance imaging (MRI) offers superior soft-tissue contrast and is utilized for assessing tumors, encephaloceles, or invasive inflammatory processes, helping to differentiate neoplastic causes from benign mucosal changes.^[102]^[67] Allergy testing is indicated for chronic or seasonal rhinorrhea suggestive of an allergic basis, with skin prick testing (SPT) serving as a first-line in vivo method to identify sensitization to specific aeroallergens through wheal-and-flare reactions. Alternatively, in vitro serum-specific IgE testing quantifies allergen-specific antibodies, offering comparable diagnostic accuracy to SPT with the advantage of being unaffected by medications like antihistamines.^[103]^[104] Microbiological cultures from nasal swabs are reserved for cases of persistent purulent rhinorrhea refractory to initial therapy, where bacterial pathogens such as Staphylococcus aureus or Streptococcus species may be identified through aerobic culture to guide targeted antibiotic selection. In outbreak settings or suspected viral etiologies, such as during community respiratory virus seasons, polymerase chain reaction (PCR) testing on nasal swabs detects viral nucleic acids from common pathogens like rhinovirus or influenza, facilitating rapid diagnosis and infection control measures.^[105]^[106]^[107]

Management

Symptomatic Treatments

Symptomatic treatments for rhinorrhea focus on alleviating nasal discharge and associated discomfort through non-invasive methods that do not address underlying etiologies. These approaches are generally safe for short-term use and can be employed across various causes of rhinorrhea, such as environmental irritants or mild inflammatory responses.^[61] Nasal irrigation involves the use of saline solutions delivered via sprays, squeeze bottles, or neti pots to mechanically clear mucus from the nasal passages, thereby reducing congestion and runny nose symptoms. This method enhances mucociliary clearance and improves nasal hygiene without pharmacological effects. Clinical studies, including a meta-analysis of trials on allergic rhinitis, have demonstrated that daily nasal saline irrigation can reduce symptoms by approximately 28% and decrease the need for additional medications by up to 66%. Seawater-based irrigations have also shown significant symptom improvement in allergic rhinitis patients when used consistently. Irrigation is typically recommended once or twice daily, with proper technique to avoid contamination, such as using distilled or boiled water.^[108]^[109]^[110] Decongestants provide rapid relief from nasal congestion that often accompanies rhinorrhea by constricting blood vessels in the nasal mucosa. Oral options like pseudoephedrine work systemically to reduce swelling and mucus production, while topical agents such as oxymetazoline nasal spray offer localized effects for quicker onset. Guidelines recommend oral pseudoephedrine at 60 mg every 4-6 hours for adults, not exceeding 240 mg daily, and topical oxymetazoline at 2-3 sprays per nostril twice daily. However, topical decongestants should be limited to 3 days to prevent rebound congestion, known as rhinitis medicamentosa, which can worsen symptoms upon discontinuation. Oral forms carry a lower risk of rebound but may cause side effects like elevated blood pressure.^[61]^[111]^[112] Antihistamines are particularly useful when rhinorrhea stems from histamine-mediated responses, blocking H1 receptors to decrease nasal secretion and itching. First-generation antihistamines, such as diphenhydramine, are effective for mild, acute cases at doses of 25-50 mg every 4-6 hours but often cause sedation due to blood-brain barrier penetration. Second-generation antihistamines, including loratadine (10 mg daily) or cetirizine (5-10 mg daily), provide comparable efficacy with minimal sedation and fewer cognitive impairments, making them preferable for daily use. These agents are most beneficial in allergic contexts but can offer symptomatic relief in non-allergic rhinorrhea as well.^[113]^[114]^[115] Humidification methods, such as steam inhalation or the use of room humidifiers, help thin nasal secretions and soothe irritated mucosa, facilitating easier mucus expulsion. Steam from a hot shower or bowl of warm water can be inhaled for 10-15 minutes several times daily to moisturize the nasal passages and reduce dryness-related discharge. Humidifiers maintaining 40-50% indoor humidity are recommended, especially in dry environments, to prevent mucosal irritation that exacerbates rhinorrhea. While clinical trials show mixed results for chronic cases, these approaches are widely endorsed for acute symptom relief.^[116]^[117]^[118] Simple home remedies complement other treatments by supporting overall nasal health. Adequate hydration, aiming for 8-10 glasses of water daily, thins mucus consistency, making it easier to clear from the nasal passages. Elevating the head during sleep with an extra pillow promotes gravitational drainage and reduces nighttime pooling of secretions, thereby minimizing postnasal drip. These measures are low-risk and can be integrated into daily routines for sustained symptom management.^[2]^[116]^[119]

Etiology-Specific Interventions

Interventions for rhinorrhea target the underlying etiology to address the root cause, such as infections, allergies, cerebrospinal fluid (CSF) leaks, or structural abnormalities. For infectious causes, viral upper respiratory infections, which commonly present with rhinorrhea, are typically managed supportively unless a specific pathogen like influenza is identified, in which case antivirals such as oseltamivir are recommended to reduce symptom duration and severity, including nasal discharge.^[120]^[121] In cases of bacterial superinfection, such as acute bacterial rhinosinusitis leading to purulent rhinorrhea, antibiotics like amoxicillin are the first-line treatment, with a typical course of 5-7 days to resolve the infection and associated symptoms.^[36]^[57] For allergic rhinitis, a frequent noninfectious cause of chronic rhinorrhea, intranasal corticosteroids such as fluticasone are the preferred first-line pharmacotherapy, effectively reducing nasal inflammation and discharge by targeting the allergic response.^[122]^[123] In persistent or severe chronic cases unresponsive to pharmacotherapy, allergen immunotherapy—either subcutaneous or sublingual—induces long-term tolerance by modulating the immune response to specific allergens, thereby decreasing rhinorrhea frequency and intensity.^[124]^[125] CSF rhinorrhea, often resulting from trauma or spontaneous skull base defects, requires etiology-specific management to prevent complications like meningitis. Conservative approaches, including 5-7 days of bed rest with head elevation at 15-30 degrees and avoidance of straining, allow spontaneous closure in up to 70% of traumatic cases.^[126]^[127] For persistent leaks, endoscopic surgical repair is the standard, involving multilayer closure with grafts to seal the defect, achieving success rates exceeding 90% with minimal morbidity.^[126]^[128] Structural issues contributing to rhinorrhea, such as nasal polyps or deviated septum, are addressed surgically when conservative measures fail. Functional endoscopic sinus surgery with polypectomy removes inflammatory polyps obstructing sinus drainage, alleviating rhinorrhea in chronic rhinosinusitis with nasal polyposis.^[69]^[129] Similarly, septoplasty corrects a deviated nasal septum to restore airflow and reduce post-obstructive rhinorrhea, particularly beneficial in patients with comorbid allergic rhinitis.^[130]^[131] Emerging biologic therapies target severe eosinophilic inflammation in cases like chronic rhinosinusitis with nasal polyps. Dupilumab, a monoclonal antibody inhibiting IL-4 and IL-13 signaling, was FDA-approved in 2019 as add-on maintenance therapy for inadequately controlled disease, significantly reducing polyp size and rhinorrhea while sparing the need for systemic corticosteroids.^[132]^[133] In October 2025, tezepelumab (Tezspire) received FDA approval as an add-on maintenance treatment for adults and pediatric patients aged 12 years and older with chronic rhinosinusitis with nasal polyps, demonstrating significant reductions in nasal polyp severity and congestion.^[134]

Prognosis and Complications

Typical Course

The typical course of rhinorrhea varies significantly depending on its underlying etiology, with acute forms generally following a self-limited trajectory while chronic forms exhibit persistence or periodicity. In acute viral rhinorrhea, symptoms such as nasal discharge typically peak within 2-3 days of onset and resolve spontaneously within 7-10 days in most cases, as the immune response clears the infection. Similarly, rhinorrhea triggered by environmental irritants, such as cold air or pollutants in nonallergic rhinitis, is often self-limiting and subsides promptly upon removal of the trigger, though repeated exposure can lead to episodic flares.^[135] In contrast, chronic rhinorrhea associated with untreated allergic rhinitis tends to persist over months or years, characterized by ongoing nasal discharge that may wax and wane in intensity, particularly in seasonal variants triggered by pollen exposure during spring or fall.^[3] Without intervention, symptoms can remain stable or intermittently exacerbate due to ongoing allergen sensitization, leading to a relapsing pattern rather than complete resolution. The progression of rhinorrhea is influenced by several factors, including patient compliance with avoidance strategies or therapies, which can shorten duration and reduce severity if adhered to consistently.^[136] Comorbid conditions, such as asthma, often complicate the course by amplifying nasal inflammation and prolonging symptoms through shared airway hyperreactivity.^[137] Recurrence rates are notably high in allergic rhinitis without preventive measures, with affected individuals often experiencing annual symptom episodes due to seasonal or perennial allergen exposure. Over the long term, the incidence and severity of rhinorrhea, particularly allergic forms, tend to decrease with aging, attributed to reduced mucosal reactivity and declining immune responsiveness in the nasal epithelium.^[138]

Potential Complications

Untreated or severe rhinorrhea, particularly arising from viral upper respiratory infections, can lead to secondary bacterial infections. Acute bacterial sinusitis complicates approximately 5-10% of viral cases, often due to impaired mucociliary clearance allowing bacterial overgrowth in the paranasal sinuses. Similarly, progression to acute otitis media occurs in approximately 30% of upper respiratory infections in young children, as Eustachian tube dysfunction facilitates middle ear effusion and infection.^[139]^[140]^[141] In traumatic rhinorrhea associated with cerebrospinal fluid (CSF) leaks, such as those from skull base fractures, the risks include meningitis and pneumocephalus. Meningitis develops in 10-25% of posttraumatic CSF rhinorrhea cases, with untreated infections carrying a mortality rate of up to 10%. Pneumocephalus, involving air entry into the intracranial space, further heightens morbidity, with overall mortality in complicated CSF leak subgroups reaching 8-11%. Prompt surgical intervention, such as dural repair, is essential to mitigate these sequelae.^[142]^[143] Chronic rhinorrhea may result in structural complications like nasal septal perforation from habitual aggressive nose blowing, which inflicts repetitive trauma to the septal cartilage and mucosa. Persistent nasal obstruction due to unresolved rhinorrhea can also exacerbate sleep-disordered breathing, increasing the risk of obstructive sleep apnea through elevated upper airway resistance. In allergic contexts, rhinorrhea from perennial allergic rhinitis often precedes the "allergic march," with up to 38% of affected children with allergic rhinitis developing asthma due to shared type 2 inflammatory pathways.^[144]^[145]^[146] Iatrogenic complications arise from mismanagement of rhinorrhea, notably rhinitis medicamentosa from prolonged overuse of topical decongestants like oxymetazoline. This condition manifests as rebound nasal congestion, perpetuating a cycle of dependency and worsening mucosal edema through alpha-adrenergic receptor downregulation. Discontinuation and supportive therapies, such as intranasal corticosteroids, are required for resolution, which may take weeks.^[147]

References

[1]
Runny nose - Mayo Clinic
Rhinorrhea involves a thin, mostly clear fluid running from the nose. Rhinitis involves irritation and swelling inside the nose.Missing: credible | Show results with:credible
[2]
Rhinorrhea (Runny Nose) - Cleveland Clinic
Rhinorrhea (runny nose) is mucus dripping or “running” out of your nose. It has several possible causes, such as cold and/or dry air, allergies or viral ...Missing: credible | Show results with:credible
[3]
Allergic Rhinitis - StatPearls - NCBI Bookshelf
Allergic rhinitis (AR) is an atopic disease characterized by symptoms of nasal congestion, clear rhinorrhea, sneezing, postnasal drip, and nasal pruritis.Missing: credible | Show results with:credible
[4]
Stuffy or runny nose – adult: MedlinePlus Medical Encyclopedia
Jul 8, 2023 · A stuffy or congested nose occurs when the tissues lining it become swollen. The swelling is due to inflamed blood vessels.
[5]
RHINORRHEA Definition & Meaning | Merriam-Webster Medical
The meaning of RHINORRHEA is excessive mucous secretion from the nose.
[6]
Nasal Congestion and Rhinorrhea - Ear, Nose, and Throat Disorders
Nasal congestion and rhinorrhea (runny nose) are extremely common problems that commonly occur together but occasionally occur alone.
[7]
Rhinorrhea - Etymology, Origin & Meaning
Rhinorrhea, from Greek rhino- "nose" + rhoia "flow," means mucous discharge from the nose; its origin traces to the PIE root *sreu- "to flow."
[8]
rhinorrhoea, n. meanings, etymology and more | Oxford English ...
The earliest known use of the noun rhinorrhoea is in the 1840s. OED's earliest evidence for rhinorrhoea is from 1846, in the writing of Robley Dunglison, ...
[9]
Vasomotor Rhinitis - StatPearls - NCBI Bookshelf
[10] Patients with vasomotor rhinitis tend to categorize into two groups depending on predominant symptomatology: “blockers” with congestion and “runners” with ...
[10]
About Common Cold - CDC
Oct 15, 2024 · Every year in the United States, adults have an average of two to three colds, and children often have more. Signs and symptoms. The signs ...
[11]
Common cold - Frontiers
Jun 21, 2023 · The incidence of common cold is inversely related to age with infants having 6–8 colds a year compared to adults having 2–4 colds a year (36).<|separator|>
[12]
Worldwide prevalence of rhinitis in adults: A review of definitions ...
Mar 11, 2022 · Rhinitis prevalence ranged from 1% to 63%. The overall median prevalences of unspecified rhinitis, AR and NAR were 29.4%, 18.1% and 12.0%, and they varied ...
[13]
Rhinovirus (RV) Infection (Common Cold) - Medscape Reference
Aug 18, 2023 · Although infections occur year-round, the incidence is highest in the fall and the spring. Of persons exposed to the virus, 70-80% have ...
[14]
Allergic Rhinitis: Rapid Evidence Review - AAFP
Epidemiology and Pathophysiology · Approximately 15% to 30% of people in the United States have allergic rhinitis. · Allergic rhinitis is caused by IgE-mediated ...
[15]
Smoking, environmental tobacco smoke and occupational irritants ...
Mar 14, 2018 · Smoking, environmental tobacco smoke, and occupational irritants are significant risk factors for nasal symptoms with an additive pattern.
[16]
Upper Respiratory Tract Infections With Focus on The Common Cold
May 4, 2025 · Children represent the reservoir of rhinovirus, and the incidence rate of infection is approximately 4-fold higher than that of adults ...
[17]
Rhinitis in Older Adults - PMC - NIH
Furthermore, rhinitis is recognized as a significant risk factor for development of frequent or chronic sinus infections. Whether the effects of rhinitis on ...
[18]
COVID-19 signs, symptoms and severity of disease: A clinician guide
Typical symptoms reported during the Omicron wave included runny nose, headache, sneezing, and sore throat.
[19]
Physiology and pathophysiology of respiratory mucosa of the nose ...
Goblet cells represent 5–15% of cells in the respiratory mucosa and produce secretions for the endonasal mucus together with the submucosal glands. Next to ...
[20]
Molecular Mechanisms of Nasal Epithelium in Rhinitis and ...
Some secretory cells, known as mucous or goblet cells, produce mucins and store them within easily visualized collections of mucin granules, whereas other ...
[21]
ALLERGY CLINICAL IMMUNOLOGY
They contain a sub- epithelial capillary system; tubuloalveolar, seromucous glands; goblet cells; parasympathetic and sympathetic innervation; and ...
[22]
[PDF] The secretory senescence of the airway
It is produced by submucosal, seromucous glands, goblet cells, transudation of blood plasma, mucosal tissue fluid and tear fluid. Due to transudate, most pro-.
[23]
Neuroregulation of Human Nasal Mucosa - PMC - PubMed Central
This response is a rapidly induced defense mechanism for hypersecretion of mucus and protection of the nasal mucosa. Acetylcholine stimulates muscarinic M3 and ...
[24]
The role of the nervous system in rhinitis
Action potentials traveling through parasympathetic efferent nerves can lead to glandular activation and rhinorrhea, as well as to some vasodilation.
[25]
Autonomic nervous system dysfunction and sinonasal symptoms
Apr 16, 2018 · Stimulation of parasympathetic activity results in increased nasal secretions rich in lysozyme, immunoglobulin A and glycoproteins. Electrical ...
[26]
Expression, Distribution and Role of Aquaporins in Various ...
Aug 14, 2020 · Aquaporins (AQPs) are water-specific membrane channel proteins that regulate cellular and organismal water homeostasis. The nose, an organ ...
[27]
Epithelial and sensory mechanisms of nasal hyperreactivity - Velasco
Feb 17, 2022 · In the nasal epithelium, water transport relays mainly in the activity of aquaporin water channels, particularly AQP5, located at the apical ...
[28]
Modulation of Allergic Inflammation in the Nasal Mucosa ... - Frontiers
Degranulation induces the release of chemical mediators (primarily histamine) that stimulate sensory nerve endings, mucous glands and small vessels of the nasal ...
[29]
The complex pathophysiology of allergic rhinitis: scientific rationale ...
Apr 16, 2019 · LTRAs (e.g. montelukast, zafirlukast, and pranlukast) block the activity or secretion of cysteinyl leukotrienes (CysLTs), a potent inflammatory ...Leukotriene Receptor... · Mp-Azeflu: Clinical Evidence · Controlled Clinical Studies...
[30]
Inflammatory mediators in allergic rhinitis
As a result of cytokine or mediator release, the nasal mucosa becomes infiltrated with inflammatory cells, basophils, eosinophils, neutrophils, mast cells, and ...
[31]
[PDF] Mediators involved in the pathophysiology of allergic rhinitis
Acting on the cysLT 1 receptor, these leu- kotrienes induce nasal vasodilatation and increase blood-vessel permeability, mucus secretion and the re- cruitment ...
[32]
The role of nociceptive neurons in allergic rhinitis - Frontiers
Aug 8, 2024 · Nociceptive neurons in the nasal mucosa mainly originate from V1 and V2 of the trigeminal nerve. A variety of nociceptive stimuli, such as ...
[33]
Nasal sensory nerve populations responding to histamine and ...
Inflammation of the nasal mucosa leads to sneezing, nasal itch, rhinorrhea, and nasal blockage. Many of these symptoms are likely the result of nasal ...Missing: secretion | Show results with:secretion<|control11|><|separator|>
[34]
[PDF] The intranasal trigeminal system: roles in rhinitis (allergic and non ...
When the in- tranasal trigeminal nerve endings are stimulated, the nose becomes congested and obstructed, there is watery rhinorrhoea and sneezing occurs. It ...
[35]
Acute Rhinosinusitis in Adults - AAFP
May 1, 2011 · Classification of Adult Rhinosinusitis ; Acute, Up to four weeks ; Subacute, At least four weeks but less than 12 weeks ; Recurrent acute, Four or ...
[36]
Respiratory Tract Symptom Complexes - PMC - PubMed Central
Jun 22, 2020 · Mucopurulent rhinorrhea, or purulent nasal discharge, denotes nasal discharge that is thick, opaque, and colored. It occurs at any age.
[37]
Unilateral Clear Thin Rhinorrhea: How Often Is It a Cerebrospinal ...
May 15, 2025 · Unilateral clear thin rhinorrhea (UCTR) raises suspicion for a nasal cerebrospinal fluid (CSF) leak. CSF rhinorrhea can occur spontaneously or ...
[38]
Chronic Nonallergic Rhinitis - AAFP
Aug 1, 2018 · Clinically, chronic nonallergic rhinitis is characterized by its nonallergic triggers, including weather changes, tobacco smoke, automotive ...
[39]
Classification of Nonallergic Rhinitis Syndromes With a Focus on ...
There are at least 8 recognized nonallergic rhinitis syndromes: drug-induced rhinitis including rhinitis medicamentosa, gustatory rhinitis, hormonally induced ...
[40]
Upper airways reactions to cold air - PubMed
Sensory nerve activation generates a cholinergic reflex that leads to rhinorrhea; therefore, anticholinergic agents are highly effective in treating cold-air ...Missing: response | Show results with:response
[41]
Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis
Jun 15, 2009 · Cold air leads to excessive nasal blockage with copious discharge in some skiers ("skier's rhinitis"). The rhinorrhea is due to a hyperactive ...<|separator|>
[42]
Chronic Rhinorrhea (Runny Nose) - Stanford Medicine Children's ...
Rhinorrhea, or a runny nose, happens when excess fluid drains from the nose. The fluid is mucus that is thin or thick, clear or opaque, and can be intermittent ...Missing: definition credible
[43]
Nonallergic rhinitis - Symptoms & causes - Mayo Clinic
Mar 14, 2023 · Nonallergic rhinitis involves sneezing or a stuffy, drippy nose. It can be a long-term problem, and it has no clear cause.Overview · Causes · ComplicationsMissing: subtypes serous mucoid
[44]
Management of Rhinitis: Allergic and Non-Allergic - PubMed Central
NAR has 8 major subtypes which includes nonallergic rhinopathy (previously known as vasomotor rhinitis), nonallergic rhinitis with eosinophilia, atrophic ...Missing: source | Show results with:source
[45]
Vasomotor Rhinitis (VMR) - Asthma and Respiratory Foundation NZ
Triggers of Vasomotor Rhinitis · Changes in temperature or barometric pressure, turbulent air. · Perfumes, strong cooking odours, smoke. · Inorganic dust (which is ...Missing: trigeminal | Show results with:trigeminal
[46]
Rhinitis and pregnancy: literature review - PMC - NIH
Hormonal changes have a presumed etiological role, but knowledge about the physiopathology of gestational rhinitis is still lacking. Management of rhinitis ...
[47]
Pregnancy Rhinitis: Pathophysiological Mechanisms, Diagnostic ...
Elevated levels of estrogen, progesterone, and placental hormones are thought to contribute significantly by modifying the structure and function of the nasal ...
[48]
Hormonal Effects on Asthma, Rhinitis, and Eczema - PMC - NIH
Aug 1, 2023 · New onset rhinitis occurs in approximately 20% of pregnant women, and changes in sex hormones are considered to be the primary reason for the ...Missing: rhinorrhea | Show results with:rhinorrhea
[49]
EXERCISE INDUCED RHINITIS: A PREVALENT BUT ELUSIVE ...
Exercise induced rhinitis is defined as inflammation of the nasal passages leading to rhinorrhea, sneezing, congestion or nasal itching related to physical ...
[50]
Exercise and Rhinitis in Athletes - European Medical Journal - EMJ
Sep 12, 2019 · This review aims to investigate the physiology of the nose during exercise, examine the relationship between exercise and nasal dysfunction, and ...
[51]
Gustatory rhinitis: A syndrome of food-induced rhinorrhea
Thus, gustatory rhinitis is produced by spicy foods that stimulate atropine-inhibitable muscarinic receptors (probably on submucosal glands), and the syndrome ...Missing: cholinergic | Show results with:cholinergic
[52]
Pharmacotherapy for Nonallergic Rhinitis - Medscape Reference
Sep 25, 2023 · Gustatory rhinitis. Gustatory rhinitis occurs after eating, particularly hot and spicy foods. The end result, ie, profuse watery rhinorrhea ...
[53]
Assessment of the prevalence of respiratory pathogens and the level ...
Feb 21, 2025 · Upper respiratory tract infections (URTIs) affect the nose, throat, sinus, and larynx, and in 80–90% of cases, they are caused by viruses. Among ...
[54]
Common cold - Symptoms and causes - Mayo Clinic
May 24, 2023 · Most often, common cold symptoms start 1 to 3 days after someone is exposed to a cold virus. Symptoms vary. They can include: Runny or stuffy ...Missing: 80-90% | Show results with:80-90%
[55]
The Common Cold - PMC - PubMed Central - NIH
Clinical Manifestations. The onset of common cold symptoms typically occurs 1 to 3 days after viral infection. The first symptom noted is frequently a sore ...
[56]
Acute Sinusitis - StatPearls - NCBI Bookshelf - NIH
Aug 2, 2025 · Major symptoms: Purulent anterior nasal discharge. Purulent or discolored posterior nasal discharge. Nasal congestion or obstruction. Facial ...
[57]
Acute Bacterial Rhinosinusitis - AJMC
Acute bacterial rhinosinusitis (ABRS) occurs in approximately 0.5% to 2% of all cases of viral upper respiratory tract infections (URI).
[58]
Current Concepts in Adult Acute Rhinosinusitis - AAFP
Jul 15, 2016 · Four signs and symptoms that significantly increase the likelihood of a bacterial cause when present are double sickening, purulent rhinorrhea, ...
[59]
Allergic rhinitis | Nature Reviews Disease Primers
Dec 3, 2020 · Allergic rhinitis (AR) is caused by immunoglobulin E (IgE)-mediated reactions to inhaled allergens and is one of the most common chronic conditions globally.
[60]
Treatment of Allergic Rhinitis - AAFP
Dec 1, 2015 · Allergic rhinitis is an immunoglobulin E–mediated disease that occurs after exposure to indoor or outdoor allergens, such as dust mites, insects ...<|control11|><|separator|>
[61]
Nonallergic rhinitis with eosinophilia syndrome - PubMed
The pathophysiology of NARES is poorly understood, but a key component involves a self-perpetuating, chronic eosinophilic nasal inflammation with development of ...
[62]
Persistence of post-COVID symptoms in the general population two ...
Dec 13, 2023 · The prevalence of post-COVID symptoms is 30% two-years after COVID-19. Fatigue, cognitive disorders, and pain are the most prevalent post-COVID symptoms two- ...Missing: rhinorrhea | Show results with:rhinorrhea
[63]
Post-COVID-19 Symptoms Common 2 Years After Infection
Jan 26, 2024 · The most frequently occurring post-COVID respiratory and general symptoms were fatigue (28.0%), runny nose (8.2%), and dyspnea (5.7%). Post- ...
[64]
Cerebrospinal Fluid Leak - StatPearls - NCBI Bookshelf - NIH
Aug 2, 2025 · Traumatic rhinorrhea is classified according to the timing, and the diagnostic evaluation differs for each type. In the acute/early-onset ...
[65]
Diagnostic Relevance of β2-Transferrin for the Detection of ...
The β 2 -transferrin assay is a reliable method for confirming suspected CSF and should be used as a primary screening method in all patients with suspected ...
[66]
CSF Rhinorrhea Workup - Medscape Reference
Nov 18, 2024 · Beta-2 transferrin is the single most useful laboratory study that can be obtained. High-resolution CT scanning is the imaging modality of ...Imaging Studies · Computed Tomography (ct)... · Nuclear Medicine Studies
[67]
Cerebrospinal Fluid (CSF) Leak | Choose the Right Test
Aug 8, 2024 · Beta (β)-2 transferrin testing is the preferred laboratory approach to assess patients for cranial CSF leaks because it is highly specific and sensitive for ...Cerebrospinal Fluid (csf)... · Laboratory Testing · Beta-2 Transferrin
[68]
Nasal Polyps - StatPearls - NCBI Bookshelf
May 5, 2025 · Nasal polyps are benign, inflammatory outgrowths of the sinonasal mucosa that can lead to chronic nasal obstruction, congestion, and diminished quality of life.
[69]
Nasal Polyps: Symptoms, Causes, Treatment & Removal
Nasal polyps are noncancerous growths that can form in your nose or sinuses. They're more common with allergies, asthma or frequent infections.
[70]
Nasal and Sinus Tumors: Symptoms, Causes, and Treatment
Mar 19, 2024 · Common Symptoms · Persistent nasal congestion or stuffiness · Sinus pain or pressure · Frequent nosebleeds · Decreased sense of smell · Post-nasal ...
[71]
Rhinorrhoea - ent4gp.com
Unilateral serosanguinous nasal discharge may rarely be due to sinonasal malignancy. There are usually other associated symptoms such as pain and nasal ...
[72]
Nasal Foreign Body - StatPearls - NCBI Bookshelf
Nasal foreign bodies are usually benign but have the potential to cause mucosal damage, bleeding, infection, and aspiration.
[73]
Foreign Bodies in the Nose | Children's Hospital of Philadelphia
The most common symptom of a foreign body in the nose is nasal drainage. The drainage appears only on the side of the nose with the object, and often has a bad ...
[74]
Nasal Foreign Bodies: Overview, Patient History, Physical Examination
Aug 4, 2023 · Nasal foreign bodies (NFBs) are a common complaint in the emergency department (ED), especially among children, as well as adults with intellectual ...
[75]
Rhinitis in patients with acquired hypothyroidism
Aug 4, 2020 · Nasal obstruction and rhinorrhea are the most commonly encountered complaints of hypothyroidism. Before and after the thyroid replacement ...Missing: rhinorrhea | Show results with:rhinorrhea<|separator|>
[76]
ACE inhibitors: upper respiratory symptoms - PMC - NIH
Cough and angioedema are well-known adverse reactions of ACE inhibitors. However, other adverse effects of upper airways such as postnasal drainage, rhinitis ...
[77]
Post-procedure Rhinitis After Use of Sedatives and Supplemental ...
Mar 22, 2022 · Impingement of nasal oxygen cannula against the nasal mucosal membrane in a sedated patient can result in nonallergic rhinitis. Based on this ...
[78]
Is clear, watery discharge normal 2 days post-op after a septoplasty?
Apr 20, 2014 · A clear drainage from the nose after a rhinoplasty is called rhinitis and is very common. A CSF leak is extremely uncommon but can occur.Missing: rhinorrhea non-
[79]
Runny nose Causes - Mayo Clinic
such as colds, flu or sinusitis — and allergies often cause runny and stuffy noses. Some people have noses that run all the time without a known ...
[80]
Respiratory Tract Symptom Complexes - PMC - PubMed Central
In uncomplicated viral nasopharyngitis or rhinitis, the nasal discharge initially is clear but can become white, yellow, or green due to mucous secretions, ...
[81]
Allergic Rhinitis: A Clinical and Pathophysiological Overview - PMC
Apr 7, 2022 · Nasal symptoms include anterior or posterior rhinorrhea, sneezing, nasal blockage and/or itching of the nose (9). These symptoms may persist for ...
[82]
Chronic Cough, Reflux, Postnasal Drip Syndrome, and the ... - NIH
Associated symptoms and negative outcomes with this condition include loss of sleep, exhaustion, irritability, urinary incontinence, cough syncope, social ...Missing: impact | Show results with:impact
[83]
Effects of a Proton-Pump Inhibitor on Postnasal Drip Symptoms in ...
This condition is marked by a variety of symptoms, including frequent throat clearing, a hoarse voice, the sensation of a foreign object in the throat, a sore ...
[84]
Neonatal Nasal Obstruction: A Comprehensive Analysis of Our 20 ...
Feb 18, 2024 · Synechia formation between septum and turbinate can be seen and the child might have respiratory distress and feeding problems.
[85]
Pediatric Bronchiolitis - StatPearls - NCBI Bookshelf - NIH
Severe symptoms include poor feeding, lethargy, cyanosis, and signs of respiratory distress or failure (such as grunting and belly breathing). Diagnosis is ...<|control11|><|separator|>
[86]
Rhinitis and Sinusitis - PMC - PubMed Central - NIH
Mucus during infection becomes thick and difficult to clear. Granulomas/Vasculitis. A number of granulomatous diseases may involve the nose and sinuses as ...Missing: yellow | Show results with:yellow
[87]
Multi-morbidities of allergic rhinitis in adults - PubMed Central - NIH
Jun 1, 2017 · If turbinate hypertrophy develops, it causes persistent nasal congestion and, sometimes, pressure and headache in the middle of the face and ...
[88]
Can Postnasal Drip Contribute to Bad Breath?
Jun 1, 2012 · Many people with chronic postnasal drip also report symptoms of frequent throat clearing, coughing or hoarseness and change in their voice.
[89]
Sinus Infection Basics - CDC
Apr 17, 2024 · Runny nose; Stuffy nose; Facial pain or pressure; Headache; Mucus dripping down the throat (post-nasal drip); Sore throat; Cough; Bad breath ...Missing: halitosis | Show results with:halitosis
[90]
Evaluation of Children with Chronic Rhinosinusitis after ... - NIH
Chronic rhinosinusitis (CRS) is diagnosed when a child experiences symptoms of nasal congestion, rhinorrhea, post nasal drip, halitosis, cough, headaches, or ...Missing: irritation | Show results with:irritation
[91]
Relationship between allergic rhinitis and allergic conjunctivitis ...
Allergic rhinitis and allergic conjunctivitis are often concomitant diseases showing a strong epidemiological correlation.Missing: pain | Show results with:pain
[92]
Rhinitis and Sinusitis - PMC - NIH
Symptoms include nasal congestion, clear to mucopurulent nasal discharge, a sensation of discomfort and pressure in the face, headache, olfactory disturbances, ...
[93]
Epistaxis - StatPearls - NCBI Bookshelf - NIH
Sep 12, 2022 · The rupture of a blood vessel within the nasal mucosa causes nosebleeds. Rupture can be spontaneous, initiated by trauma, use of certain ...Missing: fever | Show results with:fever
[94]
Diagnosis and management of chronic rhinosinusitis - PMC
Feb 18, 2025 · Unilateral, persistent, salty, or metallic-tasting rhinorrhea, Cerebrospinal fluid leak ; Recurrent or persistent epistaxis, Neoplasm, nasal ...Missing: tumor | Show results with:tumor
[95]
https://pmc.ncbi.nlm.nih.gov/articles/PMC11835454/
[96]
Allergic Rhinitis Clinical Presentation: History, Physical, Causes
Feb 14, 2023 · A thorough history may help identify specific triggers, suggesting an allergic etiology for the rhinitis. Symptoms that can be associated with ...History · Physical · Causes<|separator|>
[97]
Differentiating Rhinitis in the Paediatric Population by Giving Focus ...
Feb 26, 2019 · Chronic rhinitis is defined as an inflammation of the nasal epithelium, and is characterized by the presence of two or more specific nasal ...
[98]
Scraping nasal cytology in the diagnostics of rhinitis and the ...
Aug 25, 2022 · Nasal scraping cytology is a non-invasive tool used in the diagnostics of allergic and non-allergic rhinitis.
[99]
Use of Beta-2-Transferrin to Diagnose CSF Leakage Following ... - NIH
With sensitivity of 94% - 100%, and specificity of 98% - 100%, this assay has become the gold standard in detection of CSF leakage. While the beta-2-tranferrin ...
[100]
Nasal polyps - Diagnosis and treatment - Mayo Clinic
Aug 8, 2023 · Imaging studies. CT scans can show the size of polyps deep in the sinuses and where they are. These studies can also help rule out other reasons ...Diagnosis · Treatment · MedicinesMissing: rhinorrhea structural fractures
[101]
MRI of the Paranasal Sinuses - The Radiology Assistant
Feb 25, 2009 · MRI is extremely helpful in complicated sinonasal disease. MRI can discern secretions and mucosa from masses.Role Of Ct And Mri · Enhancement · Tumor And Tumorlike Lesions
[102]
Diagnosing Allergic Rhinitis: Skin Test vs. IgE Testing - AAFP
May 1, 2006 · Furthermore, the latest generation of specific IgE blood tests have been shown to be comparable to skin-prick testing in terms of sensitivity, ...
[103]
Diagnostic Tools in Allergic Rhinitis - Frontiers
Sep 22, 2021 · The presence of atopy, positive skin prick test (SPT) and/or detectable serum allergen-specific IgE (sIgE), further classifies allergic patients ...
[104]
Nasal Swab: MedlinePlus Medical Test
Aug 5, 2024 · A nasal swab is a test that checks for viruses and bacteria that cause respiratory infections. There are many types of respiratory infections.
[105]
Nose Smear - an overview | ScienceDirect Topics
Bacterial cultures or antigen detection is useful ... Nasal swab cultures may provide organism identification in the presence of purulent nasal discharge.Laboratory Medicine · Nasal Swabs · Nasal And Paranasal Sinus...
[106]
B73: Respiratory Outbreaks in Community Settings
Aug 25, 2025 · Collect a nasopharyngeal swab specimen using a synthetic-tip flocked swab. Place swabs in viral transport medium (VTM) or universal transport ...
[107]
Investigation of the Effectiveness of Nasal Sprays in Allergic Rhinitis
Oct 10, 2024 · In a 2012 meta-analysis, Hermelingmeier et al showed that nasal saline irrigation reduced AR symptoms by 27.66%, medication use by 66%, ...<|separator|>
[108]
Nasal Irrigation as Treatment in Sinonasal Symptoms Relief - NIH
Jan 13, 2017 · Daily nasal irrigation with seawater significantly improved the symptoms of the allergic rhinitis, proving its effectiveness in controlling ...
[109]
Nasal saline irrigation: prescribing habits and attitudes of physicians ...
Feb 11, 2021 · The majority of the respondents recommended nasal saline irrigation for their patients either as a symptomatic treatment (98.0%) or to treat a ...
[110]
Oxymetazoline (nasal route) - Side effects & dosage - Mayo Clinic
Sep 1, 2025 · Oxymetazoline is used for the temporary relief of nasal (of the nose) congestion or stuffiness caused by hay fever or other allergies, colds, or sinus trouble.Before Using · Drug Interactions · Proper Use
[111]
Rhinitis Medicamentosa - StatPearls - NCBI Bookshelf - NIH
Sep 4, 2023 · Rhinitis medicamentosa (RM), also known as 'rebound congestion' is inflammation of the nasal mucosa caused by the overuse of topical nasal decongestants.Missing: hypertrophy | Show results with:hypertrophy<|separator|>
[112]
Treatment of Allergic Rhinitis - AAFP
Jun 15, 2010 · Compared with first-generation antihistamines, second-generation antihistamines have a better adverse effect profile, including less sedation ( ...
[113]
Allergic Rhinitis Medication: Antihistamines, 2nd Generation ...
Feb 14, 2023 · The newer, second-generation (ie, nonsedating) antihistamines are usually preferable to avoid sedation and other adverse effects associated ...<|separator|>
[114]
Evidence-based use of antihistamines for treatment of allergic ...
Jul 28, 2023 · Second-generation antihistamines are superior to first-generation antihistamines due to high H1 receptor selectivity, low brain permeability, ...
[115]
Nonallergic rhinitis - Diagnosis & treatment - Mayo Clinic
Mar 14, 2023 · Allergies often cause symptoms such as sneezing and a stuffy, runny nose. ... Or you could breathe in the steam from a warm shower. This ...
[116]
Steam Inhalation: Benefits, Risks, and How To - Healthline
Aug 31, 2023 · Steam inhalation won't directly treat an illness, but it can help loosen mucus and decrease irritation in your sinuses.
[117]
Effectiveness of steam inhalation and nasal irrigation for chronic or ...
Advice to use steam inhalation for chronic or recurrent sinus symptoms in primary care was not effective. A similar strategy to use nasal irrigation was less ...
[118]
Treatments for post-nasal drip - Harvard Health
A humidifier or steam inhalation (as during a hot shower) · Keeping well-hydrated (to keep the mucus thinner) · Sleep on propped up pillows, to keep the mucus ...Can't shake that cough? · Why does everything taste... · Sinusitis
[119]
The common cold in adults: Treatment and prevention - UpToDate
Oct 7, 2025 · Outline · - Antibiotic therapy · - Antihistamines · - Antiviral therapies · - Vitamins and herbal remedies · - Other.
[120]
Upper Respiratory Tract Infection Treatment & Management
May 30, 2024 · Symptom-based therapy represents the mainstay of URI treatment in immunocompetent adults, although antimicrobial or antiviral therapy is appropriate in ...
[121]
Intranasal corticosteroids for allergic rhinitis - PubMed
Intranasal corticosteroids are accepted as safe and effective first-line therapy for allergic rhinitis. Several intranasal corticosteroids are available.
[122]
Intranasal Corticosteroids: Topical Potency, Systemic Activity ... - NIH
Sep 8, 2021 · Intranasal corticosteroid (INCS) therapy is the preferred treatment option for allergic rhinitis (AR). As many patients with AR also have asthma ...
[123]
Immunotherapy in Allergic Rhinitis: It's Effect on the Immune System ...
Jul 20, 2018 · Subcutaneous immunotherapy for specific allergens decreases clinical symptoms in patients with allergic rhinitis and induces tolerance in T lymphocytes.
[124]
Immunotherapy can Provide Lasting Relief | AAAAI
Research has demonstrated that allergy immunotherapy can be effective in treating: • Allergic asthma • Allergic rhinitis and conjunctivitis • Stinging ...
[125]
CSF Rhinorrhea Treatment & Management - Medscape Reference
Nov 18, 2024 · Unless surgical contraindications exist, operative repair is recommended in patients with spontaneous or iatrogenic CSF rhinorrhea in order to prevent ...Complications · Surgical Care · Endoscopic Surgical Techniques · Consultations
[126]
CSF leak (Cerebrospinal fluid leak) - Diagnosis and treatment
Nov 21, 2023 · Surgery may involve repairing the CSF leak with stitches or grafts made from patches of muscle or fat. Trans-venous embolization. This minimally ...
[127]
Contemporary Management of Cerebrospinal Fluid Rhinorrhoea
Feb 4, 2025 · Endoscopic repair of CSF rhinorrhoea continues to evolve, with modern techniques significantly enhancing success rates and reducing morbidity.
[128]
Nasal Polyp Surgery - Medscape Reference
Jul 23, 2024 · Polyp formation in the nasal cavity is due to chronic allergic rhinitis, chronic sinusitis, and, less commonly, underlying disease such as cystic fibrosis.
[129]
Septoplasty - StatPearls - NCBI Bookshelf
The main indication for performing a septoplasty is a nasal septal deformity. This is usually a deviation of the cartilaginous and/or bony parts of the septum ...
[130]
The benefits of septoplasty for patients with deviated nasal septum ...
Nov 21, 2024 · Patients with a deviated nasal septum and allergic rhinitis benefit more from septoplasty. However, the procedure should be performed cautiously by experienced ...
[131]
FDA Approves Dupixent® (dupilumab) for Chronic Rhinosinusitis ...
Jun 26, 2019 · Dupixent is the first FDA-approved medicine for adults with chronic rhinosinusitis with nasal polyposis, and the only approved therapy shown to shrink nasal ...
[132]
FDA Approves Dupilumab for Chronic Rhinosinusitis With Nasal ...
Jun 27, 2019 · Dupilumab (Dupixent) has gained FDA approval for the treatment of chronic rhinosinusitis with nasal polyps, marking the first biologic approved for adults.
[133]
Nonallergic Rhinitis - Ear, Nose, and Throat Disorders
Vasomotor rhinitis results in watery rhinorrhea and postnasal drip. The turgescent (highly vascularized) nasal mucous membrane varies from bright red to purple.
[134]
Medication adherence in allergic diseases and asthma - NIH
Dec 2, 2024 · This literature review seeks to compile and synthesize current insights on factors that influence adherence, as well as explore potential ...
[135]
Multi-morbidities of allergic rhinitis in adults: European Academy of ...
Jun 1, 2017 · AR is a systemic allergic disease and is generally associated with numerous multi-morbid disorders, including asthma, eczema, food allergies, eosinophilic ...Food Allergy · Rhinosinusitis · Otitis Media With Effusion...
[136]
Study Details | NCT05080322 | Efficacy and Safety of On-demand ...
However, up to 70% of patients suffering from AR do not follow treatment recommendation, they stopped medication when they feel better. This behavior always ...
[137]
Treating rhinitis in the older population: special considerations
Dec 1, 2009 · The incidence of allergic rhinitis decreases with age. The peak incidence of 37 per 1000 occurs at 10 to 15 years of age, with the incidence ...
[138]
Rhinorrhea - an overview | ScienceDirect Topics
Rhinorrhea is defined as an extremely rare complication of rhinoplasty, often associated with misdirection of nerves within the septum that stimulate the ...<|separator|>
[139]
Incidence of Acute Otitis Media and Sinusitis Complicating Upper ...
Jun 1, 2007 · It has been found that 29% to 50%1,2 of all URIs develop into AOM and 5% to 10% develop into sinusitis.Missing: rhinorrhea | Show results with:rhinorrhea
[140]
Diagnosis and treatment of cerebrospinal fluid rhinorrhea following ...
The authors review here the pathophysiology, diagnosis, and management of CSF rhinorrhea relevant exclusively to traumatic anterior skull base injuries.Methods · Results · Classification of Anterior Skull... · Diagnosis of CSF Rhinorrhea
[141]
Risk of death in patients with post-traumatic cerebrospinal fluid ...
The mortality rates were 8.5% (48/568) in the otorrhea subgroup, 10.9% (33/302) in the rhinorrhea subgroup, and 8.6% (78/903) in the tension pneumocephalus ...
[142]
Perforated Septum: Symptoms, Causes & Treatment - Cleveland Clinic
Apr 14, 2025 · A perforated septum (septal perforation) is a hole in the cartilage or bone in between your nostrils. Causes include injuries and conditions ...
[143]
Nasal obstruction as a risk factor for sleep-disordered breathing
Experimentally produced nasal obstruction increases resistance and leads to sleep-disordered breathing events, including apnea, hypopnea, and snoring.
[144]
New progress in pediatric allergic rhinitis - Frontiers
Over 80% of asthma patients are also affected by AR, while approximately 10-40% of AR patients have asthma (71). The inflammatory processes in the nasal mucosa ...Etiology · Diagnosis · Classification · Treatment and health...
[145]
Rhinitis Medicamentosa: Background, Etiology, Pathophysiology
Mar 31, 2025 · Rhinitis medicamentosa (RM), also known as rebound rhinitis, is a condition characterized by nasal congestion that is triggered by the overuse of topical ...