Sneezing normally occurs under the influence of chemical or physical stimuli of the nasal mucosa, when in a dry room, pregnancy. The pathological symptom occurs in acute and chronic rhinitis, allergic rhinitis, sinusitis and nasal polyps. Diagnostics includes anterior and posterior rhinoscopy, radiography of the paranasal sinuses, microbiological and cytological analysis of a nasal smear. Local therapy is carried out with nasal drops with hormones, antibiotics, immunomodulators. Treatment is supplemented with antihistamines and nonsteroidal anti-inflammatory drugs, allergen-specific immunotherapy, surgical methods.
Causes of sneezing
Physiological factors
Sneezing is a natural protective reaction of the respiratory system to stimuli. The symptom is provoked by getting dust particles into the nose, inhaling pungent odors (cigarette smoke, perfumes). People sneeze when entering cold air from a warm room and vice versa. 20-25% of people have a “light sneezing reflex” – when looking at bright light or the sun. Irritation of nerve receptors when cleaning the ears with cotton swabs also stimulates sneezing.
The symptom is often observed with prolonged stay in a room with dry air. This is especially noticeable in winter, when the radiators are working, after installing an air conditioner to heat the room. A person sneezes periodically, feels constant dryness and discomfort in the nose. At the same time, a meager amount of viscous mucus is released. Sometimes the drying out of the nasal mucosa leads to damage to the capillaries and blood veins become noticeable in the secretions.
Rhinitis of pregnant women
The condition is more often manifested in the third trimester. Sneezing is caused by hormonal changes in the woman’s body, which affect the tone of the vessels of the nasal mucosa. The symptom is noted periodically, supplemented by nasal congestion and minor mucous secretions. Sneezing appears against the background of the general satisfactory condition of a woman without typical signs of respiratory infection.
Rhinitis
The inflammatory process is the most common cause of sneezing. Runny nose occurs mainly in respiratory infections: influenza, rhinovirus, adenovirus. Less often, the symptom is associated with the action of bacterial pathogens. Sneezing is one of the first signs of incipient rhinitis, which is accompanied by discomfort and tickling in the nose, difficulty breathing. The features of the clinical manifestations of the symptom depend on the nature of the common cold:
- Acute rhinitis. Typically, frequent repeated sneezing, in which liquid transparent mucus is released. The symptom may increase with nasal flushing, instillation of medicinal drops. After 2-3 days, sneezing appears much less often, only with the accumulation of mucus in the nose.
- Vasomotor rhinitis. Periodic sneezing attacks (10-20 times) are characteristic, during which copious transparent mucus is released. Symptoms worsen after a night’s sleep, when eating food, when in contact with cold or dry air. There is no sneezing outside the paroxysm, but the patient is concerned about nasal congestion.
- Hypertrophic rhinitis. With this form of runny nose, sneezing mainly develops in the morning, when a viscous secret accumulates in the nose. The patient sneezes several times, trying to get rid of the interfering mucus. Often the discharge is so thick that they have to be removed by washing or manually.
- Ozena. Sneezing is observed in the initial stages of this form of atrophic rhinitis. Fetid mucus or pus, dried yellow or brown crusts are released from the nasal cavity. Gradually, the protective reflex disappears, which is associated with a violation of the functioning of the nasal nerve endings.
Allergic rhinitis
Seasonal rhinitis is more common, characterized by sneezing attacks at the time of contact with pollen from trees and flowers. The patient feels excruciating itching and tickling in the nose, sneezes continuously 15-20 times or more. Sneezing is combined with copious watery discharge from the nose, lacrimation, redness of the eyes. After the interruption of direct contact with the allergen, sneezing stops, but the feeling of stuffiness remains.
Year-round allergic rhinitis is detected much less frequently. It is characterized by the occurrence of paroxysms of sneezing and difficulty in nasal breathing, regardless of the season. The disease is caused by allergens that are present at home or in the environment all the time, so it is more difficult to treat. When sneezing, a person secretes watery or thicker mucus.
Bronchial asthma
The symptom is usually observed in the allergic form of the disease. Sneezing becomes a harbinger of an attack of bronchial asthma, accompanied by itching in the nose, tickling in the throat, coughing. The physiological reflex is provoked by inhaling cold air, tobacco smoke, physical exertion or stress. After 5-10 minutes, sneezing stops, the patient feels a lack of air, shortness of breath and other typical signs of paroxysm.
Sinusitis
With inflammation of the paranasal sinuses, one or two sneezes occur due to the runoff of mucus into the nasal passages. Then there is a release of a moderate amount of mucous or purulent secretion, in which there may be blood veins. Repeated sneezing occurs after nasal flushing procedures, which is caused by irritation of the mucous membrane.
Other infectious diseases
Sneezing manifests many infections — rubella, measles, mononucleosis, which are more characteristic of childhood. The symptom is accompanied by mucous secretions: with measles – abundant and watery, with rubella – scanty, more viscous. Sneezing develops in the prodromal period of the disease, after 2-3 days, typical signs for each of the infections are revealed.
Nasal polyps
With benign neoplasms of small size, patients complain of frequent sneezing and watery discharge from the nose, which do not combine with other signs of ARVI. With the proliferation of polyps, a feeling of a foreign body appears in the nasal cavity, the sneezing reflex turns on less often, the serous secret is replaced by a scanty cloudy mucus. Nasal breathing disorders are typical, nasal voice is noted.
Complications of pharmacotherapy
Periodic sneezing may be a symptom of drug-induced rhinitis resulting from the uncontrolled use of nasal decongestants (vasoconstrictor drops). As a result, constant congestion, discomfort, sneezing with the release of a small amount of mucus worries. Symptoms are reduced only by instillation of drops, but the effect lasts only 1-3 hours, after which the person is forced to use the medicine again.
Diagnostics
An otolaryngologist is engaged in finding out the causes of sneezing. At the first appointment, the doctor asks the patient how long ago the symptoms began, whether the treatment was carried out at home. With an objective examination, the specialist pays attention to the presence of skin rashes, listens to the lungs in order to detect the spread of the disease to the lower respiratory tract in time. Laboratory and instrumental methods are used for diagnostics:
- Rhinoscopy. The most informative method by which a doctor examines the nasal mucosa. The pathology manifested by sneezing is indicated by hyperemia or cyanosis of the walls of the nasal passages, swelling, the presence of bloody or purulent crusts. Rhinoscopy visualizes nasal polyps in the form of cluster-like growths.
- Radiography. An X-ray of the paranasal sinuses is required to exclude sinusitis. In chronic rhinitis with sneezing, the picture shows parietal swelling of the maxillary sinus mucosa. CT of the paranasal sinuses is recommended to assess the size and location of polyps.
- Microbiological examination. When sneezing, be sure to take a smear from the nasal mucosa or a sample of secretions for analysis for viruses and bacteria. Cytological examination of biomaterial (rhinocytogram) is necessary to determine the number and ratio of eosinophils, neutrophils, lymphocytes.
- Allergy tests. After achieving remission of pollinosis or atopic bronchial asthma, skin prick tests are performed for the most common allergens. The technique is used to identify provoking factors and, if possible, exclude their effect on the patient’s body
Treatment
Help before diagnosis
With a banal cold caused by ARVI, special therapeutic measures are not required. It is necessary to use saline solutions for rinsing the nasal cavity to remove pathogen particles and exudate, moisten the mucous membrane. If you feel stuffy and have difficulty breathing, you can use vasoconstrictor drops for no longer than 7 days, strictly following the instructions.
To reduce allergic sneezing, it is necessary to limit contact with irritating factors: to be outside less during the flowering period of trees, regularly do wet cleaning to get rid of dust. With an exacerbation of allergic rhinitis, it is advisable to exclude products that enhance the production of histamine (strawberries and citrus fruits, chocolate and coffee, peanuts).
Conservative therapy
To reduce sneezing and other nasal symptoms, local treatment is selected. There are several types of nasal drops, the choice of which takes into account the causes of rhinitis. Antimicrobial drugs are recommended for patients with a disease of bacterial etiology, for viral diseases — immunomodulators, interferons. To quickly cope with allergic sneezing, there are nasal sprays with corticosteroid hormones.
Systemic drugs are prescribed to treat the underlying disease that triggers the sneezing reflex. In the case of acute respiratory viral infections, antipyretics, immunostimulants are used, and specific antiviral medications are used for influenza. Antihistamines and leukotriene inhibitors are indicated for the treatment of allergic pathologies. With their insufficient effect, allergen-specific immunotherapy (ASIT) is resorted to.
In chronic rhinitis, nasal electrophoresis with calcium, diphenhydramine or vitamins is used. The technique reduces dryness and swelling of the mucous membrane, normalizes the tone of the vessels of the nasal cavity. Of the areas of physiotherapy for sneezing, UHF, paraffin therapy and acupuncture work best. In rare cases, treatment is supplemented with methods of homeopathic medicine.
Surgical treatment
Surgical intervention is required for chronic forms of the common cold (especially with hypertrophic form), when it is impossible to restore breathing by medical methods. The ENT surgeon uses laser vasotomy, ultrasound disintegration of the nasal passages or classical submucosal conchotomy. With ozen, the reverse operation is shown — a decrease in the lumen of the nasal passages.
