A runny nose is referred to medically as rhinorrhoea. Rhinorrhoea can be due to a number of causes and can take several forms:

  • A continually streaming nose
  • A nose which runs only when there is a change of temperature or humidity
  • A problem with a runny nose at certain times of the year
  • A feeling of mucus running down the back of the throat rather than out of the front of the nose.

Each of these histories is due to a different cause

A continually streaming nose

In a child this may be due to a foreign body which has found its way into one of the nostrils on the end of a finger. Children in this predicament tend to have a one sided stream of mucus out of the front of the nose which is a typical sign. Until the foreign body is removed, the symptoms will continue. There is typically a red, sore, inflamed area under the affected nostril.

Rarely, instead of developing properly, the nose fails to develop passages into the throat. The only way for mucus to travel is therefore out of the front of the nose. This is termed choanal atresia. Although it is usually diagnosed shortly after birth, occasionally it is not spotted. In these cases it is usually an ENT Specialist who will make the diagnosis. An operation is required to correct the blockage at the back of the nose and is usually very successful. Children with this condition very rarely have it affecting both sides of the nose.

In an adult the streaming nose tends to be from both nostrils and is termed rhinitis. When constant, this is called perennial rhinitis. It may be due to an allergy such as house dust mite (HDM). In many homes there is a problem with HDM all year round leading to constant symptoms. The problem may be worse at night as HDM tend to live in bedclothes, mattresses and pillows and so the sufferer is often closer to the problem at night than during the day. The allergy is to the faeces of the house dust mite which tends to rise from the mattress as a fine dust as the bedclothes and mattress warm up due to body heat. It can also exacerbate the symptoms of asthma. Although a history will often given enough information to start treatment, skin prick testing is the best way to confirm or refute this diagnosis. Treatment is by avoidance - use of hypo-allergenic covers for the mattress, pillows and bedding, and reducing sensitivity - use of a nasal spray to the nasal mucosa.

A nose which runs only when there is a change of temperature or humidity

Some people are unfortunate enough to have symptoms which occur simply by moving out of doors or walking into a room with the central heating turned on. A change in humidity, temperature, or even stress can be sufficient to produce a streaming nose often accompanied by sneezing. This condition is termed ‘vasomotor rhinitis’. Treatment is available but requires an accurate diagnosis – which is often not made until the patient sees an ENT Specialist.

A problem with a runny nose at certain times of the year

This is due to allergic rhinitis. A doctor who understands the seasonal pollen fluctuations can usually diagnose the offending plant type by the time of the year in which the symptoms are at their worst. Although avoidance is the best route this is often impossible, particularly in those who work outdoors. It is therefore best to control the symptoms before they peak by giving medications which will reduce the patients sensitivity to the offending antigen well before it is in the air. For those patients in whom symptoms are severe enough to affect their work, it is sometimes possible to desensitize them to the responsible allergen.

Desenstization works by changing the body's immune response to the allergen. It requires placing a small drop of the allergen in a solution, under the tongue over several months each year for three to five years until the sensitivity has drastically reduced or resolved completely. It tends to be very successful – particularly for grass pollen allergy.

A feeling of mucus running down the back of the throat rather than out of the front of the nose.

This is a common problem for many people and is more complicated than it seems. It may indeed be due to an excess of mucus running down the throat. It may however be due to a sensitized throat which then perceives more mucus than is actually present. Sufferers in this category may well be smokers, have heartburn, or simply have throat inflammation due to ‘silent reflux’ in which no symptoms of heartburn are present but nevertheless, enzymes from the stomach are periodically released on gas and expelled via the throat and mouth. The enzymes cause a low level of inflammation in the throat leading to a feeling of excessive mucus in the sensitized mucosa. Although the history is very important it is also necessary to pass a small camera into the nose and upper throat to examine the lining before the correct diagnosis can be made. Treatment is based upon the findings and tends to be very effective, usually without the need for surgery.

If you would like to arrange a consultation with Mr Banerjee to look into this condition further please contact us.

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