Rhinorrhea (also rhinorrhoea especially in UK English) is a term for a discharge or flow from the nose. Some sources give a rather more precise definition as a discharge from the nasal mucous membranes and, although this is usually the case, there are rare instances where the the flow initiates elsewhere. As with most medical terms, the name is written as new Latin but it originates from the old Greek words “rhino” meaning nose and “rhoia” meaning a flow. Everyone is familiar with the symptoms of a runny nose but the term rhinorrhea goes a little further being an all-encompassing name for nasal congestion including post-nasal drip.
When considering the common symptoms of rhinorrhea, it is useful to first look at the normal functioning of the nasal mucous membranes. These specialised membranes constantly secrete mucous to line the nasal cavities. There are various reasons for this, the first and perhaps most obvious being to act as an air cleaner entrapping any particulate matter before it can reach further into the respiratory tract. This mucous lining also provides an effective barrier against microscopic particles including bacteria, viruses, fungi and other pathogens.
Another function is related to the sense of smell with minute levels of odorants becoming dissolved in the mucous-coated lining of a specific part of the nasal cavity where these molecules can then be analysed by the olfactory receptors. It is also believed that the mucous membranes serve as heat-exchangers conditioning the temperature of the inhaled air. The production of mucus is normally a steady constant process with the nasal mucous lining usually being completely renewed around six times an hour.
Rhinorrhea occurs at times when mucous is being created at a greater rate than it is being removed resulting in a build-up of nasal mucous. This excess mucous typically blocks the air passages making it difficult or impossible to breathe through the nose. The mucous may be discharged in the form of a runny nose or as post-nasal drip where it may accumulate in the back of the throat. In some cases, blockages of the openings to the sinuses (air-filled cavities in the skull) can occur interrupting the flow of sinus mucous. This can lead to sinusitis. The Eustachian tube connects the nasal cavity to the ear and, particularly in the case of children, earache can occur. Coughing, sneezing and a sore throat are all symptoms commonly associated with rhinorrhea and nose-bleeds may also accompany the condition.
Rhinorrhea is a symptom rather than a disease and it can be caused by a variety of things. As the mucous membranes form part of the body’s defence mechanism, the rates of mucous production vary and, in the presence of a threat or perceived threat, levels will increase. A simple example of this is found in the condition known as gustatory rhinorrhea in which a runny nose follows the consumption of a spicy food such as a hot curry. There are many other types of allergic rhinorrhea including hay fever and hypersensitivity to many other allergens such as dust mites and pets. Perhaps the best known cause of rhinorrhea is the common cold but various other viral, as well as bacterial and fungal infections can also give rise to the condition.
In most cases, the symptoms of rhinorrhea will recede as the disease runs its course but chronic, long-term rhinorrhea also occurs. This can be a symptom of a serious condition such as cystic fibrosis or even a tumour but is more often due to a deviated septum or nasal polyp. Other times when rhinorrhea may be observed include when crying. Tears are almost invariably accompanied by a runny nose. The weather also affects mucous production and cold or very dry environments cause the mucous membranes to work extra hard to compensate for the drying or chilling effect. This is typically noticed when entering a warm house after spending time outside in the cold and a runny nose is almost inevitable in such circumstances. Other possible causes include cocaine abuse or the withdrawal of opioid medications.
Effective treatment of rhinorrhea depends on dealing with the causative factors. In the case of allergic rhinorrhea, avoidance of the allergens triggering the condition is the first step but where this is impractical or impossible, the use of antihistamines usually relieves the symptoms. The same applies to other simple physical causes and understanding the causes allows suitable avoidance action to be taken. Cases involving infections are rather more difficult and in some cases suitable medication can be effective but most viral infections are fairly short-lived and in these cases it is usually best to simply allow the disease to run its course. The treatment of chronic rhinorrhea depends on the specific reasons and may require intervention to correct any physical abnormalities. Chronic cases can also be associated with chronic sinusitis in which case the sinus problems need to be addressed. Although in some cases of rhinorrhea, the symptoms may be relieved by the use of decongestant and anti-inflammatory drugs, many patients opt for home remedies and many are available including the use of steam, saline nasal irrigation, eating various pungent spicy foods, and drinking herbal tea. When suffering from rhinorrhea, it is advisable to sleep with the head elevated with an extra pillow.
Rhinorrhea Classification ICD9 & ICD10
The increasing use of diagnostic codes is particularly relevant to the field of health insurance and, especially in the US, each condition has a specific code assigned to it. The current code for rhinorrhea is ICD-10 J 34.8. The previous code (up until 2015) was ICD-9-CM 478.19. For specific types of rhinorrhea, more specific codes may be available.
Rhinorrhea v. Rhinitis
There is often some confusion regarding the distinction between rhinorrhea and rhinitis and the two words are sometimes erroneously regarded as being interchangeable. Both refer to the nose of course but the suffix “rrhea” denotes a flow or discharge whereas “itis” refers to inflammation. In many cases both inflammation and discharge may be present and, in such cases the correct description would be “rhinitis and rhinorrhea”.
All of the above information refers to the normally accepted definition of rhinorrhea i.e. excessive discharge of mucous from the nasal mucous membranes but there is a rare and potentially life-threatening condition in which fluid discharged from the nose consists not of mucous but cerebrospinal fluid. The most common cause of this is trauma and it normally indicates a basal skull fracture. Such a discharge is typically unilateral and constant. This is a medical emergency as there is a very real danger of infection of the meninges. Depending on the severity of the condition, treatment may be conservative (the flow often stops spontaneously) or surgical intervention may be required.