Rhinitis at children – the polietiologichesky disease which is characterized by development of local inflammatory changes of a mucous membrane of a cavity of a nose. Rhinitis at children is shown by a congestion of a nose and difficulty of nasal breath, allocations from the nasal courses, sneezing, loss of sense of smell, pressure sense in a nose, headaches. Diagnosis of rhinitis at children means survey of the child by the otolaryngologist or allergist, a forward rinoskopiya, laboratory (cytologic, virologic, bacteriological) analyses of dab from a nose cavity. Therapy of rhinitis at children includes removal of slime, an instillation of vasoconstrictive solutions, inhalations, physical therapy.
Rhinitis at children
Rhinitis at children – the acute or chronic inflammatory disease of a cavity of a nose leading to violation of free nasal breath. Rhinitis is the dominating pathology of ENT organs, making 28–30% among all diseases of the top airways at children. Children of preschool age in a year have from 4 to 9 episodes of rhinitis. Frequent or chronic incidence of rhinitis negatively influences psychomotor development of the child and success of training, increases risk of development of average otitis, sinusitis, bronchial asthma, pneumonia and other complications. Considering degree of prevalence and medico-social importance of inflammatory diseases of a cavity of a nose at children's age, the solution of this problem is found in focus of special attention of various disciplines: pediatrics, children's otolaryngology, allergology, pulmonology.
The rhinitis reasons at children
Rhinitis at children can be as independent pathology of virus, bacterial or allergic genesis, and one of displays of various infections (flu, paraflu, an adenoviral infection, measles, whooping cough, scarlet fever, diphtheria, a meningococcal infection, etc.).
Rhinitis at children is caused by mainly kokkovy flora (a streptococcus, a pneumococcus, staphylococcus, Friedlander's stick) or the filtered viruses (flu A, B, C, paraflu, adenoviruses, rhinoviruses, Koksaki's viruses and ECHO, respiratory viruses). Development of rhinitis in children is more rare happens is connected with atypical (a mycoplasma, hlamidiya, legionella) and specific bacterial microorganisms (causative agents of gonorrhea, tuberculosis), fungi.
The mucous membrane of a cavity of a nose is the first and major barrier blocking penetration of microorganisms into a respiratory path. It is normal bacteria and viruses are adsorbed by the slime emitted by sekretorny cells of a mucous membrane of a nose and then are removed by means of a vibrating epithelium. Changes of the environment (cold or dry air, dust content, the irritating smells, the general overcooling) cause insolvency of protective functions of a mucous membrane. Violation of local protection leads to penetration of a virus into cells of a mucous membrane, release of its nucleinic acids from fibrous casings, intracellular maturing and reproduction with the subsequent exit from the perishing cage. At the following stage there is an accession of bacterial flora.
At chronic rhinitis at children permanent infiltration and a degeneration of a mucous membrane develop, and at a long current – its hypertrophy or an atrophy. As the contributing factors reducing protective functions of a mucous membrane of a nose and causing development of rhinitis in children adenoides, tonsillitis, the sinusitis latentno proceeding, a foreign matter of a cavity of a nose, ekssudativno-catarrhal and limfatiko-hypoplastic diathesis, vaccination, etc. can act.
Allergic rhinitis at children is the IgE-mediated inflammation caused by influence of various allergens (animal, dust, pollen, food and so forth). Development of vasomotorial rhinitis in children is promoted by a curvature of a nasal partition, nose cavity polyps, adenoides, prolonged use of vasoconstrictive drops in a nose, etc. factors against the background of which disorder of neurovegetative and endocrine regulation, vascular neurosis and microcirculator violations in a mucous membrane of a nose develops.
Classification of rhinitis at children
Rhinitis at children differs in a form (sharp or chronic), etiologies (infectious, allergic, traumatic), to a current (seasonal, pristupoobrazny, constant). Development of sharp rhinitis in children takes place three stages:
- irritation stage – it is characterized by a nose congestion, dryness, hypostasis and hyperaemia of a mucous membrane;
- serous – is followed by sharp violation of passability of the nasal courses, plentiful rinorey, slezotecheny, sneezing, symptoms of conjunctivitis;
- stage of mucopurulent allocations – it is characterized by a condensation and gradual reduction of mucopurulent allocations.
Serve as separate types of chronic rhinitis at children:
- idle time catarrhal
- hypertrophic (vascular (kavernozny), edematous, fibrous, polipozny and mixed forms; diffusion and limited options)
- atrophic (idle time, ozena (fetid cold)
- vasomotorial (allergic and neurovegetative forms)
Symptoms of sharp rhinitis at children
The hard sharpest rhinitis proceeds at newborns (especially premature) and babies that is connected with prevalence of the general symptoms and frequent complications. The narrowness of the nasal courses and the small vertical size of a nasal cavity leads to the fact that even at small swelling mucous a nose nasal breath sharply is at a loss or stops. At rhinitis at babies "flying" breath is noted – the child breathes superficially and often. Sharply there is impossible a sucking, the sleep is interrupted, there is a concern, body temperature increases.
The compelled oral breath leads to swallowing air (aerofagiya); on this background dispepsichesky frustration (vomiting, a liquid chair) join, the child loses body weight. At the long and expressed difficulty of breath the hypoxia develops that causes delay of psychomotor development. Considerable narrowing of the nasal courses forces the child to throw back the head back to facilitate breath – arises so-called false , characterized by tension of a big fontanel, spasms.
Owing to tendency of babies to generalization of any inflammation, sharp rhinitis at them can be followed by pharyngitis (rinofaringit), to be complicated by stomatitis, otitis, etmoidity, nose threshold dermatitis, zaglotochny abscess, dakriotsistity, trakheobronkhity and bronchial pneumonia.
At children of advanced age sharp rhinitis develops quickly. In the beginning there is a feeling of tickling, burning and scratching in a nose cavity. Further development of a disease is characterized by a nose congestion, plentiful mucous allocations, sneezing, dacryagogue, decrease in sense of smell, pressure sense in a nose bridge, a headache. The continuous expiration of slime irritates skin of a threshold of a nose and an upper lip, being followed by reddening and formation of painful cracks.
Violation of a drainage of a cavity of a nose at rhinitis promotes accession of bacterial flora and change of character of mucous separated – it becomes muddy, yellowish-greenish. Together with it there is an improvement of a condition of children: subsiding of the general symptoms, reduction of the quantity separated improvement of nasal breath. All displays of sharp rhinitis at children usually abate by 7-8 day.
Symptoms of chronic rhinitis at children
Simple chronic catarrhal rhinitis at children on the manifestations is close to a sharp form, however proceeds with the less sharply expressed symptomatology. Constant mucous or mucopurulent allocations, periodic violation of nasal breath, an alternate mortgaging one, other half of a nose are noted. At slime flowing in a nasopharynx the child has a persuasive cough or vomiting.
Chronic hypertrophic rhinitis at children is followed by the continuous and sharply expressed difficulty of nasal breath, a headache, decrease in hearing and sense of smell, violation of a voice owing to the closed rinolaliya, increased fatigue, decrease in progress of the child at school.
Vasomotorial rhinitis usually occurs at children of school age and proceeds with periodic violation of nasal breath, plentiful rinorey, attacks of sneezing, dacryagogue. At children paresteziya, the increased perspiration, face reddening, tachycardia, pristupoobrazny headaches are characteristic of this form of rhinitis. Usually attacks of cold are provoked by nervous tension, fluctuations of temperature and other irritants.
Atrophic rhinitis occurs at children rather infrequently and usually proceeds in the form of an ozena, or fetid cold. Existence in a nose of the rough crusts exuding specific, extremely unpleasant smell is a typical sign of an ozena. Owing to an anosmiya patients do not feel the fetid odor proceeding from itself. Among other symptoms of atrophic rhinitis take place painful dryness in a nose, violation of nasal breath, existence is difficult otsmarkivayemy viscous allocations, nasal bleedings. Owing to an atrophy of bone walls of a cavity of a nose deformation of an external nose with flattening and a zapadeniye of a bone part of a back ("a duck nose") can be noted.
The current, diagnostics and treatment of allergic rhinitis at children are in detail considered in the relevant article.
Diagnosis of rhinitis at children
Primary diagnosis of rhinitis at children is carried out by the pediatrician; consultation of the children's otolaryngologist is necessary for definition of a form of cold and medical tactics. The diagnosis of rhinitis is made on the basis of the anamnesis, complaints of the child or the parents epidemiological yielded of results of tool and laboratory inspection. At allergic rhinitis children have to be examined by the allergist-immunologist.
For performing differential diagnostics and the choice of etiotropny treatment results of a rinoskopiya to the child have the greatest value; data of a cytologic, virologic or bacteriological research of dab from a nose; immunological blood tests. At endoscopy of a cavity of a nose narrowing of the nasal courses, a stagnant krovenapolneniye and hypostasis of a mucous membrane mainly in the field of the lower nasal sinks usually comes to light.
For an exception of a rinosinusit the X-ray analysis of additional bosoms can be required; for an exception of a rinofaringit – a faringoskopiya. If necessary the endoscopic biopsy and a histologic research of a bioptat mucous a nose is carried out.
Treatment of rhinitis at children
At sharp rhinitis at children, mainly, symptomatic treatment is shown. The nose cavity toilet (suction of slime at babies, a softening and removal of crusts), irrigational therapy (washing of a cavity of a nose isotonic solution), endonasal instillation of vasoconstrictive and antiviral medicines, irrigation (spraying) of a cavity of a nose by antiseptics, inhalations is carried out. Good effect at rhinitis at children the distracting therapy (statement of cans, mustard plasters, carrying out mustard foot bathtubs) has.
According to indications febrifugal, antihistaminic, immunocorrective, antiviral or antibacterial medicines of local and general action are appointed. From physical therapy methods at rhinitis at children OKUF-therapy, UVCh, an endonasal electrophoresis, , a parafinolecheniye are used. Treatment of infectious and allergic rhinitises at children can be carried out by means of homeopathic medicine. In this case selection of medicines and their dosage is carried out by the children's homeopathist.
At treatment of chronic rhinitis at children, first of all, it is necessary to remove a cause of illness in this connection carrying out operation on structures of a cavity of a nose and throat can be required by the child (to an adenotomiya, a submucous resection of a partition, ultrasonic disintegration, cryodestruction of a hypertrophied mucous membrane of nasal sinks, a submucous vazotomiya, a konkhotomiya, a resection of nasal sinks, septoplastik, etc.). At vasomotorial rhinitis at children intra nasal blockade with a hydrocortisone, novocaine are shown; specific hyposensitization, magnetotherapy, IRT, lazero-and electroacupuncture.
The forecast and prevention of rhinitis at children
At children recovery, a frequent recurrence (can be a rhinitis outcome at virus and allergic forms), development of complications from ENT organs and airways. Treatment of rhinitis at children should not be performed uncontrolledly as prolonged or unreasonable use of medicines can cause development of atrophic process, allergic reaction, paresis of nasal vessels, "medicamentous" cold.
Prevention of rhinitis at children includes a package of measures, the harmful factors providing an exception of influence, timely treatment of the accompanying infections and LOR-pathologies, holding the tempering procedures and the all-strengthening gymnastics, the good vitaminized nutrition, maintenance of optimum climate indoors.