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In most cases treatment for rhinorrhea is not necessary since it will clear up on its own—especially if it is the symptom of an infection. For general cases blowing your nose can get rid of the mucus buildup. Though blowing may be a quick-fix solution, it would likely proliferate mucosal production in the sinuses, leading to frequent and higher mucus buildups in the nose. Alternatively, saline nasal sprays and vasoconstrictor nasal sprays may also be used, but may become counterproductive after several days of use, causing rhinitis medicamentosa.
In recurring cases, such as those due to allergies, there are medicinal treatments available. For cases caused by histamine buildup, several types of antihistamines can be obtained relatively cheaply from drugstores.
People who prefer to keep clear nasal passages, such as singers, who need a clear nasal passage to perform, may use a technique called "nasal irrigation" to prevent rhinorrhea. Nasal irrigation involves rinsing the nasal cavity regularly with salty water or store bought saline solutions.
First-generation antihistamine has been suggested as first-line therapy to treat post-nasal drip.
The treatment of nasal congestion frequently depends on the underlying cause.
Alpha-adrenergic agonists are the first treatment of choice. They relieve congestion by constricting the blood vessels in the nasal cavity, thus resulting in relieved symptoms. Examples include oxymetazoline and phenylephrine.
Both influenza and the common cold are self-limiting conditions that improve with time; however, drugs such as acetaminophen (paracetamol), aspirin, and ibuprofen may help with the discomfort.
A cause of nasal congestion may also be due to an allergic reaction caused by hay fever, so avoiding allergens is a common remedy if this becomes a confirmed diagnosis. Antihistamines and decongestants can provide significant symptom relief although they do not cure hay fever. Antihistamines may be given continuously during pollen season for optimum control of symptoms. Topical decongestants should only be used by patients for a maximum of 3 days in a row, because rebound congestion may occur in the form of rhinitis medicamentosa.
Nasal decongestants target discomfort directly. These come as nasal sprays like naphazoline (Privine), oxymetazoline (Afrin, Dristan, Duramist), as inhalers, or phenylephrine (Neo-Synephrine, Sinex, Rhinall) or as oral pills (Bronkaid, Sudafed, Neo-Synephrine, Sinex, Rhinall). Oral decongestants may be used for up to a week without consulting a doctor, with the exception of Bronkaid and Sudafed, which can be taken as long as needed, but nasal sprays can also cause "rebound" (Rhinitis medicamentosa) and worsen the congestion if taken for more than a few days. Therefore, you should only take nasal sprays when discomfort cannot be remedied by other methods, and never for more than three days.
If an infant is unable to breathe because of a plugged nose, a nasal aspirator may be useful to remove the mucus. The mucus might be thick and sticky, making it difficult to expel from the nostril.
The treatment of RM involves withdrawal of the offending nasal spray or oral medication. Both a "cold turkey" and a "weaning" approach can be used. Cold turkey is the most effective treatment method, as it directly removes the cause of the condition, yet the time period between the discontinuation of the drug and the relief of symptoms may be too long and uncomfortable for some individuals (particularly when trying to go to sleep when they are unable to breathe through their nose).
A benefit of the gradual “weaning” approach is that it helps preserve normal nasal airflow during the withdrawal process. United States Patent Number 5,988,870 was issued for a method and apparatus used to facilitate the precise titration and gradual withdrawal of decongestant nasal sprays containing addictive compounds. The system is sold under the brand name Rhinostat.
The use of over-the-counter (OTC) saline nasal sprays may help open the nose without causing RM if the spray does not contain a decongestant. Symptoms of congestion and runny nose can often be treated with corticosteroid nasal sprays under the supervision of a physician. For very severe cases, oral steroids or nasal surgery may be necessary.
For RM caused by topical decongestants, there are anecdotal reports of persons having success by withdrawing treatment from one nostril at a time.
A study has shown that the anti-infective agent benzalkonium chloride, which is frequently added to topical nasal sprays as a preservative, aggravates the condition by further increasing the rebound swelling.
The majority of cases of throat irritation usually go away without any treatment. There is no real treatment for throat irritation from a virus. If you have difficulty swallowing then one should drink liquids, suck on lozenges, ice chips or mix salt with warm water to gargle. Bacterial infections generally require antibiotics.
Home remedies for throat irritation include gargling with warm water twice a day, sipping honey and lemon mixture or sucking on medicated lozenges. If the cause is dry air, then one should humidify the home. Since smoke irritates the throat, stop smoking and avoid all fumes from chemicals, paints and volatile liquids.
Rest your voice if you have been screaming or singing. If you have pharyngitis, avoid infecting others by covering your mouth when coughing and wear a mask.
Tonsillectomy may be indicated if bad breath due to tonsillar stones persists despite other measures.
Larger tonsil stones may require removal by curettage (scooping) or otherwise, although thorough irrigation will still be required afterwards to effectively wash out smaller pieces. Larger lesions may require local excision, although these treatments may not completely help the bad breath issues that are often associated with this condition.
For unconfirmed acute sinusitis, intranasal corticosteroids have not been found to be better than a placebo either alone or in combination with antibiotics. For cases confirmed by radiology or nasal endoscopy, treatment with corticosteroids alone or in combination with antibiotics is supported. The benefit, however, is small.
There is only limited evidence to support short treatment with oral corticosteroids for chronic rhinosinusitis with nasal polyps.
There is some low quality evidence suggesting that mometasone may lead to symptomatic improvement in children with adenoid hypertrophy.
Surgical removal of the adenoids is a procedure called adenoidectomy. Carried out through the mouth under a general anaesthetic, adenoidectomy involves the adenoids being curetted, cauterised, lasered, or otherwise ablated. Adenoidectomy is most often performed because of nasal obstruction, but is also performed to reduce middle ear infections and fluid (otitis media). The procedure is often carried out at the same time as a tonsillectomy, since the adenoids can be clearly seen and assessed by the surgeon at that time.
Recommended treatments for most cases of sinusitis include rest and drinking enough water to thin the mucus. Antibiotics are not recommended for most cases.
Breathing low-temperature steam such as from a hot shower or gargling can relieve symptoms. There is tentative evidence for nasal irrigation. Decongestant nasal sprays containing oxymetazoline may provide relief, but these medications should not be used for more than the recommended period. Longer use may cause rebound sinusitis. It is unclear if nasal irrigation, antihistamines, or decongestants work in children with acute sinusitis.
Treatment of atrophic rhinitis can be either medical or surgical.
Medical measures include:
- Nasal irrigation using normal saline
- Nasal irrigation and removal of crusts using alkaline nasal solutions prepared by dissolving a spoonful of powder containing one part sodium bicarbonate, one part sodium biborate and two part sodium chloride.
- 25% glucose in glycerine can be applied to the nasal mucosa to inhibit the growth of proteolytic organisms which produce foul smell.
- Local antibiotics, such as chloromycetine.
- Vitamin D (Kemicetine).
- Estradiol spray for regeneration of seromucinous glands and vascularization of mucosa.
- Systemic streptomycin (1g/day) against Klebsiella organisms.
- Oral potassium iodide for liquefaction of secretion.
- Placental extract injected in the submucosa.
Surgical interventions include:
- Young's operation.
- Modified Young's operation.
- Narrowing of nasal cavities, submucosal injection of Teflon paste, section and medial displacement of the lateral wall of the nose.
- Transposition of parotid duct to maxillary sinus or nasal mucosa.
Reduction of hypertrophied turbinates, correction of nasal septum deviation, removal of polyps, sectioning of the parasympathetic secretomotor fiber to nose (vidian neurectomy) for controlling refractory excessive rhinorrhea.
Speech-language pathologists provide behavioral treatment of VCD. Speech therapy usually involves educating the client on the nature of the problem, what happens when symptoms are present, and then comparing this to what happens during normal breathing and phonation. Intervention goals target teaching a client breathing and relaxation exercises so that they can control their throat muscles and keep the airway open, allowing air to flow in and out.
Breathing techniques can be taught to reduce tension in the throat, neck, and upper body and bring attention to the flow of air during respiration. Diaphragm support during breathing decreases muscle tension in the larynx. These techniques are meant to move awareness away from the act of breathing in and focus on the auditory feedback provided by the air moving in and out.
Other techniques can involve breathing through a straw and panting, which widens the opening of the throat by activating the Posterior cricoarytenoid (PCA) muscle. Endoscopic feedback can also be used to show a patient what is happening when they are doing simple tasks such as taking a deep breath or speaking on an inspiration. This provides the client with visual information so that they can actually see what behaviours help to open the throat and what behaviors constrict the throat. Respiratory muscle strength training, a form of increased resistance training using a hand-held breathing device has also been reported to alleviate symptoms.
Speech therapy has been found to eliminate up to 90% of ER visits in patients suffering from VCD.
Medical often works in conjunction with behavioral approaches. A pulmonary or ENT (otolaryngologist) specialist will screen for and address any potential underlying pathology that may be associated with VCD. Managing GERD has also been found to relieve laryngospasm, a spasm of the vocal cords that makes breathing and speaking difficult.
Non-invasive positive pressure ventilation can be used if a patient's vocal cords adduct (close) during exhalation. Mild sedatives have also been employed to reduce anxiety as well as reduce acute symptoms of VCD. Benzodiazepines are an example of one such treatment, though they have been linked to a risk of suppression of the respiratory drive. While Ketamine, a dissociative anesthetic, does not suppress respiratory drive, it has been thought to be associated with laryngospasms.
For more severe VCD cases, physicians may inject botulinum toxin into the vocal (thyroarytenoid) muscles to weaken or decrease muscle tension. Nebulized Lignocaine can also been used in acute cases and helium-oxygen inhalation given by face mask has been used in cases of respiratory distress.
Avoiding turbinectomy or using turbinate-sparing techniques may prevent ENS.
The avoidance of inciting factors such as sudden changes in temperature, humidity, or blasts of air or dust is helpful.
Intranasal application of antihistamines, corticosteroids, or anticholinergics may also be used for vasomotor rhinitis. Intranasal cromolyn sodium may be used in patients older than two years.
Astelin (Azelastine) "is indicated for symptomatic treatment of vasomotor rhinitis including rhinorrhea, nasal congestion, and post nasal drip in adults and children 12 years of age and older."
Treatments that may help with symptoms include simple pain medication and medications for fevers such as ibuprofen and acetaminophen (paracetamol). It, however, is not clear if acetaminophen helps with symptoms. It is not known if over the counter cough medications are effective for treating an acute cough. Cough medicines are not recommended for use in children due to a lack of evidence supporting effectiveness and the potential for harm. In 2009, Canada restricted the use of over-the-counter cough and cold medication in children six years and under due to concerns regarding risks and unproven benefits. The misuse of dextromethorphan (an over-the-counter cough medicine) has led to its ban in a number of countries. Intranasal corticosteroids have not been found to be useful.
In adults short term use of nasal decongestants may have a small benefit. Antihistamines may improve symptoms in the first day or two; however, there is no longer-term benefit and they have adverse effects such as drowsiness. Other decongestants such as pseudoephedrine appear effective in adults. Ipratropium nasal spray may reduce the symptoms of a runny nose but has little effect on stuffiness. The safety and effectiveness of nasal decongestant use in children is unclear.
Due to lack of studies, it is not known whether increased fluid intake improves symptoms or shortens respiratory illness, and there is a similar lack of data for the use of heated humidified air. One study has found chest vapor rub to provide some relief of nocturnal cough, congestion, and sleep difficulty.
They are removed under general anaesthesia . Most can be removed through anterior nares . Large ones need to be broken into pieces before removal . Some particularly hard and irregular ones may require lateral rhinotomy .
Medications may be needed as an adjunct to assist the closure of the defect. Antibiotics can help control or prevent any sinus infections. Preoperative nasal decongestants usage can reduce any existing sinus inflammation which will aid surgical manipulation of the mucosa over the bone.
Common issues that lead to overuse of topical decongestants:
- Deviated septum
- Upper respiratory tract infection
- Vasomotor rhinitis
- Cocaine use and other stimulant abuse
- Pregnancy (these products are not considered safe for pregnancy)
- Chronic rhinosinusitis
- Hypertrophy of the inferior turbinates
The first line of treatment for nasal polyps is topical steroids. Steroids decrease the inflammation of the sinus mucosa to decrease the size of the polyps and improve symptoms. Topical preparations are preferred in the form of a nasal spray, but are often ineffective for people with many polyps. Steroids by mouth often provide drastic symptom relief, but should not be taken for long periods of time due to their side effects. Because steroids only shrink the size and swelling of the polyp, people often have recurrence of symptoms once the steroids are stopped. Decongestants do not shrink the polyps, but can decrease swelling and provide some relief. Antibiotics are only recommended if the person has a co-occurring bacterial infection.
In people with nasal polyps caused by aspirin or NSAIDs, avoidance of these medications will help with symptoms. Aspirin desensitization has also been shown to be beneficial.
Endoscopic sinus surgery with removal of polyps is often very effective for most people providing rapid symptom relief. Endoscopic sinus surgery is minimally-invasive and is done entirely through the nostril with the help of a camera. Surgery should be considered for those with complete nasal obstruction, uncontrolled runny nose, nasal deformity caused by polyps or continued symptoms despite medical management. Surgery serves to remove the polyps as well as the surrounding inflamed mucosa, open obstructed nasal passages, and clear the sinuses. This not only removes the obstruction caused by the polyps themselves, but allows medications such as saline irrigations and topical steroids to become more effective.
Surgery lasts approximately 45 minutes to 1 hour and can be done under general or local anesthesia. Most patients tolerate the surgery without much pain, though this can vary from patient to patient. The patient should expect some discomfort, congestion, and drainage from the nose in the first few days after surgery, but this should be mild. Complications from endoscopic sinus surgery are rare, but can include bleeding and damage to other structures in the area including the eye or brain.
Many physicians recommend a course of oral steroids prior to surgery to reduce mucosal inflammation, decrease bleeding during surgery, and help with visualization of the polyps. Nasal steroid sprays should be used preventatively after surgery to delay or prevent recurrence. People often have recurrence of polyps even following surgery. Therefore, continued follow up with a combination of medical and surgical management is preferred for the treatment of nasal polyps.
The management of rhinitis depends on the underlying cause.
For allergic rhinitis, intranasal corticosteroids are recommended. For severe symptoms intranasal antihistamines may be added.
No medications or herbal remedies have been conclusively demonstrated to shorten the duration of infection. Treatment thus comprises symptomatic relief. Getting plenty of rest, drinking fluids to maintain hydration, and gargling with warm salt water are reasonable conservative measures. Much of the benefit from treatment is, however, attributed to the placebo effect.
Rhinorrhea can occur as a symptom of opioid withdrawal accompanied by lacrimation. Other causes include cystic fibrosis, whooping cough, nasal tumors, hormonal changes, and cluster headaches. Due to changes in clinical practice, Rhinorrhea is now reported as a frequent side effect of oxygen-intubation during colonoscopy procedures [A simple, innovative way to reduce rhinitis symptoms after sedation during endoscopy" by Nai-Liang Li, et al, Canadian Journal of Gastroenterology, 2011, Feb; volume 25(2): pages 68–72.]. Rhinorrhea can also be the side effect of several genetic disorders, such as primary ciliary dyskinesia.