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Rhinorrhea, rhinorrhoea, or informally runny nose is the free discharge of a thin
mucus Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It ...
fluid from the nose; it is a common condition. It is a common symptom of
allergies Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermat ...
( hay fever) or certain viral infections, such as the common cold or
COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quickly ...
. It can be a side effect of
crying Crying is the dropping of tears (or welling of tears in the eyes) in response to an emotional state, or pain. Emotions that can lead to crying include sadness, anger, and even happiness. The act of crying has been defined as "a complex secr ...
, exposure to cold temperatures,
cocaine Cocaine (from , from , ultimately from Quechua: ''kúka'') is a central nervous system (CNS) stimulant mainly used recreationally for its euphoric effects. It is primarily obtained from the leaves of two Coca species native to South Ameri ...
abuse, or
drug withdrawal Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome, is the group of symptoms that occur upon the abrupt discontinuation or decrease in the intake of pharmaceutical or recreational drugs. In order for the symptoms of wit ...
, such as from
methadone Methadone, sold under the brand names Dolophine and Methadose among others, is a synthetic opioid agonist used for chronic pain and also for opioid dependence. It is used to treat chronic pain, and it is also used to treat addiction to heroi ...
or other
opioid Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use ...
s. Treatment for rhinorrhea is not usually undertaken, but there are a number of medical treatments and preventive techniques. The term was coined in 1866 from the
Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...
''rhino-'' ("of the nose") and ''-rhoia'' ("discharge" or "flow").


Signs and symptoms

Rhinorrhea is characterized by an excess amount of mucus produced by the
mucous membranes A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...
that line the nasal cavities. The membranes create mucus faster than it can be processed, causing a backup of mucus in the nasal cavities. As the cavity fills up, it blocks off the air passageway, causing difficulty breathing through the nose. Air caught in nasal cavities, namely the sinus cavities, cannot be released and the resulting pressure may cause a headache or facial pain. If the sinus passage remains blocked, there is a chance that
sinusitis Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, head ...
may result. If the mucus backs up through the Eustachian tube, it may result in ear pain or an ear infection. Excess mucus accumulating in the throat or back of the nose may cause a
post-nasal drip Post-nasal drip (PND), also known as upper airway cough syndrome (UACS), occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the back of the nose, and eventually in the throat once it drips down the back of ...
, resulting in a sore throat or coughing. Additional symptoms include
sneezing A sneeze (also known as sternutation) is a semi-autonomous, convulsive expulsion of air from the lungs through the nose and mouth, usually caused by foreign particles irritating the nasal mucosa. A sneeze expels air forcibly from the mouth and ...
,
nosebleeds A nosebleed, also known as epistaxis, is bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low bloo ...
, and nasal discharge.


Causes

The Mayo Clinic says that a runny nose can be caused by anything that irritates or inflames the nasal tissues, including infections such as the common cold and influenza, and allergies and various irritants. Some people have a chronically runny nose for no apparent reason (non-allergic rhinitis or vasomotor rhinitis). Less common causes include polyps, a foreign body, a tumor or migraine-like headaches. Causes listed (alphabetically) and discussed are: acute sinusitis (nasal and sinus infection), allergies, chronic sinusitis, common cold, coronavirus disease 2019 (COVID-19), decongestant nasal spray overuse, deviated septum, dry air,
eosinophilic granulomatosis with polyangiitis Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as allergic granulomatosis, is an extremely rare autoimmune condition that causes inflammation of small and medium-sized blood vessels (vasculitis) in persons with a history of ...
,
granulomatosis with polyangiitis Granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis (WG), is a rare long-term systemic disorder that involves the formation of granulomas and inflammation of blood vessels (vasculitis). It is a form of vasculitis ...
, hormonal changes, influenza (flu), lodged object, medicines (such as those used to treat high blood pressure, erectile dysfunction, depression, seizures and other conditions), nasal polyps, non-allergic rhinitis (chronic congestion or sneezing not related to allergies), occupational asthma, pregnancy, respiratory syncytial virus (RSV), spinal fluid leak, and tobacco smoke.


Cold temperatures

Rhinorrhea is especially common in cold weather. Cold-induced rhinorrhea occurs due to a combination of thermodynamics and the body's natural reactions to cold weather stimuli. One of the purposes of nasal mucus is to warm inhaled air to body temperature as it enters the body; this requires the nasal cavities to be constantly coated with liquid mucus. In cold weather the mucus lining nasal passages tends to dry out, so that mucous membranes must work harder, producing more mucus to keep the cavity lined. As a result, the nasal cavity can fill up with mucus. At the same time, when air is exhaled, water vapor in breath condenses as the warm air meets the colder outside temperature near the nostrils. This causes excess water to build up inside nasal cavities, spilling out through the nostrils.


Inflammatory


Infection

Rhinorrhea can be a symptom of other diseases, such as the common cold or influenza. During these infections, the nasal mucous membranes produce excess mucus, filling the nasal cavities. This is to prevent infection from spreading to the lungs and respiratory tract, where it could cause far worse damage. It has also been suggested that rhinorrhea is a result of viral evolution whereby virus variants that increase nasal secretion are selected for. Rhinorrhea caused by these infections usually occur on circadian rhythms. Over the course of a viral infection,
sinusitis Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, head ...
(the inflammation of the nasal tissue) may occur, causing the mucous membranes to release more mucus. Acute sinusitis consists of the nasal passages swelling during a viral infection. Chronic sinusitis occurs when one or more
nasal polyp Nasal polyps (NP) are noncancerous growths within the nose or sinuses. Symptoms include trouble breathing through the nose, loss of smell, decreased taste, post nasal drip, and a runny nose. The growths are sac-like, movable, and nontender, tho ...
s appear. This can be caused by a
deviated septum Nasal septum deviation is a physical disorder of the nose, involving a displacement of the nasal septum. Some displacement is common, affecting 80% of people, mostly without their knowledge. Signs and symptoms The nasal septum is the bone and ...
as well as a viral infection.


Allergies

Rhinorrhea can also occur when individuals with allergies to certain substances, such as pollen, dust, latex, soy, shellfish, or animal dander, are exposed to these allergens. In people with sensitized immune systems, the inhalation of one of these substances triggers the production of the
antibody An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of the ...
immunoglobulin E Immunoglobulin E (IgE) is a type of antibody (or immunoglobulin (Ig) " isotype") that has been found only in mammals. IgE is synthesised by plasma cells. Monomers of IgE consist of two heavy chains (ε chain) and two light chains, with the � ...
(IgE), which binds to
mast cell A mast cell (also known as a mastocyte or a labrocyte) is a resident cell of connective tissue that contains many granules rich in histamine and heparin. Specifically, it is a type of granulocyte derived from the myeloid stem cell that is a par ...
s and
basophil Basophils are a type of white blood cell. Basophils are the least common type of granulocyte, representing about 0.5% to 1% of circulating white blood cells. However, they are the largest type of granulocyte. They are responsible for inflammator ...
s. IgE bound to mast cells are stimulated by pollen and dust, causing the release of inflammatory mediators such as
histamine Histamine is an organic nitrogenous compound involved in local immune responses, as well as regulating physiological functions in the gut and acting as a neurotransmitter for the brain, spinal cord, and uterus. Since histamine was discovered ...
. In turn, this causes, among other things, inflammation and swelling of the tissue of the nasal cavities as well as increased mucus production. Particulate matter in polluted air and chemicals such as chlorine and detergents, which can normally be tolerated, can make the condition considerably worse.


Crying

Rhinorrhea is also associated with shedding tears (lacrimation), whether from emotional events or from eye irritation. When excess
tears Tears are a clear liquid secreted by the lacrimal glands (tear gland) found in the eyes of all land mammals. Tears are made up of water, electrolytes, proteins, lipids, and mucins that form layers on the surface of eyes. The different types of ...
are produced, the liquid drains through the inner corner of the eyelids, through the
nasolacrimal duct The nasolacrimal duct (also called the tear duct) carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. T ...
, and into the nasal cavities. As more tears are shed, more liquid flows into the nasal cavities, both stimulating mucus production and hydrating any dry mucus already present in the nasal cavity. The buildup of fluid is usually resolved via mucus expulsion through the nostrils.


Non-inflammatory


Head trauma

Rhinorrhea can be caused by a head injury, a serious condition. A
basilar skull fracture A basilar skull fracture is a break of a bone in the base of the skull. Symptoms may include bruising behind the ears, bruising around the eyes, or blood behind the ear drum. A cerebrospinal fluid (CSF) leak occurs in about 20% of cases and ...
can result in a rupture of the barrier between the sinonasal cavity and the
anterior cranial fossa The anterior cranial fossa is a depression in the floor of the cranial base which houses the projecting frontal lobes of the brain. It is formed by the orbital plates of the frontal, the cribriform plate of the ethmoid, and the small wings and fr ...
e or the
middle cranial fossa The middle cranial fossa, deeper than the anterior cranial fossa, is narrow medially and widens laterally to the sides of the skull. It is separated from the posterior fossa by the clivus and the petrous crest. It is bounded in front by the pos ...
e. This can cause the nasal cavity to fill with cerebrospinal fluid ( cerebrospinal fluid rhinorrhoea, CSF rhinorrhea), a condition that can lead to a number of serious complications, including death if not addressed properly.


Other causes

Rhinorrhea can occur as a symptom of opioid withdrawal accompanied by
lacrimation Tears are a clear liquid secreted by the lacrimal glands (tear gland) found in the eyes of all land mammals. Tears are made up of water, electrolytes, proteins, lipids, and mucins that form layers on the surface of eyes. The different types of ...
. When it occurs due to exercise, it is described as exercise-induced rhinitis. Other causes include cystic fibrosis,
whooping cough Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious bacterial disease. Initial symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough, but these are followed by two or t ...
, 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. Rhinorrhea can also be the side effect of several genetic disorders, such as
primary ciliary dyskinesia Primary ciliary dyskinesia (PCD) is a rare, autosomal recessive genetic ciliopathy, that causes defects in the action of cilia lining the upper and lower respiratory tract, sinuses, Eustachian tube, middle ear, Fallopian tube, and flagella of sper ...
.


Treatment

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 nose-blowing 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 or
vasoconstrictor Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vess ...
nasal spray Nasal sprays are used to deliver medications locally in the nasal cavities or systemically. They are used locally for conditions such as nasal congestion and allergic rhinitis. In some situations, the nasal delivery route is preferred for syst ...
s may be used, but may become counterproductive after several days of use, causing
rhinitis medicamentosa Rhinitis medicamentosa (or RM) is a condition of rebound nasal congestion suspected to be brought on by extended use of topical decongestants (e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays) and certain oral med ...
. In recurring cases, such as those due to allergies, there are medicinal treatments available. Several types of
antihistamine Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provid ...
s can be obtained relatively cheaply to treat cases caused by histamine buildup.


References


External links


Coping with colds and flu
(NHS Direct) {{Respiratory pathology Symptoms and signs: Respiratory system Nose disorders