Etiology
Acute rhinitis is an acute inflammatory disease of the nasal mucosa caused by viral infection. It is very common in children and represents one of the most frequent types of upper respiratory tract infections. Rhinovirus is the most common causative agent, accounting for 30% to 50% of cases, followed by coronaviruses, respiratory syncytial virus, parainfluenza virus, and others. Secondary bacterial infections may also occur.
If acute rhinitis is not thoroughly treated, or if it coexists with systemic diseases such as endocrine disorders or immune dysfunction, it may lead to prolonged symptoms and progression to chronic rhinitis.
Pathology
The primary pathological features include congestion, swelling, and inflammatory cellular exudate of the nasal mucosa, as well as increased activity of the mucus glands, resulting in an increase in secretions. The secretions are typically serous or mucoid in nature but can become mucopurulent if bacterial infection is present.
Clinical Manifestations
Symptoms
Acute Rhinitis
This condition can occur in all seasons but is more common in winter, spring, or during seasonal transitions. The onset is usually sudden, with early symptoms including sneezing, nasal congestion, clear watery nasal discharge, and sore throat. Systemic symptoms, such as fever, are more pronounced in children. Young children and those with weakened immunity may present with high fever, reduced appetite, and fatigue.
Chronic Rhinitis
Nasal congestion is the predominant symptom. Younger children may exhibit mouth breathing, noisy breathing, snoring during sleep, or behavioral abnormalities such as inattention, irritability, or restlessness. Older children often report intermittent or alternating nasal congestion and may produce thick nasal secretions. In cases where nasal secretions cannot be adequately expelled, eczema or localized infection of the nasal vestibule may develop. A minority of children may report diminished olfactory sensitivity and headaches. Postnasal drip can also lead to chronic coughing.
Signs
In the early stages, nasal mucosa edema and clear watery secretions may be observed. If secondary bacterial infection occurs in later stages, mucopurulent secretions may become evident. Some children may also exhibit signs of adenoid hypertrophy and/or tonsillar hypertrophy or features of secretory otitis media.
Supplementary Examinations
Anterior rhinoscopy is the most commonly used diagnostic technique. If possible, diagnostic procedures may be supplemented with nasal endoscopy for children. For children with systemic symptoms or suspected bacterial infections, blood tests (e.g., complete blood count or C-reactive protein [CRP]) may be conducted.
Diagnosis and Differential Diagnosis
Diagnosis is based on a combination of medical history, clinical symptoms, signs, and examination findings. Attention should be given to distinguishing acute rhinitis from allergic rhinitis.
Treatment
Management of rhinitis in children primarily involves identifying the underlying cause and providing supportive and symptomatic treatment. Acute rhinitis should also be managed with a focus on preventing complications. For cases involving adenoid hypertrophy, adenoidectomy may be considered.
Antibiotics
Acute Rhinitis
Systemic antibiotics may be administered if bacterial infection is confirmed, with preference given to oral formulations. Penicillin-based antibiotics are the first choice, while second-generation cephalosporins or macrolides can be used in cases of resistance or allergy. The use of multiple antibiotics is not recommended.
Chronic Rhinitis
Antibiotics are generally not recommended unless there is purulent nasal discharge or laboratory evidence indicating infection.
Intranasal Corticosteroids
Intranasal corticosteroids have anti-inflammatory and anti-edematous effects and are considered first-line therapy for rhinitis. They can significantly alleviate nasal congestion, rhinorrhea, nasal itching, and sneezing. For acute rhinitis, a course of 2 to 4 weeks is suggested; for chronic rhinitis, the duration of use is recommended to be no longer than one month. Age-related restrictions on corticosteroid use in children should be observed. Systemic corticosteroid therapy is not recommended for routine use.
Nasal Irrigation
Nasal irrigation with normal saline or 2.2% to 2.3% hypertonic saline can improve symptoms, stimulate the ciliary activity of the nasal mucosa, enhance clearance rates, and improve the local nasal environment. This approach is suitable for children who can cooperate effectively.
Mucolytics
Mucolytic agents, which dilute mucus and improve ciliary activity, may be considered for selective use.
Decongestants
For children with persistent and severe nasal congestion, short-term use (no longer than 7 days) of low-concentration intranasal decongestants may be considered to improve nasal airflow.