Chronic Rhinorrhea (Runny Nose)

What is rhinorrhea or runny nose?

Rhinorrhea, or a runny nose, happens when excess fluid drains from the nose. The fluid is mucus that is thin or thick, clear or opaque, and can be intermittent or constant.

What causes rhinorrhea?

The nose and sinuses normally produce mucus which keeps the nose moist and is typically swept back into the throat and swallowed. There are many conditions that can cause the nose to run, including:

• Colds and flus: Mucus from illnesses can fill the nasal cavity and cause temporary nasal obstruction.
• Crying: When you cry, tears drain through the tear ducts, into the nasal cavity, and then into the nose. 
• Cold Weather: Cold weather can sometimes cause a reaction which produces mucus.
• Infections of the sinuses and or adenoids: The sinuses, or cavities of the face that drain into the nose, can fill with infected mucus resulting in sinusitis (inflammation of the sinuses). The adenoids, tissue found in the back of the nose (nasopharynx), in children can also get infected and result in a similar production of infected mucus.
• Allergic rhinitis: Mucus can result from allergies, or a nasal reaction to allergens such as pollen or pet dander.
• Non-allergic rhinitis: Mucus can result from a nasal reaction to an irritant like smoke or pollution, or the body’s reaction to other stimuli like cold weather or hot food.
• Large/swollen turbinates: The bones along the inside the nose (turbinates) can swell due to allergies or infections and result in nasal obstruction.
• Large adenoids: When the tissue in the back of the nose in children is enlarged.
• Nasal polyps: Grape-like growths in the lining of the nose.
• Foreign body insertion: Often in younger children, the cause of obstruction may be the placement of an object in the nose, such as a peanut or a bead, causing obstruction, and foul smelling mucus drainage.
• Nasal cysts or tumors: Rarely, obstruction is from benign or malignant tumors, or cysts, more commonly seen when the symptoms affect only one side of the nose.
• Choanal atresia or piriform aperature stenosis: Choanal atresia describes the situation when the back of the nose (nasopharynx), is closed off with bone and/or tissue at birth. When this is present on both sides (bilateral), it is often found right after birth. However, if it is only present on one side, it is often not discovered until later in life. Piriform aperature stenosis describes when the bony nasal opening is narrow, obstructing the nose.
• Deviated nasal septum: The right and left sides of the nose are separated by a wall made of bone and cartilage called the nasal septum. At times, the septum can lean more to one side, causing obstruction on that side. This deformity can be present at birth or a result of trauma to the nose later in life.

Why is rhinorrhea a concern?

Often, rhinorrhea goes away on its own. When it persists, or lasts longer than 10 days, a runny nose can be a sign of other conditions, such as those listed above. If a high fever is present, consult your doctor.

How do we evaluate rhinorrhea?

When a runny nose is persistent, your child may be asked to see an allergist by your primary care doctor.  Your child may also be asked to see an Ear, Nose and Throat specialist (Otolaryngologist). The specialist will get a complete history and examine the front of the nose, and just along the inside.  A speculum may be used for a better view of the nose, and in some cases, a flexible fiberoptic camera may be used to evaluate the entire nasal cavity to the very back of the nose (nasopharynx). This can be done in clinic without the need for general anesthesia.

How is rhinorrhea treated?

Once the source of the runny nose is found, treatment can include watchful waiting, washing the nose with nasal rinses, medications taken by mouth or sprayed into the nose, or even surgery.

What are the long-term effects of rhinorrhea?

Depending on the source of the runny nose, the long-term effects can vary. Nasal irritation and nasal obstruction can impact a child’s quality of life if it is longstanding. An obstructed nasal passageway can affect sleep quality. Breathing from the nose is also important for facial development in childhood. Rarely, acute infections of the sinuses can lead to more serious infections if left untreated.  Nasal obstruction and rhinorrhea may impact the health of the ears and hearing as the drainage pathway for the middle ear is through the back of the nose (nasopharynx).