The common cold can be considered the most ordinary illness, but when we experience nasal congestion and rhinorrhea, we may not be clear on how to deal with it: should we go to the internal medicine department at the hospital for medication? Should we visit the ENT department for a nose examination? Or should we rely on advertisements and buy a nasal spray to use ourselves?
Dr. Song Wenjiang, Director of the ENT Department at Guangzhou Red Cross Hospital, believes that individuals experiencing cold-like symptoms should first visit the ENT department so that a doctor can diagnose whether it's a cold or allergic rhinitis, as their treatment methods are completely different. After a clear diagnosis, patients should follow the doctor’s guidance for medication treatment and must avoid the misuse of nasal sprays.
When people hear someone sneezing or sniffling, they often ask with concern: "Do you have a cold?" Dr. Song Wenjiang from the ENT Department at Guangzhou Red Cross Hospital states that allergic rhinitis can also present with these symptoms, but it is not caused by bacteria or viruses; instead, it is due to an allergic reaction in the nasal cavity to substances such as pollen, dust mites, pet fur, or industrial dust. In Lingnan, which falls under tropical and subtropical climates, flowers are abundant, spreading pollen everywhere, and the city’s air quality is poor, making allergic rhinitis quite common.
Dr. Song Wenjiang says that patients with allergic rhinitis taking cold medicine may alleviate symptoms because many cold medicines already contain antihistamine components. However, misusing cold medicine carries unnecessary side effects and is not advisable. He suggests that these patients stay away from allergens; for instance, those allergic to pollen could take vacations elsewhere, and those allergic to pet fur could give their pets away. Additionally, specific antiallergic drugs can be used to reduce nasal sensitivity, or treatments such as nasal laser therapy, radiofrequency, or blockage can eliminate the "trigger points" causing sensitivity.
In medical terms, what we call a "cold" is actually acute rhinitis, which is essentially an acute viral infection of the nasal mucosa. If left untreated, it can lead upwards to sinusitis or otitis media, or downwards to tracheitis or pneumonia.
Problems with the upper respiratory tract should be seen by the ENT department. Dr. Song Wenjiang argues that strictly speaking, the entire human respiratory system is divided at the larynx; above it is the upper respiratory tract, and issues here should be seen by the ENT department. Below it includes the trachea and lungs, which fall under the jurisdiction of the respiratory medicine department. Although general practitioners may use tongue depressors to check the throat, they cannot perform nasal examinations, making it difficult to distinguish between allergic rhinitis and acute rhinitis in the early stages without fever. Patients are often simply diagnosed with "upper respiratory tract infection."
In terms of treatment, the internal medicine department generally uses systemic medication, whether oral or injectable, resulting in low local concentrations in the upper respiratory tract, necessitating higher doses for maintenance therapy.
Dr. Song Wenjiang notes that the ENT department has the advantage of localized treatment for colds, offering better efficacy. Even if the cold progresses downward into tracheitis or pneumonia, ENT doctors can detect this through a stethoscope and refer the patient to the respiratory medicine department.
Misuse of nasal sprays can cause "reactive rhinitis." To restore nasal airflow, nasal sprays are commonly used. However, colds and rhinitis have different clinical treatment methods; chronic rhinitis alone is categorized into chronic hypertrophic rhinitis, dry rhinitis, atrophic rhinitis, etc., each requiring different nasal sprays. Many people experiencing nasal congestion do not see a doctor but prefer to buy nasal sprays themselves.
Dr. Song Wenjiang states that some nasal sprays heavily advertised have not undergone proper drug approval processes and are unavailable in legitimate hospital pharmacies, with unclear ingredients, thus not recommended. Nasal sprays often contain vasoconstrictors like ephedrine, which may initially work but will quickly develop resistance.
Dr. Song Wenjiang further explains that the course of a cold typically lasts around 7 days, and clinically, medications would not be prescribed for more than a week; otherwise, "drug-induced reactive rhinitis" could easily occur, worsening nasal congestion. If the nasal spray contains hormones that act on the whole body, it could lead to severe consequences such as osteoporosis, moon face, or buffalo hump. (Wu Junyi, Cui Yanling, Kuang Ying)