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Saturday, August 23, 2025

Catarrh


Introduction

Catarrh is a descriptive term, commonly used in the UK and Middle East, to describe excessive mucus secretion and accumulation in the upper airways. Patients often complain of:

  • Stuffy or blocked nose.

  • Frequent throat clearing.

  • Postnasal drip (mucus dripping into throat).

  • Cough and hoarseness.

Catarrh may be acute (e.g., during a viral cold) or chronic (lasting >3 weeks), and may reflect infections, allergies, irritant exposure, or structural sinus disease.

Pathophysiology

  • Normally, the nasal and respiratory mucosa produce a thin layer of mucus that traps dust, microbes, and irritants.

  • In catarrh, there is hypersecretion of mucus due to inflammation, infection, or irritation.

  • Postnasal drip occurs when excessive mucus flows down the back of the throat, causing cough and irritation.

Causes of Catarrh

1. Infective Causes

  • Common cold (viral rhinitis): Rhinovirus, coronavirus, influenza.

  • Sinusitis (bacterial/viral): Prolonged catarrh with facial pain, fever.

  • Pharyngitis, tonsillitis.

  • Bronchitis.

2. Allergic Causes

  • Allergic rhinitis (hay fever).

  • Atopy, asthma associations.

3. Environmental / Irritant

  • Smoking.

  • Air pollution, dust, chemical fumes.

  • Dry air, sudden weather changes.

4. Structural / Chronic Conditions

  • Nasal polyps.

  • Deviated nasal septum.

  • Chronic rhinosinusitis.

5. Systemic Conditions

  • Gastroesophageal reflux (GERD) → laryngopharyngeal reflux (LPR).

  • Cystic fibrosis (chronic thick secretions).

  • Primary ciliary dyskinesia.

Clinical Features

  • Nasal congestion or blockage.

  • Runny nose (rhinorrhea).

  • Postnasal drip (mucus sensation in throat).

  • Frequent throat clearing.

  • Sore throat, hoarseness, cough.

  • Loss of smell (hyposmia).

  • Headache, facial pressure (sinus involvement).

  • Ear fullness or hearing loss (Eustachian tube blockage).

Diagnostic Approach

1. History

  • Duration: acute (<3 weeks) vs chronic (>3 months).

  • Triggers: infection, allergens, environmental irritants.

  • Associated symptoms: fever, sneezing, facial pain, reflux.

  • Past history of allergy, asthma, sinus surgery.

2. Examination

  • Nasal exam: mucosal swelling, polyps, discharge.

  • Throat exam: mucus in posterior pharyngeal wall.

  • Ear exam: effusion if Eustachian tube blocked.

  • Chest auscultation if cough/bronchitis suspected.

3. Investigations (if persistent/severe)

  • Allergy testing (skin prick, serum IgE).

  • Nasal endoscopy: Polyps, structural lesions.

  • CT scan of sinuses: Chronic rhinosinusitis, obstruction.

  • Sputum culture if chronic infection.

  • pH monitoring if reflux suspected.

Management and Treatment

Treatment depends on cause — often supportive for acute catarrh, specific for chronic/recurrent cases.

A. General Supportive Measures

  • Hydration (2–3 L/day) to thin mucus.

  • Steam inhalation, humidifiers.

  • Saline nasal irrigation (isotonic or hypertonic).

  • Avoid smoking, irritants, allergens.

B. Pharmacological Treatment

1. Decongestants (short-term relief)

  • Pseudoephedrine 60 mg orally every 6 h (max 240 mg/day).

  • Oxymetazoline 0.05% nasal spray, 2–3 sprays per nostril twice daily (max 5–7 days).
    ⚠️ Avoid long-term nasal decongestants → rebound congestion (rhinitis medicamentosa).

2. Antihistamines (allergic catarrh)

  • Loratadine 10 mg orally once daily.

  • Cetirizine 10 mg orally once daily.

  • Fexofenadine 120 mg orally once daily.

3. Intranasal Corticosteroids (chronic/allergic rhinitis, polyps)

  • Fluticasone propionate nasal spray: 2 sprays per nostril once daily.

  • Mometasone furoate nasal spray: 2 sprays per nostril once daily.

4. Antibiotics (only if bacterial sinusitis suspected)

  • Amoxicillin 500 mg orally every 8 h for 7–10 days.

  • Amoxicillin–clavulanate 875/125 mg orally twice daily for 7–10 days.

  • Doxycycline 100 mg orally once daily × 7 days (penicillin allergy).

5. Mucolytics (to thin secretions in chronic catarrh)

  • Acetylcysteine 200 mg orally three times daily.

  • Carbocisteine 750 mg orally three times daily.

6. Reflux-associated Catarrh

  • Omeprazole 20–40 mg orally once daily.

  • Lifestyle: avoid late meals, elevate head of bed.

C. Procedural / Surgical Options

  • Nasal polyp removal (endoscopic polypectomy).

  • Septoplasty for deviated nasal septum.

  • Functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis.

Complications

  • Chronic sinusitis.

  • Middle ear effusion and hearing loss (children).

  • Asthma exacerbation (if allergic).

  • Sleep disturbance, poor quality of life.

Prognosis

  • Acute catarrh (common cold): Resolves in 7–10 days.

  • Allergic catarrh: Recurrent but controlled with antihistamines and nasal sprays.

  • Chronic catarrh: May require surgery (polyps, structural causes).

Patient Education

  • Most catarrh is not serious and resolves on its own.

  • Maintain hydration, use steam inhalation, and saline sprays.

  • Avoid smoking and allergen exposure.

  • Use decongestants for short periods only.

  • Seek medical advice if catarrh is persistent >3 weeks, blood-stained, associated with fever, facial swelling, or weight loss.




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