[Trovato in CompuServe:HNT.]

   Upper Respiratory Diseases

 The Common Cold

   The so-called common cold is actually a collection of similar diseases affecting the lining tissue of the nose, throat, and upper airways including the trachea and larynx (vocal cords). Many viruses can cause a cold and among the most common are rhinoviruses, coronavirus, and adenovirus.  The average number of colds per year varies from around three for most adults to eight or more for young children in group settings; their mothers may have a similar number.

   The symptoms of a common cold require little elaboration.  The most common include sneezing, nasal discharge and blockage, cough, sore throat, hoarseness, and a sense of pressure around the nose, ears, and eyes. Notably absent with a cold is a fever which, if present at all is rarely more than one degree above the usual 98.6 degrees Fahrenheit (rectal).  Higher fevers should prompt a search for complications.

   The incubation period of most of the viruses is 2 or 3 days, and contagiousness correlates roughly with the degree of symptoms.  In general the symptom intensity peaks at 3 or 4 days, and the syndrome resolves within a week or two. Complications are common, and are discussed below; they are generally caused by bacteria which invade the already inflamed tissues caused by the cold virus.

 Diagnosis

   The history and findings are so common as to be almost diagnostic.  In severely symptomatic patients, a search for possible bacterial complications will include examinations of the ears, sinuses, throat and lungs.  Some authorities feel that every sore throat should be cultured to look for strep throat. If a bacterial complication is suspected, appropriate x-rays may be necessary.

 Treatment

   Viruses are unaffected by the usual antibiotics including penicillin.  Thus treatment is largely symptomatic.  Some common remedies include the following:

   Sore throat--ice chips, mild anesthetic lozenges, aspirin and acetaminophen, mild salt water gargles to cleanse mucus from the area, and anesthetic solutions (these may depress the swallowing reflex and should only be used under a doctor's supervision if at all).

   Stuffed Nose--nasal sprays for no more than 2 or 3 days, such as oxymetazoline and xylometazoline, or phenylephrine; oral decongestants such as phenylpropanolamine or pseudoephedrine are of unproven benefit, but some people experience relief with them; antihistamines alone or with decongestants are probably best avoided since they do little except dry out secretions. They regularly cause drowsiness. Nonetheless, some people find them helpful when discharge is copious.

   General--aspirin or acetaminophen can be useful for achiness or pain.  Vitamin C has no proven benefit, although the placebo (psychologic) effect is considerable in some. Rest, plenty of fluids, and avoidance of high personal contact situations are all prudent.

           Prevention

   No vaccine is likely in view of the many different viruses involved.  Vitamin C has been shown to be ineffective. Some interesting and promising results in reducing spread of cold has been noted with specially treated tissues, but the importance of this is not clear at present.

         COMPLICATIONS

   When the upper respiratory tissues are prevented from draining mucus and air normally by a cold-related swelling and inflammation, the bacteria normally present in small numbers may cause infection of a more serious nature. Some of these are:

# Earache (otitis media)--the middle ear cavity fills with pus, causing pain, decreased hearing, fever, and even rupture with permanent hearing loss. Antibiotic treatment, often with amoxicillin, ampicillin, penicillin, erythromycin or Bactrim is usually curative. Physician management is crucial for any earache.

# Sinusitis--the boney cavities around the nose can be blocked and fill with pus much like the middle ear.  Pain around the eyes, cheeks, upper teeth, and nose can result, sometimes with a bloody or pus-like nasal discharge.  Fever is common. Antibiotic treatment as for earache is usually curative. Severe or resistant cases may require a drainage operation to relieve the pressure.

# Strep throat--occurring either alone or with a viral cold can cause severe throat symptoms, but more importantly can lead to rheumatic fever and heart disease (see Heart Valve diseases) or to glomerulonephritis (see kidney- nephritis section).  The only accurate way to rule this out is with a cotton swab culture of the throat, although it is usually negative with routine sore throats.

# Laryngitis--hoarseness is the primary symptom.  This occurs from swelling and mucus collections on the vocal cords. Rarely is specific treatment helpful other than humidity, voice rest (whispering does not rest the cords).  Occasionally germs called mycoplasma can cause this and will respond to antibiotics.  In persistent cases, this may be used.  Any hoarseness for more than 2 weeks warrants a physician exam to rule out cancer and polyps.

# Bronchitis--often in smokers, but occasionally in nonsmokers, a cold leads to bacterial overgrowth in the upper airways of the lungs.  When this occurs, sputum production increases and a cough which brings up large amounts of green, yellow, gray, or otherwise colored sputum is noted.  Antibiotics are used to treat this.  Clear, white or moderate amounts of sputum are usually just from the cold itself.  A physician evaluation is important to distinguish bronchitis from pneumonia.

# Conjunctivitis (pink eye)-- occurring alone or with a cold usually manifests as redness of the eye with a yellow discharge which typically pastes the lids together upon awakening. Physician evaluation is advised to rule out other eye diseases, and treatment is by eye drops or ointments containing antibiotics.

 SUMMARY

    The common cold is a syndrome of considerable prevalence and importance in that it causes much time lost from work, annoying symptoms, and occasional more serious complications.  However, it is self-limited, almost never serious or life-threatening in otherwise healthy people, and rarely highly disabling.  Thus the ancient caution "first do no harm" in medicine applies strongly. Treatment should be minimal or not given in most cases, and complications should be generally managed under a physician's care.