Nasal Congestion

Differential Dx — Nasal Congestion / Discharge

Initial Diagnoses to Consider URI (if Sx <2 wks duration) Allergic Rhinitis Rhinitis Medicamentosa Local Lesions (acute) Perforated Septum Deviated Septum (+ Allergy) Foreign Body (young children) Acute Sinusitis (uncommon)

Rare Conditions Nasal Polyposis Adenoid Enlargement Chronic Sinusitis Granulomatous Disorders Tumors “Laryngopharyngeal Reflux”

Summary Approach

<2 Weeks’’ Duration

**  Probably Dx Common Cold (URI)

**  Dx Allergic Rhinitis if any of following:

• Lots of sneezing
• Teary eyes a prominent component
• Hx of frequent prior episodes
• Hx of prior episodes lasting >3-4 weeks
• “Allergic Shiners” / “Allergic Salute”

**  Other Diagnoses possibly found by  H&P (uncommon):

• Rhinitis Medicamentosa
• Anterior lesions
• Perforated / Deviated Septum
• Foreign Body (young children)

**  Sinusitis (bacterial)  —  either of following:

• Fever PLUS unilateral discharge PLUS unilateral tenderness to percussion of sinus or maxillary teeth  [severe but uncommon]
•  Began as URI, got worse unilaterally after 5-10 days
• NOTE:  Beware of over-diagnosis (= over-Rx antibiotics)

>2 Weeks’ Duration

**  R/O “Other Diagnoses by H&P” as above

**  Diagnose Allergic Rhinitis & Tx

• Nasal Steroid + non-sedating Antihistamine
• Teach correct use [see Blog posting]

If no change after 1-2 weeks [with correct use], consider:

• Empiric Tx for Sinusitis
• Non-Contrast CT for rare disorders
• ENT referral for nasal endoscopy
• Tx GERD if suggestive Sx (“laryngopharyngeal reflux”)

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