Nasal Congestion

Differential Dx — Nasal Congestion / Discharge

Initial Diagnoses to Consider

Rare Conditions

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”)