SNEEZING

SNEEZING: Excerpt from Differential Diagnosis in Primary Care

Allergic rhinitis (hay fever) is the most common cause of this condition and perhaps any patient with sneezing as the chief complaint needs to have this excluded first. Other conditions, however, may present with sneezing and the clinician needs to be able to recall these while examining the patient. The mnemonic MINT forms a good method for recalling these conditions.

1. M—Malformations include a deviated septum, a cleft palate that allows food to enter the nose, and large tonsils and adenoids.
2. I—Inflammation suggests pertussis, acute viral influenza, the common cold, chronic rhinitis, measles, and other upper respiratory infections. The I also suggests immunologic disorders; allergic rhinitis and bronchial asthma head the list.
3. N—Neoplasms suggest nasal polyps and carcinomas of the nasopharynx.
4. T—Toxic disorders suggest reactions to substances such as pepper, tear gas, phosphine, chlorine, and iodine compounds.

Approach to the Diagnosis

The workup of sneezing involves a careful ear, nose, and throat (ENT) examination to exclude the presence of foreign bodies, polyps, and malformations. The typical mucoid bluish mucosa of allergic rhinitis may be spotted. A nasal smear for eosinophils or serum IgE level will clinch the diagnosis of allergic rhinitis, and skin testing or a RAST can be performed, although a good allergy history may be more important.

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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