Nasal Congestion/Discharge
Nasal Congestion/Discharge: Excerpt from Field Guide to Bedside Diagnosis
Differential Overview
❑ Common cold
❑ Allergic rhinitis
❑ Vasomotor rhinitis
❑ Nasal polyp
❑ Sinusitis
❑ Drugs
❑ Deviated septum
❑ Intranasal foreign body
❑ Sarcoidosis
❑ Cerebrospinal fluid leak
❑ Wegener granulomatosis
Clinical Findings
Common cold The onset is acute, with a scratchy sore throat and cough. The nasal mucosa will appear red, boggy, and glassy. The nasal drainage will initially be clear but will later become colored (yellow-green).
Allergic rhinitis Acute allergic rhinitis is often associated with eye irritation, paroyxms of sneezing, itching of the eyes, nose, or palate, and postnasal drip with cough. The nasal mucosa is bluish and pale. Seasonal rhinitis is usually caused by inhaled pollens. Perennial rhinitis is caused by allergy to animals, dust, mites, or mold.
Vasomotor rhinitis Congestion is prominent, but rhinorrhea, sneezing, and itching are not. Rhinitis medicamentosa occurs after 3 to 4 days of continuous use of a topical vasoconstrictor. There will be initial relief with its use that is then followed by rebound with worsened congestion. Vasomotor rhinitis may also be precipitated by cold, emotion, or sexual arousal. The turbinates are red and boggy.
Nasal polyp Unilateral airflow will be obstructed and a polyp will be visible deep inside, beyond the turbinate, as a gray structure with the appearance of a skinned grape. There is an association between aspirin use, nasal polyps, and asthma, but the most common cause is chronic allergic rhinitis.
Sinusitis Drainage, if present, will be purulent, although colored drainage can be found in other conditions. There will be a sensation of facial fullness that worsens with bending forward, often accompanied by fever and a headache. On physical examination, there will be tenderness to concussion and pressure, overlying warmth, and fever. The affected sinus will not transilluminate.
Drugs Cocaine, beta-blockers, reserpine, and hydralazine can each cause nasal obstruction.
Deviated septum Deviation causes chronic unilateral obstruction, which is readily observed with a nasal speculum.
Intranasal foreign body There will be nasal obstruction associated with a chronic unilateral mucopurulent discharge with a foul odor.
Sarcoidosis Sarcoidosis presents with bilateral nasal congestion in as many as 20% of cases. Systemic symptoms such as fever, fatigue, or weight loss; pulmonary symptoms such as cough or dyspnea; or skin manifestations such as erythema nodosum or purple, waxy plaques are clues to the underlying diagnosis.
Cerebrospinal fluid leak Head trauma with a basilar skull fracture may go unrecognized. Clear nasal drainage tests positive for glucose using a urine dipstick.
Wegener granulomatosis Its earliest manifestation may be nasal obstruction, rhinorrhea, crusting, and chronic sinusitis with a fetid drainage. Development of a septal ulceration is classic.
Book Source Details
- Book Title: Field Guide to Bedside Diagnosis
- Author(s): David S. Smith
- Year of Publication: 2007
- Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Field Guide to Bedside Diagnosis
Authors: David S. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 0-78178-165-5
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» Next page: Allergic rhinitis (Handbook of Diseases)
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