Diagnostic Tests for Rhinitis
Rhinitis Tests: Book Excerpts
Home Diagnostic Testing
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Rhinitis Diagnosis: Book Excerpts
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Diagnostic Tests for Rhinitis: Online Medical Books
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NASAL DISCHARGE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine orders for the workup of a nasal discharge include a CBC, sedimentation rate, chemistry panel, VDRL test, smear and culture of the nasal discharge, and x-rays of the sinuses. If the discharge is chronic and mucoid or clear, one should do a nasal smear for eosinophils and serum IgE level to look for allergic rhinitis. A trial of therapy may be indicated in these cases also. If Wegener's granulomatosis is suspected, serum for ANCA should be done.
If there is still diagnostic confusion after the above tests have been done, referral to an ear, nose, and throat specialist or an allergist is indicated. The specialist will perform nasopharyngoscopy and is in a better position to evaluate whether CT scans or bone scans are needed. Also, the specialist can better evaluate when the patient should undergo allergy skin testing, inhalation testing, or radioallergosorbent tests (RASTs).
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Rhinorrhea:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin the history by asking the patient if the discharge runs from both nostrils. Is the discharge intermittent or persistent? Did it begin suddenly or gradually? Does the position of his head affect the discharge?
Next, ask the patient to characterize the discharge. Is it watery, bloody, purulent, or foul smelling? Is it copious or scanty? Does the discharge worsen or improve with the time of day? Also, find out if the patient is using medications, especially nose drops or nasal sprays. Has he been exposed to nasal irritants at home or at work? Does he experience seasonal allergies? Did he recently experience a head injury?
Examine the patient’s nose, checking airflow from each nostril. Evaluate the size, color, and condition of the turbinate mucosa (normally pale pink). Note if the mucosa is red, unusually pale, blue, or gray. Then examine the area beneath each turbinate. (See Using a nasal speculum, page 546.) Make sure to palpate over the frontal, ethmoid, and maxillary sinuses for tenderness.
To differentiate nasal mucus from cerebrospinal fluid (CSF), collect a small amount of drainage on a glucose test strip. If CSF (which contains glucose) is present, the test result will be abnormal. Finally, using a nonirritating substance, make sure to test for anosmia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Rhinorrhea:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin the history by asking the patient if the discharge runs from both nostrils. Is the discharge intermittent or persistent? Did it begin suddenly or gradually? Does the position of his head affect the discharge?
Next, ask the patient to characterize the discharge. Is it watery, bloody, purulent, or foul smelling? Is it copious or scanty? Does the discharge worsen or improve with the time of day? Find out if the patient is using any medications, especially nose drops or nasal sprays. Has he been exposed to nasal irritants at home or at work? Does he experience seasonal allergies? Did he recently experience a head injury?
Examine the patient’s nose, checking airflow from each nostril. Evaluate the size, color, and condition of the turbinate mucosa (normally pale pink). Note if the mucosa is red, unusually pale, blue, or gray. Then examine the area beneath each turbinate. (See Using a nasal speculum, page 690.) Be sure to palpate over the frontal, ethmoid, and maxillary sinuses for tenderness.
To differentiate nasal mucus from cerebrospinal fluid (CSF), collect a small amount of drainage on a glucose test strip. If CSF (which contains glucose) is present, the test result will be abnormal. Finally, using a nonirritating substance, be sure to test for anosmia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Rhinitis:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. General inspection of the patient frequently offers clues to the cause of the rhinitis. For example, “allergic shiners” (infraorbital, bluish discoloration of the skin) or a crease at the lower part of the nose from repeated rubbing are common physical findings of allergic rhinitis.
B. Focused physical examination (PE). Evaluate vital signs (especially temperature) and the ears, nose, and throat, including examination for lymphadenopathy and thyroid disease. A competent examination of nasal passages requires a nasal speculum (a 4–5 mm ear speculum on a handheld otoscope is acceptable for children) and a good light source. Carefully place the nasal speculum vertically into each vestibule. Insert a handheld otoscope light source through the speculum to survey for nasal patency, mucosal color (pale, red or bluish), degree and location of edema, presence and type of nasal drainage (thin, clear, thick, purulent, unilateral, or bilateral), anatomic deformities (bone spurs, septal deviation), and the presence of polyps or other masses. If swollen nasal turbinates block the view, apply a short-acting decongestant spray, then reexamine in 10 minutes. Evaluation of the posterior portion of the nose is often difficult or impossible with a nasal speculum and light source. A flexible nasopharyngoscope permits examination of the structures between the nasal vestibule and the larynx (1).
Assess the lungs and skin for signs of atopic disease (wheezing or eczema) (Chapters 8.9 and 13.4).
C. Additional physical examination. If systemic illness is suggested after the focused examination, a thorough multisystem PE is necessary (Table 6.2).
Testing
A. Clinical laboratory tests. After a thorough history and focused physical examination, most common causes of rhinitis will not require additional testing to initiate effective treatment. Microscopic examination of nasal secretions can be done to help define uncertain allergic or bacterial causes of rhinitis, although most primary care clinicians often leave these tests to an otolaryngologist because these are usually done to clarify less common causes of rhinitis (3). Prompt referral is indicated if doubt exists, serious pathology is suspected or found, PE is difficult secondary to nasal obstruction, or symptoms do not improve with treatment.
B. Diagnostic imaging. If an anatomic abnormality or sinus pathology is suspected, limited computerized tomography (CT) of the sinuses is recommended (1,3,5).
Diagnostic assessment
The patient’s story is critical to determining an accurate diagnosis. Additionally, purulent nasal drainage implies an infectious cause, whereas clear discharge suggests a noninfectious cause. Viral infection will create whitish to pale yellow drainage with associated symptoms of generalized head or body aches, nasal congestion, and sneezing. Bacterial infection will cause yellow or green drainage with focal sinus pain, upper teeth complaints, and possibly fever. Look for edematous, erythematous turbinates. Other less common infectious sources (fungal or parasitic) should be suspected if treatment fails or the patient has a suggestive medical or travel history (5).
To distinguish between allergic and nonallergic rhinitis, focus on symptoms of sneezing, clear drainage, postnasal drip, itching, nasal congestion, generalized sinus pressure, specific irritants or allergens, and family and personal history of atopy and allergy. Next, consider seasonal, perennial, or geographic relationships. The presence of blue or pale boggy turbinates with clear drainage suggests an allergic process.
After a thorough history is taken, the physical examination should confirm the patient’s story and help identify any anatomic defects or systemic disease. Several follow-up visits may be necessary to assess, treat, and educate those with allergic rhinitis and to confirm any need for further evaluation or treatment by an otolaryngologist or allergist (4).
References
1. Fornadley JA. The stuffy nose and rhinitis. Med Clin North Am 1999;83:211–224.
2. Hadley JA. Evaluation and management of allergic rhinitis. Med Clin North Am 1999;83:13–25.
3. Galen BA. Rhinitis. Lippincott’s Primary Care Practice 1997;1:129–141.
4. Leopold D, Ferguson BJ, Piccirillo JF. Outcomes assessment. Otolaryngol Head Neck Surg 1997;117:S58–S68.
5. Benninger MA, Anon JB, Mabry RL. The medical management of rhinosinusitis. Otolaryngol Head Neck Surg 1997;117:S41–S49.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Nasal Discharge:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Cause ofnasal discharge often can be determined by history and physicalexam. Most common causes are viral upper respiratory infection andallergic rhinitis.Nasal smear that shows many eosinophilssuggests allergic rhinitis, either seasonal or perennial, althoughthis same finding may occur with subgroup of nonallergic rhinitis.Skin testing remains principal methodof diagnosis with allergic disease. When skin test is definitelypositive, there is little need for other tests. When skin test isquestionably positive, RAST, which measures specific IgE antibodyin serum, may be performed.Nasal foreign body and sinusitis areother common causes of nasal discharge. Foul-smelling unilateraldischarge usually occurs with foreign body. Diagnosis of sinusitisis usually clinical.CT of sinuses should usually be reservedfor children with orbital or CNS complications or when sinus surgeryis contemplated.CSF rhinorrhea is rare occurrence butcan be associated with recurrent meningitis. Special imaging studiescan be used to locate site of leak.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Rhinorrhea:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin the history by asking the patient if the discharge runs from both nostrils. Is the discharge intermittent or persistent? Did it begin suddenly or gradually? Does the position of his head affect the discharge? Does anything make it better? Does anything make it worse?
Next, ask the patient to characterize the discharge. Is it watery, bloody, purulent, or foul smelling? Is it copious or scanty? Does the discharge worsen or improve with the time of day? Also, find out if the patient is using medications, especially nose drops or nasal sprays. Has he been exposed to nasal irritants at home or at work? Does he experience seasonal allergies? Did he recently experience a head injury?
Examine the patient's nose, checking airflow from each nostril. Evaluate the size, color, and condition of the turbinate mucosa (normally pale pink). Note if the mucosa is red, unusually pale, blue, or gray. Then examine the area beneath each turbinate. (See Using a nasal speculum, page 542.) Be sure to palpate over the frontal, ethmoid, and maxillary sinuses for tenderness.
To differentiate nasal mucus from cerebrospinal fluid (CSF), collect a small amount of drainage on a glucose test strip. If CSF (which contains glucose) is present, the test result will be abnormal. Finally, using a nonirritating substance, be sure to test for anosmia.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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