NASAL OBSTRUCTION

Ask the Following Questions:

1. Is it acute or chronic? The presence of acute nasal obstruction should suggest acute sinusitis, acute rhinitis, a viral URI, allergic rhinitis, nasal diphtheria, cluster headache, migraine, foreign body, and trauma. The presence of chronic nasal obstruction, particularly if it is unilateral, would suggest sinusitis, foreign bodies, neoplasm, deviated septum, polyps, Wegener's granulomatosis, mucormycosis, and nasal gumma. If it is bilateral, it would suggest allergic rhinitis, vasomotor rhinitis, adenoid enlargement, rhinitis medicamentosa, and ingestion of drugs such as reserpine.
2. Is it unilateral or bilateral? The presence of unilateral nasal obstruction suggests acute purulent sinusitis, foreign body, neoplasm, mucormycosis, Wegener's granulomatosis, polyps, and neoplasms. It also suggests a deviated septum. The presence of bilateral nasal obstruction suggests allergic rhinitis, acute viral URI, nasal diphtheria, rhinitis medicamentosa, adenoids, and vasomotor rhinitis.
3. Is there fever? The presence of fever with unilateral nasal obstruction would suggest acute sinusitis. The presence of fever with bilateral nasal obstruction would suggest acute rhinitis and acute viral URI. Nasal diphtheria may occasionally present with this picture, even in modern times.

DIAGNOSTIC WORKUP

Routine diagnostic studies include a CBC, sedimentation rate, chemistry panel, VDRL test, ANA, a nasal smear and culture for bacteria and fungi, and x-rays of the sinuses. A nasal smear for eosinophils and serum IgE antibodies should be done if allergy is suspected. A trial of antibiotics or antihistamines may assist in the diagnosis. If Wegener's granulomatosis is suspected, serum for ANCA should be done.

If there is still confusion regarding the diagnosis at this point, a referral to an ear, nose, and throat specialist or allergist would be indicated. The ear, nose, and throat specialist may do a nasopharyngoscopy and is in a better position to determine when CT scans or bone scans are indicated. The allergist can best determine whether allergy skin testing, inhalation testing, or RAST studies would be indicated.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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