Nasal Congestion
Nasal congestion is a common complaint in primary care. Although usually a sequela of an upper respiratory infection, it can also be a sign of acute or chronic illness. Regardless of its cause, the successful management of nasal congestion often significantly improves patients’ quality of life.
Differential Diagnosis
-
Upper respiratory infection
–Most common cause of nasal congestion
–Respiratory droplet spread, 1–2 day
incubation, duration 7–14 days
–Cough, rhinorrhea, fever, malaise
–Viral etiology (adenovirus, rhinovirus)
-
Perennial allergic rhinitis
–Family history of allergy
–Onset <20 years
–Persistent watery nasal discharge
–No variation with season
–Pale, bluish, watery, nasal mucosa
-
Seasonal allergic rhinitis
–Itchy, teary eyes
–Sneezing
–Watery nasal discharge
–Varies with season
–Exposure to allergen (dust, mold, pollen)
–Pale, bluish, watery, nasal mucosa
-
Perennial nonallergic rhinitis
–No variation with season
–Obstruction may alternate nares
–Swollen nasal mucosa -
Sinusitis (acute or chronic)
–Patients often have a history of sinusitis
–Craniofacial discomfort
–Sinus headaches
–Pain with percussion of teeth in maxillary sinusitis
–Retro-orbital pain upon coughing or sneezing in cases of ethmoid sinusitis
–Mucopurulent nasal drainage
-
Rhinitis medicamentosa (rebound rhinitis)
–Prolonged use of intranasal decongestants
-
NARES
-
Nasal polyps
-
Vasomotor rhinitis
-
Foreign body in nose
-
Intranasal cocaine use
–May see nasal septum perforation -
Medication side effects (e.g. aspirin, β-blockers, NSAIDs, oral contraceptives,
reserpine, and thioridazine)
-
Idiopathic rhinitis
-
Less common etiologies include cystic fibrosis, Wegener's granulomatosis, folliculitis of nasal hair, congenital abnormality, sarcoidosis
Workup and Diagnosis
- History and physical examination with attention to head and neck
–Onset, duration, recurrence pattern, associated symptoms (e.g., cough, fever, itchy palate or eyes), medication/illicit drug use, and family history
–Examine the eyes, ears, sinuses, nares, oral mucosa, tongue, posterior pharynx, neck, chest, and heart in all cases
-
Allergy (skin prick) testing to common inhaled antigens will be positive in patients with perennial and seasonal allergic rhinitis (perform only if chronic or recurrent)
-
Nasal lavage with identification of cell type
–Increased eosinophils in NARES and perennial and seasonal allergic rhinitis
–Increased PMNs in infectious etiologies
-
Rhinoscopic exam/flexible nasopharyngolaryngoscopy may reveal polyps, deformity, mucosal inflammation, or discharge draining from sinus meatus
-
CT scan of the sinuses is usually reserved for patients who
are resistant to medical therapy for 6–8 weeks
–May see opacification and air fluid levels in sinusitis
-
Nasal cultures have low specificity and are of little clinical value
Treatment
-
Initial symptomatic treatment with intranasal saline lavage may provide short-term symptomatic relief
-
Intranasal decongestants (e.g., oxymetazoline, phenylephrine) or oral decongestants (e.g., pseudoephedrine, phenylephrine, ipratropium)
-
Treat sinusitis (but never viral URI) with antibiotics
–First-line agents include amoxicillin, trimethoprimsulfamethoxazole, or doxycycline
–Amoxicillin plus clavulanic acid is indicated if a
β-lactamase-producing strain is suspected
–Surgery may be indicated for recurrent disease
-
Allergic rhinitis
–Intranasal steroids: Budesonide, fluticasone
–First- or second-generation antihistamines
–Cromolyn sodium
–Allergen avoidance
-
Perennial nonallergic rhinitis is treated with decongestants and intranasal steroids for symptoms
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Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
Other Book Chapters Related to Stuffed nose
Read excerpts from these other book chapters related to Stuffed nose:
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Stuffed nose
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: Epistaxis (Nosebleed) (In A Page: Pediatric Signs and Symptoms)
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