DIFFERENTIAL DIAGNOSIS

• Allergic Rhinitis
• URI
• Foreign Body- Nose
• Sinusitis
• CSF Rhinnorhea
• Medication withdrawal or side effect
• Systemic Illness (Hypothryroidism,Wegener’s, CF, Sarcoidosis)

AGE/GENDER CONSIDERATIONS

• Allergic Rhinitis can begin at any age.
• Nasal fractures are uncommon under age five.

DIAGNOSIS

HISTORY

• General health-fever
• Seasonality to symptoms (Allergic Rhinitis)
• Nasal Itching (Allergic Rhinitis)
• History of asthma or eczema/ Family history of atopy (Allergic Rhinitis)
• Medication cessation (Nasal decongestion withdrawal)
• Duration (Sinusitis, Nasal polyps, Nasal tumor)
• Foul smelling (Foreign Body)
• Facial trauma (CSF Rhinorrhea)
• New Medication (Oral contraceptive, Anti-Hypertensive)

PHYSICAL EXAM

• Allergic Shiners/Allergic salute (Allergic Rhinitis)
• Nasal Polyps
• Septal deviation/perforation
• Foreign body

Tests

• None are generally needed. CT Scan if concern for facial fracture/CSF leak.

MANAGEMENT

Transfer/Admit considerations

• Urgent evaluation by ENT if CSF leak is suspected.

REFERRAL

PEARLS AND PITFALLS

REFERENCES

ALLERGIC RHINITIS

TREATMENT

• Analgesics (Tylenol, Ibuprofen),

DISCHARGE CRITERIA

• Pain controlled with PO medications
• Able to tolerate PO

FOLLOW UP

• Primary care physician
• Encourage fluids
• Medications as indicated

PROGNOSIS

• Generally very good

ANTICIPATORY GUIDANCE

SINUSITIS

TREATMENT

• Analgesics (Tylenol, Ibuprofen),

DISCHARGE CRITERIA

• Pain controlled with PO medications
• Able to tolerate PO

FOLLOW UP

• Primary care physician
• Encourage fluids
• Medications as indicated

PROGNOSIS

• Generally very good

ANTICIPATORY GUIDANCE

UPPER RESPIRATOR INFECTION

TREATMENT

• Analgesics (Tylenol, Ibuprofen),

DISCHARGE CRITERIA

• Pain controlled with PO medications
• Able to tolerate PO

FOLLOW UP

• Primary care physician
• Encourage fluids
• Medications as indicated

PROGNOSIS

• Generally very good