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