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The most common causes of nasal congestion and rhinorrhea are viral and allergic. Dry air may provoke congestion. Acute sinusitis is slightly less common, and a nasal foreign body is unusual (and occurs predominantly in children).
Patients who use topical decongestants > 1 day often experience significant rebound congestion when the effects of the drug wear off, causing them to continue using the decongestant. This situation (rhinitis medicamentosa) may persist for some time and be misinterpreted as continuation of the original problem rather than a consequence of treatment.
Evaluation
History includes the nature of the discharge, including relation to patient location and season, and associated symptoms (eg, fever, pain). Examination focuses on the nose, throat, and area over the sinuses.
Sore throat, malaise, and erythematous nasal mucosa suggest a URI. Watery, itchy eyes and pale, boggy nasal mucosa suggest allergy, particularly if symptoms are seasonal or if they recur with exposure to possible triggers (eg, animal dander, down pillows). Mucopurulent discharge (sometimes with a foul or metallic taste), focal facial pain or headache, and sometimes erythema or tenderness over the maxillary or frontal sinus suggest sinusitis. Unilateral foul-smelling discharge in a child suggests a nasal foreign body. Testing is generally not indicated for acute nasal symptoms unless invasive sinusitis (see Nose and Paranasal Sinus Disorders: Sinusitis) is suspected in a diabetic or immunocompromised patient.
Treatment
Specific conditions are treated. Symptomatic relief of congestion can be achieved with topical or oral decongestants (eg, phenylephrine or pseudoephedrine , respectively). Prolonged use should be avoided. Viral rhinnorhea can be treated with oral antihistamines because of their anticholinergic properties unrelated to their histamine-blocking properties. Allergic congestion and rhinorrhea can be treated with antihistamines; in such cases, nonanticholinergic antihistamines provoke fewer adverse effects. Nasal corticosteroids also help allergic conditions.
Last full review/revision November 2005
Content last modified November 2005
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