Some Causes of Nasal Congestion and Rhinorrhea

Acute sinusitis

Mucopurulent discharge, often unilateral

Red mucosa

Sometimes a foul or metallic taste, focal facial pain or headache (often positional), and erythema or tenderness over the maxillary or frontal sinus

Usually history and physical examination alone

CT considered in patients with diabetes, immunocompromise, or signs of serious illness

Allergic rhinitis

Watery discharge; sneezing; watery, itchy eyes; pale, boggy nasal mucosa, especially inferior turbinates

Symptoms often seasonal or with exposure to possible triggers

History and physical examination

Allergen skin testing (percutaneous/intradermal)

Allergen blood testing (specific IgE)

Atrophic rhinitis

Chronic rhinitis with atrophic and sclerotic mucous membranes, patency of nasal passages, crust formation, a foul odor

Physical examination alone

Sometimes biopsy, which shows the normal ciliated columnar epithelium converted to stratified squamous (squamous metaplasia) and the lamina propria reduced in amount and vascularity

Decongestant overuse

Rebound congestion as decongestant wears off

Pale, markedly swollen mucosa

History and physical examination alone

Nasal foreign body

Unilateral, foul-smelling (sometimes blood-tinged) purulent discharge in a child

History and physical examination alone

Vasomotor rhinitis

Recurrent watery discharge; sneezing; red, swollen mucosa

No identifiable triggers

History and physical examination alone

Viral URI

Watery to mucoid discharge; accompanied by sore throat, malaise, erythematous nasal mucosa

History and physical examination alone