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Hello, I Am A Student And Would Like To If
Question: Hello, I am a student and would like to if I am on the right tract with this case study please (as always, we are given little information):
50-year-old male with CC of nasal congestion, sneezing, rhinorrhea, and postnasal drainage, itchy nose, eyes, palate, and ears for 5 days. Using Mucinex with minimal improvement. Patient has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. Throat is mildly erythematous.
Here are my diff. dx:
1. Allergic rhinitis
2. rhinitis medicamentosa (allergy to guaifenesin/ dextromethorphan)
2. chronic sinusitis
3. acute viral rhinitis
4.. CSF leak
Also, what diagnostic tests might you complete?
Thank you
50-year-old male with CC of nasal congestion, sneezing, rhinorrhea, and postnasal drainage, itchy nose, eyes, palate, and ears for 5 days. Using Mucinex with minimal improvement. Patient has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. Throat is mildly erythematous.
Here are my diff. dx:
1. Allergic rhinitis
2. rhinitis medicamentosa (allergy to guaifenesin/ dextromethorphan)
2. chronic sinusitis
3. acute viral rhinitis
4.. CSF leak
Also, what diagnostic tests might you complete?
Thank you
Brief Answer:
Most likely allergic rhinitis
Detailed Answer:
Hello, I'm Dr. Branch,
Thanks for using 'Ask A Doctor' service.
This is a form of rhinitis, and I agree that, with the sneezing and itching, allergic rhinitis seems most likely. After that would come acute infectious rhinitis (from a viral URI), then acute rhinosinusitis and less likely atrophic rhinitis.
Rhinitis medicamentosa is a complication of decongestant nasal sprays, and rhinitis due to Mucinex is possible but is not a typical medication that would cause this. He could not have chronic sinusitis because he has only had symptoms for 5 days, but acute rhinosinusitis is possible as I mentioned. With any head trauma, I don't think CSF leak would need to be considered.
This is usually a clinical diagnosis and treatment are tried before doing any other diagnostic tests.
However, skin or serum testing to determine if the patient is having an allergy to specific allergens is sometimes done.
Nasal cytology is rarely done to try to differentiate between rhinitis due to allergy and infection.
I hope that helps!
Let me know if you have any questions about any of that.
Most likely allergic rhinitis
Detailed Answer:
Hello, I'm Dr. Branch,
Thanks for using 'Ask A Doctor' service.
This is a form of rhinitis, and I agree that, with the sneezing and itching, allergic rhinitis seems most likely. After that would come acute infectious rhinitis (from a viral URI), then acute rhinosinusitis and less likely atrophic rhinitis.
Rhinitis medicamentosa is a complication of decongestant nasal sprays, and rhinitis due to Mucinex is possible but is not a typical medication that would cause this. He could not have chronic sinusitis because he has only had symptoms for 5 days, but acute rhinosinusitis is possible as I mentioned. With any head trauma, I don't think CSF leak would need to be considered.
This is usually a clinical diagnosis and treatment are tried before doing any other diagnostic tests.
However, skin or serum testing to determine if the patient is having an allergy to specific allergens is sometimes done.
Nasal cytology is rarely done to try to differentiate between rhinitis due to allergy and infection.
I hope that helps!
Let me know if you have any questions about any of that.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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