Primary Care Otolaryngology

Chapter 9

Rhinology, Nasal Obstruction, and Sinusitis

Patients present to primary care providers with a variety of nasal com- plaints, ranging from rhinorrhea and postnasal drainage to obstruction and pain. Rhinorrhea and postnasal drainage can result from allergic rhinitis, nonallergic rhinitis, vasomotor rhinitis, and acute and chronic rhinosinusitis. Nasal obstruction can be caused by anatomic deformities (including septal and external nasal deviation, nasal valve compromise, turbinate hypertrophy, nasal polyps) and inflammatory changes resulting in mucosal edema. Successful treatment of the varying causes of rhinor- rhea and obstruction is based on an accurate diagnosis of the underlying cause. Vasomotor rhinitis and nonallergic rhinitis can mimic allergic rhinitis. In both cases, patients present with clear rhinorrhea, no other allergic symptoms or history, and allergy tests are negative. Vasomotor rhinitis is often triggered by food, temperature change, or sudden bright light. Intranasal steroid sprays are the best treatment for nonallergic and vaso- motor rhinitis. The “Common Cold” Acute viral rhinosinusitis is frequently attributed to one of a multitude of rhinoviruses, and results in symptoms we refer to as the “common cold.” The pathophysiology involves infection, inflammation, mucosal swelling, and increased mucus production. Low-grade fever, facial discomfort, and purulent nasal drainage are also common symptoms. Treatment is symp- tomatic, with antipyretics, hydration, analgesics, and decongestants rec- ommended, as needed. Spontaneous resolution occurs in 7–10 days. Antibiotic treatment of the common cold is discouraged, but unfortunate- ly, patients often request (or demand) antibiotics early in the course of viral illness. When spontaneous recovery occurs, they assume that the antibiotics were responsible. This is a major cause of excessive antibiotic use and has contributed to the surge in antibiotic resistance.

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Primary Care Otolaryngology