Rhinitis / sinusitis (not responding to treatment)

If you have a patient with rhinitis/sinusitis who has not responded to treatment the first thing is to make sure that you have the correct diagnosis

1. Rhinitis

The predominant symptoms are

• nasal blockage
• clear bilateral nasal discharge
• sneezing
• itching

A post nasal drip sensation or chronic cough in the absence of these other symptoms is unlikely to be caused by rhinitis. The normal situation is to produce over a pint of nasal mucus a day which tracks posteriorly and is swallowed over the course of the day without the patient being aware of it. Whenever you carry out nasal endoscopy on these patients they invariably have no more nasal mucus than any other patient without the post nasal drip sensation. Often the diagnosis is globus with the patient assuming it must be coming from a post nasal drip.

For further information on managing rhinitis please click here

2. Rhinosinusitis/sinusitis

The predominant symptoms are

• Nasal blockage
• Nasal discharge anterior or posterior – yellow/green
• Reduced sense of smell

A post nasal drip or chronic cough on its own is unlikely to be due to rhinosinusitis unless they are able to expectorate it and it is green or yellow.

Facial pain can be seen in acute rhinosinusitis but is rare in chronic rhinosinusitis. Facial pain in the absence of the above symptoms is unlikely to be due to rhinosinusitis particularly if there is a long history of months or more with this.

For further information on managing rhinosinusitis please click here