Differentials
Non-allergic rhinitis
SIGNS / SYMPTOMS
Sporadic or persistent perennial symptoms not resulting from IgE-mediated immunopathological events.
Pain/pressure and a post-nasal drip sensation are common.
Presence of nasal itching and sneezing less likely.
Non-allergic triggers such as strong odours, perfumes, cigarette smoke, and weather-related changes may be present.
Not common in children. Onset of symptoms after age 20 years more likely.[56][57][58]
INVESTIGATIONS
Other than the absence of positive allergy tests, no single, specific differentiating feature exists.
Acute sinusitis
SIGNS / SYMPTOMS
Acute (<2 weeks), sub-acute (2-6 weeks).
Acute disease often due to an infectious cause.
May present with cough, discoloured nasal mucus, and facial pressure/pain.[59]
INVESTIGATIONS
Diagnosis is usually clinical.
Chronic sinusitis
SIGNS / SYMPTOMS
Symptoms >12 weeks. Usually diagnosed with the aid of radiological studies. One of the more common clinical characteristics of chronic sinusitis is the presence of hyposmia or anosmia.
More commonly characterised by chronic inflammation than a bacterial infection, especially in adults.[59]
Frequently characterised as chronic sinusitis with nasal polyposis, and chronic sinusitis without nasal polyposis.
INVESTIGATIONS
Sinus CT scans are abnormal, by definition, in people with chronic sinusitis.
Infectious rhinosinusitis
SIGNS / SYMPTOMS
Viral infection may result in acute (<2 weeks) episode of rhinitis presenting with nasal congestion, rhinorrhoea, sneezing, and varying degrees of nasal pruritus. May present with a sore throat, myalgias, headaches, discoloured mucus, and fever. More common during the autumn to spring months.
INVESTIGATIONS
Diagnosis is usually clinical.
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