Differentials
Nonallergic rhinitis
SIGNS / SYMPTOMS
Sporadic or persistent perennial symptoms not resulting from IgE-mediated immunopathologic events.
Pain/pressure and a postnasal drip sensation are common.
Presence of nasal itching and sneezing less likely.
Nonallergic triggers such as strong odors, perfumes, cigarette smoke, and weather-related changes may be present.
Not common in children. Onset of symptoms after age 20 years more likely.[60][61][62]
INVESTIGATIONS
Other than the absence of positive allergy tests, no single, specific differentiating feature exists.
Acute sinusitis
SIGNS / SYMPTOMS
Acute (<2 weeks), subacute (2 to 6 weeks).
Acute disease often due to an infectious cause.
May present with cough, discolored nasal mucus, and facial pressure/pain.[63]
INVESTIGATIONS
Diagnosis is usually clinical.
Chronic sinusitis
SIGNS / SYMPTOMS
Symptoms >12 weeks. Usually diagnosed with the aid of radiologic studies. One of the more common clinical characteristics of chronic sinusitis is the presence of hyposmia or anosmia.
More commonly characterized by chronic inflammation than a bacterial infection, especially in adults.[63]
Frequently characterized 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, rhinorrhea, sneezing, and varying degrees of nasal pruritus. May present with a sore throat, myalgias, headaches, discolored mucus, and fever. More common during the fall to spring months.
INVESTIGATIONS
Diagnosis is usually clinical.
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