Symptom Finder - Nasal Obstruction
NASAL OBSTRUCTION
The mnemonic MINTS will be very helpful in recalling the various causes of nasal obstruction.
M—Malformation prompts the recall of deviated nasal septum and congenital atresia.
I—Inflammation brings to mind nasal obstruction due to viral, bacterial, and allergic rhinitis and sinusitis. It should also help to recall the obstruction caused by mucormycosis in diabetes. Inflamed swollen adenoids cause acute and chronic obstruction.
N—Neoplasm reminds one of nasal polyps, fibromas, osteomas, teratomas, and advanced carcinomas.
T—Trauma prompts the recall of hematomas of the septum, fracture, and displacement of the nasal bones. T should also suggest toxic swelling of the membranes due to rhinitis medicamentosus.
S—Systemic causes facilitate the recall of Wegener granulomatosis.
Approach to the Diagnosis
If there is fever, one must suspect an upper respiratory infection or acute sinusitis and rhinitis. It is extremely important to ask about chronic use of topical nasal decongestants to rule out rhinitis medicamentosa. If allergic rhinitis is suspected, a nasal smear for eosinophils and serum IgE antibodies can be done. If there is a purulent discharge, smear and cultures for bacteria should be done. Wegener granulomatosis is diagnosed by an ANA, ANCA, or biopsy. In difficult cases, an otolaryngologist should be consulted.
Other Useful Tests
1. X-rays of the nose and sinuses (sinusitis, deviated septum, polyps)
2. CT scan of the sinuses (sinusitis, polyps)
3. Nasopharyngoscopy (adenoids, polyps, neoplasm)
4. Allergy skin tests (allergic rhinitis)
5. Viral antigen testing (influenza)
NASAL OBSTRUCTION
The mnemonic MINTS will be very helpful in recalling the various causes of nasal obstruction.
M—Malformation prompts the recall of deviated nasal septum and congenital atresia.
I—Inflammation brings to mind nasal obstruction due to viral, bacterial, and allergic rhinitis and sinusitis. It should also help to recall the obstruction caused by mucormycosis in diabetes. Inflamed swollen adenoids cause acute and chronic obstruction.
N—Neoplasm reminds one of nasal polyps, fibromas, osteomas, teratomas, and advanced carcinomas.
T—Trauma prompts the recall of hematomas of the septum, fracture, and displacement of the nasal bones. T should also suggest toxic swelling of the membranes due to rhinitis medicamentosus.
S—Systemic causes facilitate the recall of Wegener granulomatosis.
Approach to the Diagnosis
If there is fever, one must suspect an upper respiratory infection or acute sinusitis and rhinitis. It is extremely important to ask about chronic use of topical nasal decongestants to rule out rhinitis medicamentosa. If allergic rhinitis is suspected, a nasal smear for eosinophils and serum IgE antibodies can be done. If there is a purulent discharge, smear and cultures for bacteria should be done. Wegener granulomatosis is diagnosed by an ANA, ANCA, or biopsy. In difficult cases, an otolaryngologist should be consulted.
Other Useful Tests
1. X-rays of the nose and sinuses (sinusitis, deviated septum, polyps)
2. CT scan of the sinuses (sinusitis, polyps)
3. Nasopharyngoscopy (adenoids, polyps, neoplasm)
4. Allergy skin tests (allergic rhinitis)
5. Viral antigen testing (influenza)
