Symptom Finder - Nasal Discharge
Nasal Discharge
If the discharge is purulent, the author suggests that the physician look carefully for bacterial sinusitis, most likely maxillary sinusitis, especially
if it is unilateral. It may be possible to spot the discharge coming from the meatus with an otoscope using a large speculum, but transillumination is the best way to spot a maxillary or frontal sinusitis clinically. If one does not have a sinus transilluminator, use a powerful pin light with the patient in a dark room. Place the light in the mouth and compare the illumination in both maxillary sinuses. Alternatively, one can place the pin light in the orbit and examine for light coming through the palate with the mouth open.
If the discharge is clear, the turbinates will be swollen and bluish with a thin layer of mucus in allergic rhinitis. If the patient has rhinitis
medicamentosum from excessive use of nasal sprays, the turbinates will be swollen, but in addition, there will be small pustules on the mucosa. With cocaine abuse, septal perforation may be apparent. In long-standing allergic rhinitis, mucous polyps are evident. In children, be sure to look for foreign bodies. Also, remember that a chronic clear nasal discharge may indicate cerebrospinal rhinorrhea. (This may seem gross, but here is a little trick one might use to decide what type of discharge there is: have the patient blow into a tissue and examine it!)
If the discharge is purulent, the author suggests that the physician look carefully for bacterial sinusitis, most likely maxillary sinusitis, especially
if it is unilateral. It may be possible to spot the discharge coming from the meatus with an otoscope using a large speculum, but transillumination is the best way to spot a maxillary or frontal sinusitis clinically. If one does not have a sinus transilluminator, use a powerful pin light with the patient in a dark room. Place the light in the mouth and compare the illumination in both maxillary sinuses. Alternatively, one can place the pin light in the orbit and examine for light coming through the palate with the mouth open.
If the discharge is clear, the turbinates will be swollen and bluish with a thin layer of mucus in allergic rhinitis. If the patient has rhinitis
medicamentosum from excessive use of nasal sprays, the turbinates will be swollen, but in addition, there will be small pustules on the mucosa. With cocaine abuse, septal perforation may be apparent. In long-standing allergic rhinitis, mucous polyps are evident. In children, be sure to look for foreign bodies. Also, remember that a chronic clear nasal discharge may indicate cerebrospinal rhinorrhea. (This may seem gross, but here is a little trick one might use to decide what type of discharge there is: have the patient blow into a tissue and examine it!)
