🤧 Viral URI (Common Cold)
• Most common cause
• Gradual onset, self-limited
• Clear to mucoid discharge
• Associated cough, low-grade fever
🌸 Allergic Rhinitis
• Clear, watery discharge
• Boggy, pale/bluish nasal mucosa
• Allergic salute, shiners, sneezing
• Eosinophils on nasal smear
🦠 Bacterial Rhinosinusitis
• Symptoms >10-14 days without improvement
• Purulent discharge, halitosis, facial pain
• Double sickening pattern
• CT not helpful to differentiate viral
⚠️ Red Flags & Uncommon Causes
• Unilateral purulent/foul discharge → foreign body
• CSF leak: clear, unilateral, glucose +
• Choanal atresia: respiratory distress in newborn
• Congenital syphilis: "snuffles"
💊 Rhinitis Medicamentosa
• Rebound congestion from overuse of vasoconstrictor sprays/drops
• Also cocaine, marijuana, oral contraceptives
📌 Decision strategy: Duration & character guide diagnosis. Acute <10 days → viral. >10 days with purulence → consider bacterial sinusitis. Allergic stigmata → allergy testing. Unilateral → foreign body until proven otherwise.