Diagnostic strategies in nasal congestion

Abstract

Nasal congestion is a major symptom of upper respiratory tract disorders, and its characterization an important part of the diagnosis of these illnesses. Patient history and assessment of nasal symptoms are essential components of diagnosis, providing an initial evaluation that may be adequate to rule out serious conditions. However, current congestion medications are not always fully effective. Thus, if symptoms do not respond adequately to therapy, or symptoms suggestive of more serious conditions are present, specialized assessments may be needed. Various techniques are available for diagnosing patients, including those used chiefly by primary care clinicians and those requiring the expertise of otolaryngologists, allergists, and other specialists. Endoscopy remains a mainstay for evaluating nasal blockage and its causes, while modalities such as peak nasal inspiratory flow and acoustic rhinometry are evolving to provide easy-to-use, noninvasive procedures that are sensitive enough to measure small but clinically important abnormalities and therapeutic changes. Several imaging modalities are available to the specialist for severe or unusual cases, as are specialized diagnostic procedures that measure adjunctive features of congestion, such as impaired mucociliary function.

Keywords: allergic rhinitis; congestion; diagnosis; obstruction; rhinosinusitis.

Figure 1

Diagnostic algorithm for nasal congestion.

Figure 2

Visual analog scale for assessment of symptom severity. Adapted with permission from Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl. 2007;(Suppl 20):1–136.³ Copyright © 2007 International Rhinologic Society.

Figure 3

Acoustic rhinometry trace. Results of three superimposed rhinometry traces of the left nostril demonstrate the high reproducibility of this technique. Abbreviations: MCA, minimal cross-sectional area; Inf. turb., inferior turbinate.