📄 acute viral rhinosinusitis common cold
ESSENTIALS OF DIAGNOSIS
Nasal congestion, clear rhinorrhea, and hyposmia Associated malaise, headache, and cough Erythematous, engorged nasal mucosa without intranasal purulence Symptoms are self-limited, lasting less than 4 weeks and typically less than 10 days Clinical Findings
Because there are numerous serologic types of rhinoviruses, adenoviruses, and other viruses, patients remain susceptible to the common cold throughout life
These infections, while generally quite benign and self-limited, have been implicated in the development or exacerbation of more serious conditions, such as acute bacterial sinusitis and acute otitis media, asthma, cystic fibrosis, and bronchitis
Nasal congestion, decreased sense of smell, watery rhinorrhea, and sneezing, accompanied by general malaise, throat discomfort and, occasionally, headache are typical in viral infections
Nasal examination usually shows erythematous, edematous mucosa and a watery discharge
The presence of purulent nasal discharge suggests bacterial rhinosinusitis
Treatment
There are no effective antiviral therapies for either the prevention or treatment of most viral rhinitis despite a common misperception among patients that antibiotics are helpful
Prevention of influenza virus infection by boosting the immune system using the annually created vaccine may be the most effective management strategy
Oseltamivir is the first neuramidase inhibitor approved for the treatment and prevention of influenza virus infection, but its use is generally limited to those patients considered high risk
These high-risk patients include young children, pregnant women, and adults older than 65 years of age
Oseltamivir is hard to use because it must be started within 48 hours for optimal effect
Other specific antiviral medications are available or in clinical trials but have not achieved significant use
Zinc for the treatment of viral rhinitis has been controversial
Buffered hypertonic saline (3–5%) nasal irrigation has been shown to improve symptoms and reduce the need for nonsteroidal anti-inflammatory drugs (NSAIDs)
Other supportive measures, such as oral decongestants (pseudoephedrine, 30–60 mg every 4–6 hours or 120 mg twice daily), may provide some relief of rhinorrhea and nasal obstruction
Nasal sprays, such as oxymetazoline or phenylephrine, are rapidly effective but should not be used for more than a few days to prevent rebound conges- tion
Withdrawal of the drug after prolonged use leads to rhinitis medicamentosa, an almost addictive need for continuous usage
Treatment
of rhinitis medicamentosa requires mandatory cessation of the sprays, and this is often extremely frustrating for patients
Topical intranasal corticosteroids (eg, flunisolide, 2 sprays in each nostril twice daily), intranasal anticholinergic (ipratropium 0
06% nasal spray, 2–3 sprays every 8 hours as needed), or a short tapering course of oral prednisone may help during the withdrawal process
Complications Other than mild eustachian tube dysfunction or transient middle ear effusion, complications of viral rhinitis are unusual
Secondary acute bacterial rhinosinusitis is a well accepted complication of acute viral rhinitis and is suggested by persistence of symptoms beyond 10 days with purulent green or yellow nasal secretions and unilateral facial or tooth pain
