Upper respiratory tract infection esp. common cold
Rhinitis: acute infective, allergic, vasomotor
Vasomotor stimulation e.g. cold wind, smoke, irritants
Serious disorders not to be missed
Nasal foreign body e.g. in toddlers
Illicit drugs e.g. cocaine, opioids esp. heroin
Inhaled irritant gases or vapour
Drugs: topical OTC→rhinitis medicamentosa; narcotics
Elicit nature of discharge: watery, mucoid, bloody, ?offensive and volume. Is it acute or chronic, intermittent or continuous? Associations: respiratory symptoms, nasal blockage, post-nasal drip, headache, local pain. Check for possible influence of physical factors: wind, cold, irritants, smoke. Also check for presence of allergic rhinitis or sinusitis. Ask if there is a possible history of head trauma, nose problems or nasal surgery. Also take a drug history, including OTC medications esp. sympathomimetics, illicit drugs, prescribed drugs.
Look for cause. Inspect nose and nasal cavity with a Thudicum speculum or large auriscope. Note the position of the septum, nature of nasal mucosa and look for polyps or other tumours.
Usually none required. Consider:
Beware of persistent blood-stained discharge esp. if unilateral and obstruction. Clear discharge following direct facial or head injury may represent CSF leakage from a skull fracture.