Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Probability diagnosis

Upper respiratory tract infection esp. common cold

Rhinitis: acute infective, allergic, vasomotor

Vasomotor stimulation e.g. cold wind, smoke, irritants

Sinusitis→post-nasal drip

Senile rhinorrhoea

Serious disorders not to be missed


  • Cluster headache


  • Chronic infective granulomas e.g. TB


  • Malignancy: nasal fossa, sinus, nasopharynx


  • CSF rhinorrhoea—post head injury

  • Wegener’s granulomatosis

Pitfalls (often missed)

Nasal foreign body e.g. in toddlers

Trauma ± blood

Adenoid hypertrophy

Illicit drugs e.g. cocaine, opioids esp. heroin

Inhaled irritant gases or vapour


  • Choanal atresia

  • Barotrauma

Masquerades checklist

Drugs: topical OTC→rhinitis medicamentosa; narcotics


Key history

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.

Key examination

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.

Key investigations

Usually none required. Consider:

  • micro/culture of discharge

  • X-ray sinuses

  • CT scan

  • allergy testing

Diagnostic tips

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.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.