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Upper respiratory tract infection

Scenario: Lauren Hutton has a 10-day history of cold-like symptoms but with a continuing troublesome blocked-up nose accompanied by discharge. She is experiencing pain across her nose and face. What is your advice?

Problem representation

Continuing upper respiratory tract infection (URTI) symptoms, mainly affecting the nose in an adult female patient.

Hypothesis generation 

Nasal congestion can be a symptom of many conditions. However, based on Lauren’s age (she is 28 years old), you can draw up a relatively short list of those that should be initially considered, as concerns such as adenoiditis, nasal foreign body (both seen in children) and malignancy (older age groups) can be discounted from early thinking. You should therefore initially consider the following conditions:

Likely diagnosis 

  • Allergic rhinitis
  • Common cold
  • Sinusitis. 

Possible diagnosis 

  • Adenoiditis
  • Deviated nasal septum
  • Facial pain
    • Cluster headache
    • Dental
    • Giant cell arteritis
    • Migraine
    • Neuropathic pain – e.g. trigeminal neuralgia
    • Temporomandibular disorders
  • Nasal foreign body; nasal polyp
  • Turbinate hypertrophy.

Critical diagnosis 

  • Malignancy.
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