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Key Features

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 < 4 weeks and typically < 10 days

General Considerations

  • Because there are numerous serologic types of rhinoviruses, adenoviruses, and other viruses, patients remain susceptible throughout life

  • These infections have been implicated in the development or exacerbation of more serious conditions, such as

    • Acute bacterial sinusitis and acute otitis media

    • Asthma

    • Cystic fibrosis

    • Bronchitis

Clinical Findings

  • Nasal congestion

  • Decreased sense of smell

  • Watery rhinorrhea

  • Sneezing

  • General malaise

  • Throat discomfort

  • Headache

  • If purulent nasal discharge, suspect bacterial infection (see Complications)

Diagnosis

  • Nasal examination usually shows erythematous, edematous mucosa and a watery discharge

Treatment

  • There are no effective antiviral therapies for the prevention of viral rhinitis

  • Zinc

    • Efficacy is controversial

    • Five studies that used < 75 mg of zinc acetate daily showed no benefit

    • However, three studies that used zinc acetate in daily doses of over 75 mg showed significant reduction in duration of symptoms

    • The effect with zinc salts other than acetate was also significant at doses > 75 mg/day, but not as high as the zinc acetate lozenge studies (20% vs 42% reduction in cold duration)

  • Buffered hypertonic saline (3–5%) nasal irrigation has been shown to improve symptoms and reduce the need for nonsteroidal anti-inflammatory drugs

  • 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 congestion

  • Treatment of rhinitis medicamentosa requires mandatory cessation of the sprays; nasal spray withdrawal may be aided by

    • 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)

    • Short tapering course of oral prednisone

Outcome

Complications

  • Mild eustachian tube dysfunction or transient middle ear effusion

  • Secondary acute bacterial rhinosinusitis may occur (see Rhinosinusitis, Acute Bacterial)

References

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Bergmark  RW  et al. Diagnosis and first-line treatment of chronic sinusitis. JAMA. 2017 Dec 19;318(23):2344–5.
[PubMed: 29260210]  
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Harris  AM  et al; High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016 Mar 15;164(6):425–34.
[PubMed: 26785402]  

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