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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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King  D  et al. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst ...

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