Rhinosinusitis, Acute Viral (Common Cold)

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)

Differential Diagnosis

• SARS-CoV-2 infection (COVID-19 illness)

• Influenza

• Seasonal allergies

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 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 rhinitis medicamentosa (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)

Reference