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For further information, see CMDT Part 8-10: Infections of the Nose & Paranasal Sinuses

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


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


  • 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



  • Mild eustachian tube dysfunction or transient middle ear effusion

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


Dhama  K  et al. Coronavirus disease 2019 – COVID-19. Clin Microbiol Rev. 2020;33:e00028.
[PubMed: 32580969]  

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