When is it more than a cold?

Miss Beff writes:

How long should I be stuffed up before thinking it's maybe not a cold and then going to the doctor? Three days? A week of snot sans relief? What?

She also points out that it has been aaaages since I updated. Sorry. Consider the comment section here to be an open thread -- ask away. And if I don't get back to you promptly, email me at azureus at harborside dot com with your questions.

Back to snot. In general, if it's a cold, you should be getting better within two to three weeks. But nothing is that simple. What's the chance it could be something else?

The most likely alternate possibility is sinus infection, allergy, or other forms of chronic rhinitis. Less likely: nasal polyps, and MUCH less likely, nasal/sinus tumors.

In children, you should also consider the possibility of enlarged adenoids, as this will cause nasal airway obstruction, too.

AND unilateral nasal airway obstruction in a child, typically with unilateral foul-smelling drainage, usually means?

Ding ding ding ding! Give a peanut and a popcorn kernel to the gal in the red blouse who correctly answered, "A nasal foreign body." You're head and shoulders above most primary care docs.

Back to the other possibilities. Let's take them one at a time. Bear in mind that colds are so common (hence common cold) you might have a cold AND one of these, okay?

Acute sinus infection

In addition to nasal congestion, expect to see discolored mucus (yellow, green, or occasionally more delightful colors. Brilliant orange, that was my personal favorite), facial pain, facial pressure, and an overall crappy feeling (malaise). Fever is uncommon in adults.

Chronic sinus infection

All of the above (for acute sinusitis) but the symptoms are usually less intense and more longstanding.

Nasal polyps

Polyps do not arise overnight. Generally, the patient gives a history of gradually increasing nasal congestion (over the course of months or years), recurrent sinusitis, and/or severe problems with nasal allergy. Which brings me to . . .

Allergic rhinitis

All the things you hear about in commercials. Congestion, sneezing, watery nasal drainage, itching of the eyes, nose, and throat, itching or pressure in the ears.

Tumors of the nasal cavities or sinuses

Awful, horrible things, usually. You don't want any part of this. Fortunately, these are rare, but a gradually progressive nasal airway obstruction always raises this possibility. What are the warning signs for nasal or sinus tumors?

• Change in vision (blurry vision, double vision)
• A bulge in the cheek, to the side of the nose, or in the brow line, often only apparent on comparison to old photographs
• Numbness on the cheek, teeth, lips, nose, or brow
• Loose maxillary teeth
• Blood-streaked nasal mucus in association with gradually progressive congestion on the same side
• Facial pain
  

I hope I'm not forgetting anything.

In the discussion of chronic nasal congestion, I'm skipping certain common things like septal deviation or chronic enlargement of the turbinates. Beth is, I think, more concerned with an acute process which seems to drag on longer than usual. For that, sinusitis and allergy would be my top two concerns.

I hope this helps!

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By the way, over at Balls and Walnuts I have awarded my regular readers with a very special photo of ME. Me like you've never seen me before.

You've been warned.

D.