Friday, September 01, 2006

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!

***

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.

14 Comments:

At 4:56 PM, Anonymous Beth said...

Thanks, man. See, I always marvel at how much mucus the body can produce. The rate of snot production never fails to amaze me, and I lose all perspective and start wondering things like - but is three whole days with no slowing of snot production okay? Sudafed's not even making a dent in it, should I be worried?

I always figure if it's colorless, then I probly don't have to freak out. But then I also like to set deadlines of "If it doesn't clear up by [date], then I'm going to the doctor." When it's such a pedestrian and mundane thing, it's hard to know.

Thanks!

 
At 11:51 AM, Anonymous Doug Hoffman said...

I always marvel at how much mucus the body can produce.

4 cups a day, just about a liter! And that's under normal conditions. Yum.

You're right about colorless. Unless you're leaking cerebrospinal fluid, colorless is good.

See, now isn't that reassuring?

 
At 4:14 AM, Anonymous Nicola said...

I have a snot q too! oh lovely...

Got a cold almost 3 weeks ago now, started to feel better then crap again, the crapness continued.

As of Saturday started getting some intermittent acute ear/jaw pain accompanied by orange SNOT from same side as the ear pain. The snot has now turned blood streaked/completely blood stained.

I visited a nice UK NHS doc yesterday who gave ears a cursory look, said no infection there but you do have a chest infection. I am now on ethromycin.

what is the blood??!!

 
At 6:08 PM, Anonymous Ian said...

Ah, it seems Douglas, that i have your 'favorite' orange snots. Its really a much nicer color than the average snot. It is a little odd however seeing what looks like sticky toffee bubbles coming out of your nostril when you clear it out. Now who wants to see a picture? jk ;)


-Trusting God

 
At 10:51 AM, Blogger Pavatti said...

This is actually a question... the mucus when I blow my nose is always green no matter when I blow my nose during the day. I sleep with a fan on in my room at night, could this cause this? I don't have allergies, no cold, somtimes I get stuffed up but thats usually in the mornig. Please help?

 
At 9:07 AM, Anonymous buy viagra said...

Hello, when the weather is very cold, humans are very likely to suffer some kind of illness, including colds, allergies. Also, you mention that could occur in children sinusitis and diseases that impair the respiratory system. Therefore, we must be careful to take medicine to not suffer relapses.

 
At 7:29 AM, Blogger john said...

Thank you so much for sharing this.
-sinus flush

 
At 8:00 AM, Anonymous Anonymous said...

i read everybodies comments all of which i have experienced everytime i catch o cold but what about taste i seem to have this horrible bitter taste it makes me feel sick and im sure i can smell it what is it and what can i do about it

 
At 5:04 AM, Anonymous Heather's Sinus Infection Remedies said...

I have that beautiful disease called chronic sinusitis and the doctors have no idea regarding how to make it go away for good. Figures! In the meantime, I try to keep sinusitis at bay using saline nasal sprays, head warmers, Vicks, steam inhalation, and other methods. They seem to work well enough when used in conjunction with one another. Oh, and yes, I have experienced orange mucus. No myth there!

 
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At 2:29 PM, Anonymous Elliott Broidy said...

Good information. I will keep this all in mind.

 
At 4:47 AM, Anonymous Phentemine375 said...

Thanx man...

 
At 4:49 AM, Anonymous Essay said...

Is this serious?

 

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