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Nasal discharge


Nasal discharges are common. The most frequent causes are the common cold and allergic rhinitis, however persistent bloodstained nasal discharge is a serious symptom requiring urgent investigation.

Causes

Congenital

  • ●

    Choanal atresia

  • ●

    Cystic fibrosis

Acquired

Infective

  • ●

    Common cold (coryza)

  • ●

    Chronic rhinitis

  • ●

    Sinusitis (acute or chronic)

  • ●

    Adenoiditis (large adenoids)

  • ●

    Viral infections

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    Bacterial infections (e.g. whooping cough)

  • ●

    Fungal infections

  • ●

    Chronic infections (e.g. syphilis)

  • ●

    AIDS • (common in certain developing countries)

Allergic

  • ●

    Allergic rhinitis

Inflammatory

  • ●

    Nasal polyps

  • ●

    Decongestant spray overuse

  • ●

    Non-eosinophilic vasomotor rhinitis

  • ●

    Eosinophilic vasomotor rhinitis

Neoplastic

  • ●

    Carcinoma

    • ●

      Nasopharynx • (common in South east Asia)

    • ●

      Sinuses

  • ●

    Lymphoma (malignant granuloma)

Granulomatous disease

  • ●

    Granulomatosis with Polyangiitis (GPA – formerly Wegener’s granulomatosis)

  • ●

    Eosinophilic Granulomatosis with Polyangiitis (EGPA – formerly Churg-Strauss syndrome)

Traumatic

  • ●

    Foreign body

  • ●

    Crying

  • ●

    Fracture of the anterior or middle fossa

  • ●

    Irritant gases, e.g. chlorine, tobacco smoke

Degenerative

  • ●

    Senile rhinorrhoea

Miscellaneous

  • ●

    Pregnancy

  • ●

    Cluster headache

History

Congenital

Choanal atresia is rare and linked with other congenital abnormalities. Bilateral choanal atresia is a life-threatening condition in newborn infants. Unilateral atresia may not be picked up until 5–10 years of age, when it becomes apparent that one nostril is blocked and there is a thick mucus discharge. Cystic fibrosis is an autosomal recessive condition resulting in increased viscosity, leading to recurrent chest infections, failure to thrive as well as nasal polyps.

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