Table 2.

Components of a complete history and physical examination for suspected rhinitis [1]

History

Physical examination

Personal • Nasal itch • Rhinorrhea • Sneezing • Eye involvement • Seasonality • Triggers Family • Allergy • Asthma Environmental • Pollens • Animals • Flooring/upholstery • Mould • Humidity • Tobacco exposure Medication/drug use • Beta-blockers • ASA • NSAIDs • ACE inhibitors • Hormone therapy • Recreational cocaine use Quality of life • Rhinitis-specific questionnaire Comorbidities • Asthma • Mouth breathing • Snoring • Sinus involvement • Otitis media • Nasal polyps • Conjunctivitis Response to previous medications • Second-generation oral antihistamines • Intranasal corticosteroids

Outward signs • Mouth breathing • Rubbing the nose/transverse nasal crease • Frequent sniffling and/or throat clearing • Allergic shiners (dark circles under eyes) Nose • Mucosal swelling, bleeding • Pale, thin secretions • Polyps or other structural abnormalities Ears • Generally normal • Pneumatic otoscopy to assess for Eustachian tube dysfunction • Valsalva’s maneuver to assess for fluid behind the ear drum Sinuses • Palpation of sinuses for signs of tenderness • Maxillary tooth sensitivity Posterior oropharynx • Postnasal drip • Lymphoid hyperplasia (“cobblestoning”) • Tonsillar hypertrophy Chest and skin • Atopic disease • Wheezing

ASA: acetylsalicylic acid; NSAIDs: non-steroidal anti-inflammatory drugs; ACE: angiotensin-converting enzyme; OTC: over-the-counter

Adapted from Small et al., 2007 [1]