Table 1.

Components of a complete history and physical examination for suspected rhinitis

History

Physical examination

Personal Congestion 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 SO NSAIDs ACE inhibitors Hormone therapy Recreational cocaine use Quality of life Rhinitis-specific questionnaire Comorbidities Asthma Mouth breathing Snoring ± apnea Impaired smell or taste Sinus involvement Otitis media Nasal polyps Conjunctivitis Response to previous interventions Avoidance measures Saline nasal rinses 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