10-minute consultation: Rhinitis

doi:10.1136/bmj.324.7347.1219/a

BMJ 2002;324:1219 ( 18 May )

Letters

10-minute consultation: Rhinitis

Referral to specialist otolaryngologist may be advisable

Article is unhelpful

Referral to specialist otolaryngologist may be advisable

The first 150 words of the full text of this article appear below.

EDITOR $---$ Although the 10-minute consultation on rhinitis serves as a useful guide for treatment of this common condition, certainpoints merit clarification.¹

We agree that unilateral nasal blockage and bleeding warrant prompt referral since these symptoms may indicate an underlyingmalignancy. Contrary to the authors' suggestion, however, thisis an uncommon presentation of nasopharyngeal carcinoma, whichis more frequently associated with unilateral glue ear or cervicallymphadenopathy. Examination of the nose by an experienced doctorusing adequate illumination is essential to exclude other diagnoses,such as septal deflection, turbinate enlargement, and nasal polyposis.We are also surprised that no mention is made of the diagnosticvalue of allergy testing, which has been shown to be feasiblein primary care.²

With regard to treatment, the authors do not emphasise that topical nasal decongestants such as oxymetazoline should be avoidedin prolonged courses owing to the incidence of rebound oedemaand . . . [Full text of this article]