Login

Nasal Discharge (Rhinorrhoea)


This guideline applies to adults aged 16 years and over.

 

Introduction

Nasal discharge can be related to any condition affecting the nose, such as acute or chronic rhinosinusitis, allergic or non-allergic rhinitis, foreign bodies, nasal malignancy or CSF leak secondary to basal skull fracture.

 

Red Flag Features

Nasal malignancy should be excluded in the context of new onset, persistent and/or rapidly progressive:

  • Unilateral facial pain and/or swelling
  • Unilateral epistaxis or crusting with nasal obstruction – simple epistaxis is typically unilateral
  • Clear watery nasal discharge (CSF leak presents like a dripping tap)
  • Bulging eye associated with visual disturbance, painful eye movements and/or double vision
  • Dental changes e.g. loosening of upper teeth


Basal skull fracture:

  • Unilateral clear rhinorrhoea in context of head trauma, or signs of raised intracranial pressure i.e. headache, vomiting, papilloedema.


Nasal foreign body.

 

Not an exhaustive list.

 

Management Optimisation

In the absence of red flag features, adequate medical management prior to referral includes:

  • If allergy, treat with intranasal steroids first line, in combination with antihistamines (intranasal or oral).
  • If age related, non-allergic or other forms of bilateral clear rhinorrhoea, consider a trial of ipratropium bromidespray.
  • If rhinosinusitis suspected, treat as per Rhinosinusitis guideline.

 

Advice and Guidance

ENT Advice and Guidanceis available if:

  • suspected nasal malignancy
  • diagnostic uncertainty
  • patient falls outside of referral criteria

 

Referral

Same-day assessment

  • Suspected CSF leak – straight to ED
  • Foreign body:
    • Button/watch batteries should be removed immediately to avoid permanent nasal damage – if not confident/experienced send straight to ED
    • Other types of nasal foreign body – ENT first on-call

 

Routine Adult ENT referral

  • Persistently bothersome nasal symptoms which have failed to respond to a 3-month trial of adequate medical management and where the patient would accept nasal surgery.

 



Supporting Information

Professionals:

Patient UK – Nasal discharge

 

Page Review Information

Review date

10/10/2024

Next review date

10/10/2026

GP speciality lead

Dr Laura Vines

Contributors

Ms Aileen Lambert, Consultant ENT Surgeon

Mr Neil Tan, Consultant ENT Surgeon