1. Blocked / congested nose
This refers to a sensation of reduced airflow through one or both nostrils. Common causes include inflammation due to allergy, infections (eg. common cold, ‘flu or sinusitis), structural problems including a deviated nasal septum, swellings in the nose (benign polyps or rarely a growth or tumour) or traumatic injuries. Further investigations may need to be performed to reach a diagnosis, including allergy tests, endoscopic examination and/or Xrays/CT scanning. Treatment will depend on the cause, for example anti-allergy medication or surgery such as to correct a deviated septum or insertion titanium nasal implant to correct a weak nasal side wall.
2. Nasal discharge
This is most commonly due to infection, either a viral illness (cold, ‘flu) or a bacterial sinusitis, which causes a thick, yellow/green discharge and which is treated initially by topical nasal medications, oral antibiotics or surgery in more severe cases (including balloon sinuplasty or endoscopic sinus surgery). A more runny thin colourless discharge can be associated with allergy. Occasionally in children, a foreign body in the nose can lead to an unpleasant nasal discharge. In some cases following trauma, the presence of a clear watery discharge may point towards a leak of cerebrospinal brain fluid which requires urgent attention.
3. Nose bleeds (epistaxis)
The most common cause is following localised trauma or injury. This commonly occurs in children when it is often provoked by a digital (finger) injury. In adults, medical conditions such as high blood pressure or being on blood thinning medication such as warfarin or aspirin can exacerbate the severity of a nose bleed. A severe infection can lead to a blood stained discharge, as can growths in the nose, although the latter tend to cause bleeding from one nostril only. Also it is quite common to experience some nasal bleeding after nasal surgery. Clearly a careful examination is required to differentiate between these possibilities so that appropriate treatment can be offered.
4. Reduced / absent sense of smell
Hyposmia (a reduced sense of smell) is quite common in patients suffering with a cold or ‘flu, as well as allergies. Anosmia (complete loss of smell) is more unusual with these conditions and may suggest the possibility of nasal polyps or severe sinusitis. There are one or two extremely rare growths or tumours that can specifically affect the sense of smell, but these are likely to cause other red flag or warning symptoms and signs such as visual disturbance, CSF leak, nasal blockage and/or bleeding on one side only.
5. Facial pain
It is a common misconception that sinusitis causes facial pain. In some cases it is certainly true that a severely infected sinus can cause facial pressure and discomfort, although most cases of sinusitis are relatively painless. If facial pain is the main symptom, other causes need to be considered, for example:
- Neuralgic pain: this is a sharp shooting pain that occurs quite quickly but also usually does not last too long. It is due to an irritated or inflamed nerve ending and can be made worse by certain viral infections such as shingles, pressure on a nerve or occasionally following sinus of facial surgery
- Musculoskeletal: neck stiffness/arthritis is well known to cause pain in many different parts of the head, occasionally extending forwards into the forehead and cheeks.
- Temporomandibular joint problems: this is the jaw joint situated in front of the ears which you can easily feel moves during chewing. If this joint becomes inflamed or stiff, discomfort and pain can extend towards the front of the face
- Dental problems: Pain from any tooth related complication can radiate outside of the mouth into the cheek area
This can be quite a complex symptom to evaluate and so it is probably worth seeking medical attention for further diagnostic tests if it persists or proves resistant to simple painkillers or anti-inflammatory medication. Facial pain due to barotrauma (that which occurs due to pressure changes whilst flying or scuba diving) can be successfully treated by adequate sinus ventilation (eg. balloon sinuplasty).
One of the commonest causes of sneezing is due to allergy, such as hayfever or when in contact with a cat (if you are also unfortunate enough to be allergic to one!). Also the common cold or ‘flu often causes sneezing as the body is trying to get rid of all that unpleasant mucus.
If your main symptom is sneezing and you don’t have a cold, then it is probably worth getting some allergy tests.