YEAR 04 • MAJOR CLINICAL DISCIPLINES

ENT

20 learning units • 100 chapter sections • 200 explained questions. Assess ear, nose and throat symptoms, recognise urgent complications and plan safe treatment, referral and rehabilitation.

Original RAHBAR study material for the Year 4 learning pathway. Clinical cases support supervised undergraduate learning. Treatment choices, doses and procedures must follow current local protocols and the responsible clinical team. References & further reading ↓

MODULE 09 / 20

Rhinitis, Nasal Obstruction & Polyps

Assess inflammatory nasal symptoms while identifying persistent unilateral warning signs.

Quick revision ↓ Medical Dictionary

01Classify the symptoms

Ask about sneezing, itch, watery discharge, blockage, reduced smell and seasonal or environmental triggers. Allergic rhinitis often has associated eye symptoms or atopy. Nonallergic causes include irritants and medicine-related effects. Examine the nose and review duration and laterality; not every blocked nose represents infection or needs an antibiotic.

02Treat the pattern

Management may include trigger reduction, saline, antihistamines or intranasal corticosteroids selected for the individual and local guidance. Demonstrate spray use with the nozzle directed away from the septum and explain regular use when prescribed. Check adherence and technique before declaring treatment ineffective. Pregnancy, age and comorbidities influence safe medicine selection.

03Decongestant overuse

Topical decongestants provide short-term relief but prolonged use can produce rebound congestion. Ask specifically about over-the-counter sprays because patients may not consider them medicines. Explain the appropriate limited course and review chronic use through a treatment plan. Do not treat rebound symptoms with indefinite dose escalation of the same decongestant.

04Structural obstruction

Septal deviation, enlarged turbinates and polyps can contribute to obstruction. Polyps commonly occur with chronic inflammatory disease and reduced smell, but a unilateral mass needs specialist evaluation. Endoscopy and selected imaging may clarify the cause. Visible anatomy and symptoms must be considered together before attributing all difficulty to a single finding.

05Warning signs

Persistent unilateral blockage, blood-stained discharge, facial numbness or a neck lump requires assessment for focal disease. Clear unilateral watery discharge after trauma may represent a cerebrospinal fluid leak and needs urgent review. Safety-net patients whose symptoms change or fail to respond; a previous allergy diagnosis should not override new concerning features.

High-Yield Revision

Technique matters for prescribed nasal sprays.
Prolonged topical decongestant use can worsen congestion.
A unilateral nasal mass needs assessment.

Common Pitfalls

Using antibiotics for every blocked nose.
Ignoring new unilateral symptoms in a patient with allergy.

References & Further Reading

Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.

Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.