Chronic nasal dysfunction in children: Allergic rhinitis? Infectious? What to do if neither?

To review challenges in the diagnosis, work-up, and management of healthy children who present to the otolaryngologist with nasal dysfunction. Common symptoms include chronic nasal congestion, with or without rhinorrhea, with or without previous empirically treated 'allergic rhinitis' and/or 'sinus' infection. Symptoms are often unresolved despite chronic use of intranasal steroid, antihistamine, and/or leukotriene receptor antagonists. There are no published studies addressing nasal symptoms in children who test negative for allergies yet report persistent nasal obstruction, congestion, and/or rhinorrhea. Recent publications continue to address efficacy of medical and/or surgical treatment for allergic rhinitis or acute/chronic rhinosinusitis. Best practice for children who 'fail' medical therapy but have impaired quality of life because of nasal dysfunction remains unknown. Chronic nasal symptoms are common in childhood despite daily treatment using intranasal steroid, antihistamines, and/or leukotriene receptor antagonist therapies. Diet and dietary habit history should be included during evaluation and differential diagnosis as excessive dairy and sugar may contribute to chronic symptoms. Children who fail medical therapy for persistent nasal symptoms, allergic or not, should be referred and considered for outfracture of inferior turbinates and inferior turbinoplasty. Turbinate reduction procedures have demonstrated significant improvement in all domains of SinoNasal Quality of Life as measured by 'SN-5' survey.