Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis, nasal drainage normally is:
A. Yellow
B. Green
C. Clear
D. Gray
Correct Answer: C. Clear
Normally, nasal drainage in acute rhinitis is clear. Anterior rhinoscopy typically reveals swelling of the nasal mucosa and thin, clear secretions. The inferior turbinates may take on a bluish hue, and cobblestoning of the nasal mucosa may be present. On physical examination, clinicians may notice mouth breathing, frequent sniffling and/or throat clearing, transverse supra-tip nasal crease, and dark circles under the eyes (allergic shiners).
Option A: Yellow drainage indicates spread of the infection to the sinuses. Yellow mucus is a sign that whatever virus or infection the client has is taking hold. The body is fighting back. The yellow color comes from the cells — white blood cells, for example — rushing to kill the offending germs. Once the cells have done their work, they’re discarded in the drainage and tinge it a yellowish-brown.
Option B: Green drainage may also indicate infection. If the immune system kicks into high gear to fight infection, the drainage may turn green and become especially thick. The color comes from dead white blood cells and other waste products. Some sinus infections may be viral, not bacterial.
Option D: Gray drainage may indicate a secondary infection. This could be a fungal sinus infection. These are different from viral or bacterial infections because the fungi feeds on the nasal tissue—and reproduces. Fungal sinus infections may occur due to a previous nasal injury or long-term nasal inflammation, as well as a weakened immune system. Growths called “fungus balls” develop in the cheek sinus as clumps of fungal spores. The fungus balls must be removed by surgery.
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