Adenoiditis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Overview

Diagnosis of adenoiditis can be challenging as majority of upper respiratory tract infections show the same pattern. The most important differential diagnosis include tonsilitis, viral upper respiratory tract infection, sinusitis and pharyngitis.

Differential diagnosis

Adenoiditis must be differentiated from other diseases that cause fever, nasal airway obstruction and snoring, and sore throat.

The table below outlines the differences between adenoiditis and other respiratory tract infections.

Differential diagnosis based on fever and sore throat
Disease/Variable Presentation Causes Imaging finding Treatment
Upper respiratory tract infection[1][2][3] _ Symptomatic therapy:
Peritonsillar abscess[4][5] On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area
Croup[6][7][8] Steeple sign on neck X-ray
Epiglottitis[9][10] Thumbprint sign on neck x-ray
Pharyngitis[11][12] _
Tonsilitis [13][14] Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary
Sinusitis[15][16] On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen
  • Supportive therapy is the mainstay of treatment for both cases of acute and chronic rhinosinusitis
  • Antibiotics (macrolides, penicillins, clavulonic acid- amoxicillin) an be added in select cases of acute, as well as chronic rhinosinusitis

References

  1. "Antibiotics for adults with acute laryngitis | Cochrane Summaries". 
  2. http://www.cochrane.org/reviews/en/ab004403.html Antibiotics for exacerbations of chronic obstructive pulmonary disease
  3. http://www.cochrane.org/reviews/en/ab000980.html Vitamin C for preventing and treating the common cold
  4. Lyon M, Blaivas M (2005). "Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department.". Acad Emerg Med. 12 (1): 85–8. PMID 15635144. doi:10.1197/j.aem.2004.08.045. 
  5. Boesen T, Jensen F (1992). "Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis.". Eur Arch Otorhinolaryngol. 249 (3): 131–3. PMID 1642863. 
  6. Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. ISSN 0028-4793. doi:10.1056/NEJMcp072022. 
  7. Henrickson, K. J. (2003). "Parainfluenza Viruses". Clinical Microbiology Reviews. 16 (2): 242–264. ISSN 0893-8512. doi:10.1128/CMR.16.2.242-264.2003. 
  8. Schomacker, Henrick; Schaap-Nutt, Anne; Collins, Peter L; Schmidt, Alexander C (2012). "Pathogenesis of acute respiratory illness caused by human parainfluenza viruses". Current Opinion in Virology. 2 (3): 294–299. ISSN 1879-6257. doi:10.1016/j.coviro.2012.02.001. 
  9. Wick F, Ballmer PE, Haller A (2002). "Acute epiglottis in adults.". Swiss Med Wkly. 132 (37-38): 541–7. PMID 12557859. 
  10. Nickas BJ (2005). "A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy.". J Emerg Nurs. 31 (3): 234–5; quiz 321. PMID 15983574. doi:10.1016/j.jen.2004.10.015. 
  11. Ferri, Fred (2005). Md consult/first consult 14-month subscription : combo retail pack. Place of publication not identified: Elsevier Saunders. ISBN 9781416026075. 
  12. Kline JA, Runge JW (1994) Streptococcal pharyngitis: a review of pathophysiology, diagnosis, and management. J Emerg Med 12 (5):665-80. PMID: 7989695
  13. Nogan S, Jandali D, Cipolla M, DeSilva B (2015). "The use of ultrasound imaging in evaluation of peritonsillar infections.". Laryngoscope. 125 (11): 2604–7. PMID 25946659. doi:10.1002/lary.25313. 
  14. Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics. 80 (1): 6–12. PMID 3601520. 
  15. Vural C, Gungor A, Comerci S (2003). "Accuracy of computerized tomography in deep neck infections in the pediatric population.". Am J Otolaryngol. 24 (3): 143–8. PMID 12761699. 
  16. Philpott CM, Selvadurai D, Banerjee AR (2004). "Paediatric retropharyngeal abscess.". J Laryngol Otol. 118 (12): 919–26. PMID 15667676. 

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