Rhinitis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]


Rhinitis is a very common disease that is frequently overlooked or undertreated.[1] It is associated with several comorbidities which can have significant impact on the quality of life. It can also be the initial presentation of overt systemic illnesses which can be potentially fatal.[2] It is important to differentiate rhinitis from other conditions micmicking the symptoms of rhinitis such as intranasal foreign bodies, cerebrospinal fluid rhinorrhea, nasal polyps and tumors.

Differential Diagnosis

The following conditions can present with symptoms that are similar to those found in rhinitis:[3][4][5][6]

  1. Deviated nasal septum/septal wall anomalies
  2. Adenoidal hypertrophy
  3. Nasal tumors (benign and malignant)
  4. Foreign bodies- Unilateral, mucopurulent rhinorrhea in children could be as a result of insertion of foreign objects into the nostril.
  5. Trauma
  6. Anatomical variants in the ostiomeatal complex
  7. Choanal atresia
  8. Cleft palate
  9. Pharyngeal reflux (laryngopharyngo-nasal reflux)
  10. Metabolic conditions such as acromegaly
Disease History Physical examination Laboratory or radiological findings
Acute viral nasopharyngitis[7]
  • Diagnosis is usually clinical and lab tests are rarely needed
  • The virus can be cultured on human lung cells but results take time
  • PCR is rapid and accurate test but done only in immunocompromised patients when the virus strain needs to be known
Allergic rhinitis[8]
  • Characterized by repeated paroxysms of rhinorrhea, sneezing and cough.
  • Symptoms may be related to a specific season of the year, hence the name “seasonal allergies”.
  • Rhinorrhea fluid is usually clear and watery.
  • Examination of the nose reveals a crease below the nasal bridge from repeated pulling of the nose secondary to irritation.
  • Edema in the area below the eye if associated conjunctivitis is present.[1]
Acute sinusitis[9]
Infectious mononucleosis[11]


  1. 1.0 1.1 Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J Allergy Clin Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
  2. Romeo, Jonathan; Dykewicz, Mark (2014). "Chapter 9:Differential Diagnosis of Rhinitis and Rhinosinusitis". Diseases of the Sinuses. Springer New York. pp. 133–152. ISBN 978-1-4939-0265-1.
  3. Dykewicz MS, Hamilos DL (2010). "Rhinitis and sinusitis". J Allergy Clin Immunol. 125 (2 Suppl 2): S103–15. doi:10.1016/j.jaci.2009.12.989. PMID 20176255  20176255 Check |pmid= value (help).
  4. Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID 24007929.
  5. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A; et al. (2008). "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)". Allergy. 63 Suppl 86: 8–160. doi:10.1111/j.1398-9995.2007.01620.x. PMID 18331513.
  6. Rotiroti, Giuseppina; Scadding, Glenis (July 2016). "Allergic Rhinitis-an overview of a common disease". Paediatrics and Child Health. Volume 26 (Issue 7): 298–303. Retrieved January 20, 2017.
  7. Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.
  8. Pawankar R, Bunnag C, Chen Y, Fukuda T, Kim YY, Le LT, Huong le TT, O'Hehir RE, Ohta K, Vichyanond P, Wang DY, Zhong N, Khaltaev N, Bousquet J (2009). "Allergic rhinitis and its impact on asthma update (ARIA 2008)--western and Asian-Pacific perspective". Asian Pac. J. Allergy Immunol. 27 (4): 237–43. PMID 20232579.
  9. Low DE, Desrosiers M, McSherry J, Garber G, Williams JW, Remy H, Fenton RS, Forte V, Balter M, Rotstein C, Craft C, Dubois J, Harding G, Schloss M, Miller M, McIvor RA, Davidson RJ (1997). "A practical guide for the diagnosis and treatment of acute sinusitis". CMAJ. 156 Suppl 6: S1–14. PMID 9347786.
  10. "Acute maxillary sinusitis". N. Engl. J. Med. 305 (4): 226–7. 1981. doi:10.1056/NEJM198107233050419. PMID 7242607.
  11. Niederman JC, McCollum RW, Henle G, Henle W (1968). "Infectious mononucleosis. Clinical manifestations in relation to EB virus antibodies". JAMA. 203 (3): 205–9. PMID 4864269.

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