Adenoiditis differential diagnosis

Adenoiditis Microchapters
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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	Itchy, watery eyes Nasal discharge Nasal congestion Sneezing Sore throat Cough Headache Fever Malaise Fatigue, weakness Muscle pain	Influenza viruses	_	Symptomatic therapy: Decongestants
Peritonsillar abscess	Severe sore throat Otalgia Fever A "hot potato" or muffled voice Drooling Trismus	Aerobic and anaerobic bacteria Streptococcuspyogenes	On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area	Ampicillin-sulbactam Clindamycin Vancomycin Linezolid
Croup	Cough Stridor but no drooling Hoarseness Difficulty breathing Common cold Runny nose Fever	Parainfluenza virus	Steeple sign on neck X-ray	Dexamethasone Nebulised epinephrine
Epiglottitis	Stridor and drooling but no cough Difficulty breathing Fever Chills Difficulty swallowing Hoarseness of voice	H. influenza type b Beta-hemolytic streptococci Staphylococcus aureus Fungi Viruses	Thumbprint sign on neck x-ray	Airway maintenance Parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin Adjuvant therapy includes: corticosteroids racemic Epinephrine
Pharyngitis	Sore throat Pain on swallowing Fever Headache Abdominal pain Nausea and vomiting	Group A beta-hemolyticstreptococcus	_	Antimicrobial therapy mainly penicillin-based and analgesics
Tonsilitis	Sore throat Pain on swallowing Fever Headache Cough	Viral Adenovirus, Rhinovirus Influenza Coronavirus Respiratory syncytial virus. Bacterial Group A streptococcalbacteria	Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary	Tonsillectomy Antibiotic therapy
Sinusitis	Nasal congestion and blockage Facial pain and pressure Ear pressure or fullness Nasal discharge, which may be purulent Decreased or absent sense of smell Headache Cough Fever Fatigue Bad breath Maxillary tooth pain	Viruses Rhinovirus Influenza virus Parainfluenza virus Bacteria Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Streptococcus pyogenes Staphylococcus aureus: common in chronic sinusitis Pseudomonas aeruginosa	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