Adenoiditis differential diagnosis: Difference between revisions
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| Line 20: | Line 20: | ||
|[[Upper respiratory tract infection]] | |[[Upper respiratory tract infection]] | ||
| | | | ||
* Itchy, watery eyes | * [[Itchy]], watery eyes | ||
* Nasal discharge | * Nasal discharge | ||
* [[Nasal congestion]] | * [[Nasal congestion]] | ||
| Line 34: | Line 34: | ||
* [[Influenza]] viruses | * [[Influenza]] viruses | ||
|_ | |_ | ||
| | |Symptomatic therapy: | ||
* Decongestants | * [[Decongestants]] | ||
* Alternative medicine | * Alternative medicine | ||
** The use of [[Vitamin C]] | ** The use of [[Vitamin C]] | ||
|- | |- | ||
|[[Peritonsillar abscess]] | |[[Peritonsillar abscess]]<ref name="pmid18246890">{{cite journal| author=Galioto NJ| title=Peritonsillar abscess. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 2 | pages= 199-202 | pmid=18246890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18246890 }} </ref><ref name="pmid15635144">{{cite journal| author=Lyon M, Blaivas M| title=Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. | journal=Acad Emerg Med | year= 2005 | volume= 12 | issue= 1 | pages= 85-8 | pmid=15635144 | doi=10.1197/j.aem.2004.08.045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15635144 }} </ref><ref name="pmid1642863">{{cite journal| author=Boesen T, Jensen F| title=Preoperative ultrasonographic verification of peritonsillar abscesses in patients with severe tonsillitis. | journal=Eur Arch Otorhinolaryngol | year= 1992 | volume= 249 | issue= 3 | pages= 131-3 | pmid=1642863 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1642863 }} </ref><ref name="pmid26637999">{{cite journal| author=Bandarkar AN, Adeyiga AO, Fordham MT, Preciado D, Reilly BK| title=Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections. | journal=Pediatr Radiol | year= 2016 | volume= 46 | issue= 7 | pages= 1059-67 | pmid=26637999 | doi=10.1007/s00247-015-3505-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26637999 }} </ref><ref name="pmid10435129">{{cite journal| author=Scott PM, Loftus WK, Kew J, Ahuja A, Yue V, van Hasselt CA| title=Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis. | journal=J Laryngol Otol | year= 1999 | volume= 113 | issue= 3 | pages= 229-32 | pmid=10435129 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10435129 }} </ref><ref name="pmid15635144" /><ref name="pmid1642863" /><ref name="pmid15573356">{{cite journal| author=Brook I| title=Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. | journal=J Oral Maxillofac Surg | year= 2004 | volume= 62 | issue= 12 | pages= 1545-50 | pmid=15573356 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15573356 }} </ref><ref name="pmid18039418">{{cite journal| author=Megalamani SB, Suria G, Manickam U, Balasubramanian D, Jothimahalingam S| title=Changing trends in bacteriology of peritonsillar abscess. | journal=J Laryngol Otol | year= 2008 | volume= 122 | issue= 9 | pages= 928-30 | pmid=18039418 | doi=10.1017/S0022215107001144 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18039418 }} </ref><ref name="pmid1875138">{{cite journal| author=Snow DG, Campbell JB, Morgan DW| title=The microbiology of peritonsillar sepsis. | journal=J Laryngol Otol | year= 1991 | volume= 105 | issue= 7 | pages= 553-5 | pmid=1875138 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1875138 }} </ref><ref name="pmid12092281">{{cite journal| author=Matsuda A, Tanaka H, Kanaya T, Kamata K, Hasegawa M| title=Peritonsillar abscess: a study of 724 cases in Japan. | journal=Ear Nose Throat J | year= 2002 | volume= 81 | issue= 6 | pages= 384-9 | pmid=12092281 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12092281 }} </ref> | ||
| | | | ||
* Severe [[sore throat]] | * Severe [[sore throat]] | ||
* [[ | * [[Otalgia]] | ||
* [[ | * [[Fever]] | ||
* A "hot potato" or muffled voice | * A "hot potato" or muffled voice | ||
* [[ | * [[Drooling]] | ||
* [[ | * [[Trismus]] | ||
| | | | ||
* [[Streptococcus pyogenes|Aerobic and anaerobic]] [[Streptococcus pyogenes|bacteria]] | * [[Streptococcus pyogenes|Aerobic and anaerobic]] [[Streptococcus pyogenes|bacteria]] | ||
* [[Streptococcus pyogenes|Streptococcus]][[Streptococcus pyogenes|pyogenes]]. | * [[Streptococcus pyogenes|Streptococcus]][[Streptococcus pyogenes|pyogenes]]. | ||
|On ultrasound [[Peritonsillar abscess|peritonsillar]] abscess appears as focal irregularly marginated hypoechoic area. | |||
|[[Ampicillin-sulbactam|Ampicillin-sulbactam,]] [[Clindamycin]], [[Vancomycin]] or [[Linezolid]] | |[[Ampicillin-sulbactam|Ampicillin-sulbactam,]] [[Clindamycin]], [[Vancomycin]] or [[Linezolid]] | ||
|- | |- | ||
| Line 67: | Line 67: | ||
|[[Dexamethasone]] and nebulised [[epenephrine|epinephrine]] | |[[Dexamethasone]] and nebulised [[epenephrine|epinephrine]] | ||
|- | |- | ||
|[[Epiglottitis]] | |[[Epiglottitis]]<ref name="pmid12557859">{{cite journal| author=Wick F, Ballmer PE, Haller A| title=Acute epiglottis in adults. | journal=Swiss Med Wkly | year= 2002 | volume= 132 | issue= 37-38 | pages= 541-7 | pmid=12557859 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12557859 }} </ref><ref name="pmid15983574">{{cite journal| author=Nickas BJ| title=A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy. | journal=J Emerg Nurs | year= 2005 | volume= 31 | issue= 3 | pages= 234-5; quiz 321 | pmid=15983574 | doi=10.1016/j.jen.2004.10.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15983574 }} </ref> | ||
| | | | ||
* [[Stridor]] and [[drooling]] [[Difficulty breathing|but no cough]] | * [[Stridor]] and [[drooling]] [[Difficulty breathing|but no cough]] | ||
* [[Difficulty | * [[Difficulty breathing]] | ||
* [[Difficulty swallowing|Fever]] | * [[Difficulty swallowing|Fever]] | ||
* [[Difficulty swallowing|Chills]] | * [[Difficulty swallowing|Chills]] | ||
* [[Difficulty swallowing|Difficulty swallowing]] | * [[Difficulty swallowing|Difficulty swallowing]] | ||
* [[ | * [[Hoarseness]] of [[voice]] | ||
| | | | ||
* [[Hemolysis|H. influenza type b]] | * [[Hemolysis|H. influenza type b]] | ||
| Line 82: | Line 82: | ||
* [[viruses]]. | * [[viruses]]. | ||
|[[Thumbprint sign]] on neck x-ray | |[[Thumbprint sign]] on neck x-ray | ||
|[[Airway]] maintenance, [[Parenteral|parenteral]] [[Cefotaxime]] or [[Ceftriaxone]] in combination with [[Vancomycin]]. [[Adjuvant therapy]] includes [[corticosteroids]] and [[racemic]] [[Epinephrine]]. | |[[Airway]] maintenance, [[Parenteral|parenteral]] [[Cefotaxime]] or [[Ceftriaxone]] in combination with [[Vancomycin]]. [[Adjuvant therapy]] includes [[corticosteroids]] and [[racemic]] [[Epinephrine]]. | ||
|- | |- | ||
|[[Pharyngitis]] | |[[Pharyngitis]] | ||
| Line 88: | Line 88: | ||
* [[Sore throat]] | * [[Sore throat]] | ||
* Pain on swallowing | * Pain on swallowing | ||
* [[ | * [[Fever]] | ||
* [[ | * [[Headache]] | ||
* [[ | * [[Abdominal pain]] | ||
* [[ | * [[Nausea]] and [[vomiting]] | ||
| | | | ||
* [[Group A beta-hemolytic streptococci|Group A beta-hemolytic]] | * [[Group A beta-hemolytic streptococci|Group A beta-hemolytic]] | ||
| Line 98: | Line 98: | ||
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]]. | |[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]]. | ||
|- | |- | ||
|[[Tonsilitis]] | |[[Tonsilitis]] <ref name="pmid25946659">{{cite journal| author=Nogan S, Jandali D, Cipolla M, DeSilva B| title=The use of ultrasound imaging in evaluation of peritonsillar infections. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 11 | pages= 2604-7 | pmid=25946659 | doi=10.1002/lary.25313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25946659 }} </ref><ref name="pmid26527518">{{cite journal| author=Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H et al.| title=Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. | journal=Auris Nasus Larynx | year= 2016 | volume= 43 | issue= 2 | pages= 182-6 | pmid=26527518 | doi=10.1016/j.anl.2015.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26527518 }} </ref><ref name="pmid25945805">{{cite journal| author=Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J et al.| title=Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 12 | pages= 2799-804 | pmid=25945805 | doi=10.1002/lary.25354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25945805 }} </ref><ref name="pmid3601520">{{cite journal| author=Putto A| title=Febrile exudative tonsillitis: viral or streptococcal? | journal=Pediatrics | year= 1987 | volume= 80 | issue= 1 | pages= 6-12 | pmid=3601520 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3601520 }} </ref> | ||
| | | | ||
* [[Sore throat]] | * [[Sore throat]] | ||
* | * Pain on swallowing | ||
* [[ | * [[Fever]] | ||
* [[ | * [[Headache]] | ||
* [[ | * [[Cough]] | ||
| | | | ||
* [[ | * [[Viral]] | ||
** [[ | ** [[Adenovirus]], | ||
** [[ | ** [[Rhinovirus]] | ||
** [[ | ** [[Influenza]] | ||
** [[ | ** [[Coronavirus]] | ||
** [[ | ** [[Respiratory syncytial virus]]. | ||
* | * Bacterial; | ||
** ''[[Group A streptococcal infection|Group A streptococcal]][[Group A streptococcal infection|bacteria]]'' | ** ''[[Group A streptococcal infection|Group A streptococcal]][[Group A streptococcal infection|bacteria]]'' | ||
|Intraoral or transcutaneous USG may show an [[abscess]] making CT scan unnecessary. | |Intraoral or transcutaneous USG may show an [[abscess]] making CT scan unnecessary. | ||
|Primarily affects children | |Primarily affects children | ||
between 5 and 15 years old. | between 5 and 15 years old. | ||
|- | |- | ||
|Sinusitis | |Sinusitis<ref name="pmid12761699">{{cite journal| author=Vural C, Gungor A, Comerci S| title=Accuracy of computerized tomography in deep neck infections in the pediatric population. | journal=Am J Otolaryngol | year= 2003 | volume= 24 | issue= 3 | pages= 143-8 | pmid=12761699 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12761699 }} </ref><ref name="pmid15667676">{{cite journal| author=Philpott CM, Selvadurai D, Banerjee AR| title=Paediatric retropharyngeal abscess. | journal=J Laryngol Otol | year= 2004 | volume= 118 | issue= 12 | pages= 919-26 | pmid=15667676 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667676 }} </ref> | ||
| | | | ||
* [[Nasal]] [[congestion]] and blockage | * [[Nasal]] [[congestion]] and blockage | ||
| Line 145: | Line 145: | ||
** [[Staphylococcus aureus]]: common in chronic [[sinusitis]] | ** [[Staphylococcus aureus]]: common in chronic [[sinusitis]] | ||
** [[Pseudomonas aeruginosa]] | ** [[Pseudomonas aeruginosa]] | ||
|On CT scan, a mass impinging on the posterior [[pharyngeal]] wall with rim enhancement is seen | |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]]<nowiki/>c(macrolides, penicillins, clavulonic acid- amoxicillin)an be added in select cases of [[acute]], as well as [[chronic]]<nowiki/>rhinosinusitis. | |Supportive therapy is the mainstay of treatment for both cases of [[acute]] and [[chronic]] rhinosinusitis. [[Antibiotics]]<nowiki/>c(macrolides, penicillins, clavulonic acid- amoxicillin)an be added in select cases of [[acute]], as well as [[chronic]]<nowiki/>rhinosinusitis. | ||
|} | |} | ||
Revision as of 22:09, 1 June 2017
|
Adenoiditis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
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.
| Disease/Variable | Presentation | Causes | Imaging finding | Treatment |
|---|---|---|---|---|
| Upper respiratory tract infection |
|
|
_ | Symptomatic therapy:
|
| Peritonsillar abscess[1][2][3][4][5][2][3][6][7][8][9] |
|
On ultrasound peritonsillar abscess appears as focal irregularly marginated hypoechoic area. | Ampicillin-sulbactam, Clindamycin, Vancomycin or Linezolid | |
| Croup | Steeple sign on neck X-ray | Dexamethasone and nebulised epinephrine | ||
| Epiglottitis[10][11] | Thumbprint sign on neck x-ray | Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine. | ||
| Pharyngitis |
|
_ | Antimicrobial therapy mainly penicillin-based and analgesics. | |
| Tonsilitis [12][13][14][15] |
|
|
Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary. | Primarily affects children
between 5 and 15 years old. |
| Sinusitis[16][17] | 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. Antibioticsc(macrolides, penicillins, clavulonic acid- amoxicillin)an be added in select cases of acute, as well as chronicrhinosinusitis. |
References
- ↑ Galioto NJ (2008). "Peritonsillar abscess". Am Fam Physician. 77 (2): 199–202. PMID 18246890.
- ↑ 2.0 2.1 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. doi:10.1197/j.aem.2004.08.045. PMID 15635144.
- ↑ 3.0 3.1 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.
- ↑ Bandarkar AN, Adeyiga AO, Fordham MT, Preciado D, Reilly BK (2016). "Tonsil ultrasound: technical approach and spectrum of pediatric peritonsillar infections". Pediatr Radiol. 46 (7): 1059–67. doi:10.1007/s00247-015-3505-7. PMID 26637999.
- ↑ Scott PM, Loftus WK, Kew J, Ahuja A, Yue V, van Hasselt CA (1999). "Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis". J Laryngol Otol. 113 (3): 229–32. PMID 10435129.
- ↑ Brook I (2004). "Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses". J Oral Maxillofac Surg. 62 (12): 1545–50. PMID 15573356.
- ↑ Megalamani SB, Suria G, Manickam U, Balasubramanian D, Jothimahalingam S (2008). "Changing trends in bacteriology of peritonsillar abscess". J Laryngol Otol. 122 (9): 928–30. doi:10.1017/S0022215107001144. PMID 18039418.
- ↑ Snow DG, Campbell JB, Morgan DW (1991). "The microbiology of peritonsillar sepsis". J Laryngol Otol. 105 (7): 553–5. PMID 1875138.
- ↑ Matsuda A, Tanaka H, Kanaya T, Kamata K, Hasegawa M (2002). "Peritonsillar abscess: a study of 724 cases in Japan". Ear Nose Throat J. 81 (6): 384–9. PMID 12092281.
- ↑ Wick F, Ballmer PE, Haller A (2002). "Acute epiglottis in adults". Swiss Med Wkly. 132 (37–38): 541–7. PMID 12557859.
- ↑ 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. doi:10.1016/j.jen.2004.10.015. PMID 15983574.
- ↑ Nogan S, Jandali D, Cipolla M, DeSilva B (2015). "The use of ultrasound imaging in evaluation of peritonsillar infections". Laryngoscope. 125 (11): 2604–7. doi:10.1002/lary.25313. PMID 25946659.
- ↑ Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H; et al. (2016). "Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy". Auris Nasus Larynx. 43 (2): 182–6. doi:10.1016/j.anl.2015.09.014. PMID 26527518.
- ↑ Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J; et al. (2015). "Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess". Laryngoscope. 125 (12): 2799–804. doi:10.1002/lary.25354. PMID 25945805.
- ↑ Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics. 80 (1): 6–12. PMID 3601520.
- ↑ 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.
- ↑ Philpott CM, Selvadurai D, Banerjee AR (2004). "Paediatric retropharyngeal abscess". J Laryngol Otol. 118 (12): 919–26. PMID 15667676.