Rhinosinusitis differential diagnosis

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

Overview

Rhinosinusitis must be differentiated from other diseases that may present with a headache and/or respiratory symptoms.

Differential Diagnosis

Acute rhinosinusitis

Acute rhinosinusitis must be differentiated from:

Allergic rhinitis
Headaches and midfacial pain syndromes: migraine, tension-type headache, cluster headache, paroxysmal hemicrania, atypical facial pain and midfacial segment pain
Orofacial pain syndromes (e.g. temporomandibular disorders)
Dental disease
Chronic fatigue syndrome

Chronic rhinosinusitis

Chronic rhinosinusitis must be differentiated from:^[1]^[2]^[3]

Allergic rhinitis
Eosinophilic nonallergic rhinitis
Vasomotor rhinitis
Migraine
Tension headache
Vascular headaches
Temporal arteritis
Nasal foreign body
Gastroesophageal reflux
Asthma
Cerebrospinal fluid rhinorrhea
Benign and malignant sinonasal neoplasia


Disease	History	Physical examination	Laboratory or radiological findings
Acute viral nasopharyngitis^[4]	Symptoms start with sore throat Nasal congestion and runny nose Cough that may persist after the resolution of the other symptoms Fever is not common	Nasal mucosa is congested and hyperemic Pharynx is typically normal	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^[5]	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.^[6]	Skin testing using intradermal prick skin tests to determine the specific allergens causing allergic rhinitis. Serum immune assays to determine IgE levels in the serum.
Acute sinusitis^[7]	Presents with symptoms similar to URTIs (sneezing, cough and runny nose) Symptoms last for a longer time (about 10 days) with the peak of symptoms between 4th and 6th days. Usually, acute sinusitis is not associated with fever^[8]	Inspection may show erythema and edema over the involved sinus Palpation of sinuses shows tenderness on palpation Transillumination of the sinuses may show opacity.	X ray and CT may show air fluid level or bubbles in the affected sinus. Culture of the nasal secretions is of limited use in acute sinusitis as nasal secretions may be contaminated by nasal flora.
Infectious mononucleosis^[9]	Symptoms of pharyngitis: sore throat and difficult swallowing Fever Fatigue Lymphadenopathy especially in the posterior cervical region	Abdominal examination reveals splenomegaly Maculopapular rash may be present	Positive monospot test Elevated liver enzymes

References

↑ Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS; et al. (2005). "The diagnosis and management of sinusitis: a practice parameter update". J Allergy Clin Immunol. 116 (6 Suppl): S13–47. PMID 16416688.
↑ Fagnan LJ (1998). "Acute sinusitis: a cost-effective approach to diagnosis and treatment". Am Fam Physician. 58 (8): 1795–802, 805–6. PMID 9835855.
↑ Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M; et al. (2015). "Clinical practice guideline (update): adult sinusitis". Otolaryngol Head Neck Surg. 152 (2 Suppl): S1–S39. doi:10.1177/0194599815572097. PMID 25832968.
↑ Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.
↑ 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.
↑ Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J. Allergy Clin. Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
↑ 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.
↑ "Acute maxillary sinusitis". N. Engl. J. Med. 305 (4): 226–7. 1981. doi:10.1056/NEJM198107233050419. PMID 7242607.
↑ 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.

Template:WH Template:WS

[pmid16416688-1] Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS; et al. (2005). "The diagnosis and management of sinusitis: a practice parameter update". J Allergy Clin Immunol. 116 (6 Suppl): S13–47. PMID 16416688.

[pmid9835855-2] Fagnan LJ (1998). "Acute sinusitis: a cost-effective approach to diagnosis and treatment". Am Fam Physician. 58 (8): 1795–802, 805–6. PMID 9835855.

[pmid25832968-3] Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M; et al. (2015). "Clinical practice guideline (update): adult sinusitis". Otolaryngol Head Neck Surg. 152 (2 Suppl): S1–S39. doi:10.1177/0194599815572097. PMID 25832968.

[pmid12517470-4] Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.

[pmid20232579-5] 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.

[pmid11449200-6] Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J. Allergy Clin. Immunol. 108 (1 Suppl): S2–8. PMID 11449200.

[pmid9347786-7] 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.

[pmid7242607-8] "Acute maxillary sinusitis". N. Engl. J. Med. 305 (4): 226–7. 1981. doi:10.1056/NEJM198107233050419. PMID 7242607.

[pmid4864269-9] 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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