Differential diagnosis between allergic rhinitis and rhinosinusitis

Abstract

Viral upper respiratory tract infections and subsequent rhinosinusitis are common illnesses in children. It is sometimes difficult to differentiate these diseases from allergic rhinitis. The points in the differential diagnosis of rhinosinusitis are symptoms, local findings, and nasal cytology. Symptoms of rhinosinusitis include nasal congestion, mucopurulent rhinorrhea, postnasal drip, productive cough, and headache. Among them, productive cough is an important symptom that is observed in more than 60% of children with rhinosinusitis. Nasal findings show mucopurulent nasal discharge, and mucopurulent postnasal drip is observed on the posterior pharyngeal wall in patients with rhinosinusitis. Fiberscopic examination can reveal mucopurulent discharge flowing from the middle meatus into the posterior nares. Observation of neutrophils and eosinophils by nasal cytology is also useful. Diagnosis should be made comprehensively based on symptoms, local findings, and nasal cytology. Most cases of pediatric rhinosinusitis improve quickly with treatment. We need to carefully observe and treat nasal symptoms in children, always considering whether they are infectious or allergic.