Chronic Rhinitis
Chronic Rhinitis: Excerpt from In A Page: Pediatric Signs and Symptoms
Chronic rhinitis is a common complaint in preschoolers, especially those who attend group child care. A relatively simple differential allows for elucidation of the diagnosis, usually with merely a careful history and physical exam. Even if the primary process is noninfectious, superinfection may occur with chronic disruption of the integrity of the nasal mucosa. Presence of nasal polyps in childhood should prompt an evaluation for cystic fibrosis (CF).
Differential Diagnosis
- Allergic rhinitis
–Rhinorrhea is typically watery and profuse
–May have associated sneezing, itchy eyes
and nose (allergic salute)
- Infectious conditions
–Chronic sinusitis: Typically has mucopurulent discharge; headache and fever may or may not be present
–Succession of URIs: Can get associated bacterial overgrowth, typically group A β
-
hemolytic Streptococcus in young children;
may have low-grade fever, lymphadenopathy,
and weight loss
–Congenital syphilis
-
Nonallergic rhinitis
–Typically due to irritants such as smoke or pungent odors
-
Vasomotor rhinitis
–A hyperactive cholinergic response
–Postnasal drip is commonly associated
-
Foreign body
–Always consider when there is unilateral nasal discharge
–Halitosis or generalized body odor
(bromhidrosis) may be present
- Nasal polyps
–10% of children with CF develop polyps
–Other causes include Kartagener syndrome (immotile cilia), recurrent sinusitis, aspirin intolerance
–Woake syndrome includes polyps, broad nasal base, frontal sinus aplasia, bronchiectasis
-
Adenoid hypertrophy
–Associated with mouth breathing, noisy respirations
–Severe cases can result in obstructive sleep apnea
-
Juvenile nasopharygeal angiofibroma
–Typically in adolescent males
–Associated with recurrent epistaxis
-
Hormonal rhinitis (rare)
–Pregnancy and hypothyroidism
Workup and Diagnosis
-
History
–Onset, duration, and severity of symptoms
–Character of nasal discharge: Purulent vs clear
–Unilateral or bilateral
–History of associated atopic conditions such as
-
environmental allergies, asthma, eczema
–Family history of atopic conditions
-
Physical exam
–Complete HEENT examination
–Degree and type of nasal discharge
–Characteristics of nasal turbinates such as enlargement,
-
color (redness indicates infection, pale or blue color indicates allergy)
–Allergic features such as allergic “shiners,” Dennie lines, high-arched palate
-
Labs
–Nasal smear
–PMNs indicate an infectious process, whereas eosinophils are consistent with an allergic response
-
Radiology
–Lateral head/neck films reveal adenoidal size and configuration, may show polyps
Treatment
-
Antibiotics such as amoxicillin plus clavulanic acid for sinusitis
-
Systemic nonsedating antihistamines (e.g., Claritin, Zyrtec, Allegra) for allergic rhinitis, especially if there are other manifestations of atopy
-
Intranasal antihistamines may be useful for isolated allergic rhinitis
-
Intranasal steroids are used for allergic rhinitis, vasomotor rhinitis, and chronic sinusitis
-
Polypectomy may be sufficient therapy for nasal polyps
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
More About Rhinitis
More Medical Textbooks Online about Rhinitis
Review other book chapters online related to Rhinitis:
Medical Books Excerpts
- Rhinorrhea
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Rhinorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Rhinitis
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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» Next page: NASAL DISCHARGE (Differential Diagnosis in Primary Care)
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