Can Symptoms Differentiate Between Chronic Adenoiditis and Chronic Rhinosinusitis in Pediatric Patients
Phillip R Purnell1, Jad H Ramadan1, Hassan H Ramadan1
11 Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA.
Insights
Differentiating pediatric chronic adenoiditis from chronic rhinosinusitis (CRS) is possible. Purulent rhinorrhea with facial pain suggests CRS, while other symptoms are less predictive, potentially avoiding CT scans for adenoiditis diagnosis.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Medical Diagnostics
Background:
- Chronic adenoiditis and chronic rhinosinusitis (CRS) in children present overlapping symptoms.
- Accurate differentiation is crucial for appropriate treatment and management strategies.
Purpose of the Study:
- To distinguish pediatric patients with chronic adenoiditis from those with CRS based on presenting clinical symptoms.
- To identify key differentiating factors that can guide diagnostic decisions.
Main Methods:
- Retrospective chart review of pediatric patients with suspected CRS (2006-2014).
- Comparison of patient characteristics, symptoms, duration, and medical history using logistic regression.
- Utilized computed tomography (CT) scores to confirm diagnoses of CRS versus chronic adenoiditis.
Main Results:
- Of 99 pediatric patients, 22 had adenoiditis and 77 had CRS.
- Purulent rhinorrhea combined with facial pain was significantly more prevalent in CRS (P = .017).
- Cough and rhinorrhea were not predictive; facial pressure showed no significant difference.
Conclusions:
- Purulent rhinorrhea and facial pain are strong indicators of CRS in pediatric patients.
- In the absence of these specific symptoms, adenoidectomy may be considered for chronic adenoiditis without requiring a CT scan.
Abstract:
The purpose of this article is to differentiate pediatric patients with chronic adenoiditis from those with chronic rhinosinusitis (CRS) based on presenting symptoms. A chart review from a tertiary care facility with pediatric patients who presented with suspected CRS from 2006 to 2014 was identified. We compared patient characteristics, clinical symptoms, duration of symptoms, and past medial history using univariate and multivariate logistic regression models. Based on recent literature, utilizing the computed tomography (CT) score, we identified those children with CRS versus those with chronic adenoiditis. Of the 99 pediatric patients included, 22 patients had diagnosis of adenoiditis and 77 had diagnosis of CRS. When purulent rhinorrhea was present with facial pain, CRS was statistically more prevalent than chronic adenoiditis (P = .017). Symptoms including cough (P = .022), rhinorrhea (P = .27), and facial pressure (P = .98) were not predictive of one diagnosis over the other. Past medical history of asthma or allergy was similar in both groups. Smoke exposure was associated with CT scores >5 (odds ratio 2.4, 95% confidence interval, 0.799-7.182). We conclude that purulent rhinorrhea in the presence of facial pain is more indicative of CRS versus chronic adenoiditis. For all other children, an adenoidectomy without the need for a CT scan can be entertained.
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