Differentiating Rhinitis in the Paediatric Population by Giving Focus on Medical History and Clinical Examination

Doulaptsi, Maria; Aoi, Noriaki; Kawauchi, Hideyuki; Milioni, Athanasia; Karatzanis, Alexander; Prokopakis, Emmanuel

In general, the diagnosis of rhinitis in clinical practice can be made based on a detailed medical history as well as a simple physical examination accompanied with laboratory investigation for detection or exclusion of a clinically relevant sensitization to airborne allergens [1] . In the differential diagnosis, a detailed clinical history is of great importance to obtain all the information required to make the diagnosis of rhinitis, to characterize the type, to exclude other pathologies and co-morbidities, to deliver appropriate treatment, and to establish the best long-term management for the patient [9] . In Table 1 , the most common causes of chronic rhinitis in the paediatric population are presented. Recognizing possible rhinitis co-morbidities is essential, as many of those may have escaped parental attention. After a series of questions, an experienced clinician should be able to assume a possible diagnosis and guide clinical examination and laboratory and/or imaging investigation to confirm the speculated pathology. Table 2 includes basic questions which need to be answered during history taking. Inspection, of both nose and face is of critical importance, especially in paediatric patients, and can give us valuable information even at first site [9] . For instance, a child with the characteristic long face syndrome should raise the suspicion of chronic nasal obstruction and mouth breathing, together with underlying causes. Table 3 contains typical signs and symptoms observed during clinical examination and their possible underlying aetiologies. Clinical evaluation should include a thorough examination of ear, nose, oral cavity, and pharynx, as well as neck palpation, and chest auscultation [10] . In infants, a gross appreciation of the anterior part of the nose can be done by pushing up the tip of the nose. This move will reveal the septum and the head of the inferior turbinates. Anterior rhinoscopy will allow the inspection of the anterior parts of the nose. It can be easily performed by all physicians with the use of a nose speculum and a forehead light or with a simple otoscope. Anterior rhinoscopy may reveal nasal secretions (transparent or discoloured), crusting, mucosal oedema, anatomic asymmetries, foreign bodies, presence of large polyps, or perforation of the anterior part of the septum. Nasal airflow during expiration can be tested by using a cold mirror or a metallic tongue depressor. Asymmetrical or total lack of fogging indicates unilateral or bilateral nasal obstruction, respectively [9] .