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

Clinical examination with anterior rhinoscopy will help us to build up and strengthen our diagnosis, and to avoid unnecessary referrals, testing, or treatment. Enlarged turbinates with pale, purplish, and bluish mucosa as well as thin watery or mucoid secretions in the nose are indicative of rhinitis of allergic origin [23] . A thoroughly performed ear examination may reveal tympanic membrane retraction or features of chronic otitis media with effusion. Concerning the possible association of AR and otitis media with effusion, current evidence remains unclear. However, a transient eustachian tube obstruction was demonstrated after nasal challenge with aeroallergens [24] [25] [26] . The pharynx may reveal a cobblestone appearance of the posterior pharyngeal wall, and hyperplasia of tonsils and/or adenoids. Regarding adenoid hypertrophy in AR patients, evidence is inconsistent. Children with AR have repeatedly shown increased prevalence of adenoid hypertrophy, however, children with upper airway obstruction do not consistently show an increased sensitivity in airborne allergens [27, 28] . The significance of different age peaks for several pathologies should not be underestimated, and thus should be considered. Particularly, it is known that the prevalence of AR in the paediatric population increases with age, with its peak occurring in adolescence [29, 30] . Contrariwise, infectious rhinitis prevalence is remarkable high in early life, while it steadily decreases over time. For adenoid hypertrophy, peak age is considered to be the 4-7 years age group [11] .