Differentials
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Richtlijn acute rinosinusitisPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2023Guide de pratique clinique rhinosinusite aiguëPublished by: Groupe de travail Développement de recommandations de première ligneLast published: 2023Allergic rhinitis
SIGNS / SYMPTOMS
Ocular and/or nasal pruritus.
Sneezing.
Rhinorrhoea.
Headache, purulent discharge, and facial pain/pressure are less common.
INVESTIGATIONS
Allergen skin-prick testing: wheal and flare reaction after specific allergen is introduced into the skin is 3 mm larger than negative (saline) control.
In vitro-specific IgE determination: specific allergen response.[25]
Non-allergic rhinitis
SIGNS / SYMPTOMS
Heterogeneous group of nasal diseases that has nasal obstruction or rhinorrhoea as common factors.
History of pregnancy, barometric changes, food-associated symptoms, or hypothyroidism.
INVESTIGATIONS
Diagnosis is clinical: there are no differentiating tests.
Migraine
SIGNS / SYMPTOMS
Patient reports a history of 'recurrent sinus infection' in which moderate-severe headache is the most prominent symptom.
Sensitivity to light or noise.
Aura.
Nausea.
Symptoms decrease if sitting/lying in a quiet, dark room.
Absence of purulent nasal discharge.
INVESTIGATIONS
Diagnosis is clinical; there are no differentiating tests.[26] Radiological tests may exclude features of acute bacterial rhinosinusitis.
Adenoiditis
SIGNS / SYMPTOMS
Difficult to differentiate in paediatric population as both conditions have similar symptoms.
INVESTIGATIONS
Nasal flexible endoscopy can be used to determine the source of infection, either from the adenoids or from the sinuses.
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