Pharyngeal Tonsil Enlargement (Adenoid Hyperplasia): Or something else? Differential Diagnosis

Differential diagnoses primarily related to the symptom of nasal obstruction (“stuffy nose“) are listed below.

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Choanal atresia, unilateral (unilateral) – congenital absence of the posterior nasal opening (= congenital membranous or bony closure of the posterior nasal opening); unilateral choanal atresia, in contrast to bilateral, is often not discovered immediately after birth but later in childhood; clinical symptoms: chronic rhinorrhea (runny nose)

Respiratory system (J00-J99)

  • Allergic rhinitis (hay fever; allergic rhinitis); clinical presentation: rhinorrhea (runny nose; runny nose), sneezing attacks, watery eyes, itching, known triggers.
  • Choanal polyp – nasal polyp, often originating in the maxillary or ethmoid sinus; causes obstructed nasal breathing.
  • Chronic rhinitis – inflammation of the nasal mucosa (rhinitis) persisting over a long period of time.
  • Chronic sinusitis (sinusitis) – in children as chronic rhinosinusitis (simultaneous inflammation of the nasal mucosa (“rhinitis”) and the mucosa of the paranasal sinuses (“sinusitis“)) with polyps (Engl. “chronic rhinosinusitis with nasal polyps“, CRSwNP) (rather rare in childhood); clinical picture: rhinorrhea (runny nose; running nose), hyposmia (decreased sense of smell), facial pressure or facial pain.
  • Nasal turbinate hyperplasia – benign enlargement of the turbinates (usually affecting the inferior turbinates).
  • Nasal valve stenosis – narrowing of the nasal valves.
  • Nasal septum deviation (nasal septum curvature).
  • Polyposis nasi (nasal polyps; e.g., in cystic fibrosis (one in three children)).
  • Vasomotor rhinitis (rhinitis vasomotorica; chronic, non-allergic and non-infectious rhinitis).

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Cystic fibrosis (ZF) – genetic disease with autosomal recessive inheritance characterized by the production of secretions in various organs that need to be tamed.

Factors affecting health status and leading to health care utilization (Z00-Z99).

  • House dust mite allergy
  • Pollen allergy
  • Mold allergy

Neoplasms – tumor diseases (C00-D48)

  • Nasopharyngeal carcinoma/nasopharyngeal cancer (in adults).
  • Tornwaldt cyst (Latin: bursa pharyngea(lis)) – benign cyst (a benign, fluid-filled mass) located in the upper posterior nasopharynx (nasopharynx).
  • Tumors of the nasopharynx (e.g., nasopharyngeal fibroma: livid, dermal tumor that bleeds easily; usually occurs in boys 10 years of age and older)
  • Other nasal tumors, unspecified (e.g., melanoma, teratoma).

Ears – mastoid process (H60-H95).

  • Hearing loss

Injuries, poisoning, and other sequelae of external causes (S00-T98).