How should I differentiate between adenoid hypertrophy and other causes of nasal obstruction in a paediatric patient?

To differentiate adenoid hypertrophy from other causes of nasal obstruction in a paediatric patient, a thorough clinical assessment is essential. Adenoid hypertrophy typically presents with symptoms such as nasal obstruction, mouth breathing, snoring, and sometimes recurrent otitis media with effusion due to Eustachian tube dysfunction ¹. On examination, nasal endoscopy or flexible nasopharyngoscopy can directly visualize enlarged adenoids obstructing the nasopharynx, which is a key diagnostic step ¹.

Other causes of nasal obstruction in children include anatomical abnormalities (such as nasal polyps, choanal atresia), inflammatory conditions, or rare masses like mucoceles, as described in the literature (Eloy et al., 2016). These may present with unilateral symptoms, visible nasal masses, or atypical features not typical of adenoid hypertrophy (Eloy et al., 2016). Imaging, such as lateral neck X-rays or MRI, can help differentiate adenoid hypertrophy from other structural causes or masses when clinical examination is inconclusive ¹.

In summary, the differentiation relies on:

• Clinical history focusing on typical symptoms of adenoid hypertrophy (bilateral nasal obstruction, snoring, mouth breathing) ¹.
• Direct visualization via nasal endoscopy to assess adenoid size and exclude other lesions ¹.
• Imaging studies when necessary to identify alternative causes such as mucoceles or tumours (Eloy et al., 2016).

This integrated approach ensures accurate diagnosis and appropriate management of nasal obstruction in paediatric patients.