Category: For Allergy Fellows  

Teaching Case 9: Adenoiditis

This is a classic example of why you should perform a nasal endoscopy on the patient with chronic “postnasal drip (PND).”  The patient has longstanding dust mite allergy, nasal congestion and sinus discomfort.   He improved somewhat on allergy shots before but never reached the maintenance dose.  He wants to resume IT. There is nothing else about the history suggesting chronic sinusitis.

While the patient might yet be a candidate for IT, clearing up the infection helps to isolate the symptoms related to allergy vs. infection. Could this be why some patients do not improve with allergy shots?

Take Home Message: Positive skin tests are common. So are sinusitis, reflux, nasal polyps and adenoidal infections/hypertrophy which are detectable by rhinolaryngoscopy.