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OT8 Otolaryngology
Differential Diagnoses of Common Presentations
Toronto Notes 2019
Nasal Obstruction
Table 2. Differential Diagnosis of Nasal Obstruction
Acquired
Nasal Cavity
Rhinitis Acute/chronic Vasomotor Allergic
Rhinosinusitis Foreign bodies Enlarged turbinates Tumour
Benign: polyps, inverting papilloma Malignant
SCC
Esthesioneuroblastoma (olfactory neuroblastoma) Adenocarcinoma
Nasal Septum
Septal deviation
Septal hematoma/abscess Dislocated septum
Nasopharynx
Adenoid hypertrophy
Tumour
Benign: juvenile nasopharyngeal angiofibroma (JNA), polyps Malignant: nasopharyngeal carcinoma
Systemic
Granulomatous diseases, diabetes, vasculitis
Hoarseness
Table 3. Differential Diagnosis of Hoarseness
Congenital
Nasal Cavity
Nasal dermoid cyst Encephalocele Glioma
Choanal atresia
Nasal Septum
Septal deviation
Septal hematoma/abscess Dislocated septum
Lung malignancy is the most common cause of extralaryngeal vocal cord paralysis
Infectious Inflammatory
Trauma Neoplasia
Cysts Systemic
Neurologic (vocal cord paralysis due to superior ± recurrent laryngeal nerve injury)
Functional Congenital
Acute/chronic laryngitis Laryngotracheobronchitis (croup)
GERD
Vocal cord polyps/nodules
Lifestyle: smoking, chronic EtOH use
External laryngeal trauma
Endoscopy and endotracheal tube (e.g. intubation granuloma)
Benign tumour
Papillomas (HPV infection) Minor salivary gland tumours Other
Retention cysts
Endocrine Hypothyroidism Virilization
Central lesions
Cerebrovascular accident (CVA) Head injury
Multiple sclerosis (MS)
Skull base tumours Arnold-Chiari malformation
Peripheral lesions Unilateral
Lung malignancy
Psychogenic aphonia (hysterical aphonia)
Laryngomalacia Laryngeal web Laryngeal atresia
Malignant tumours (e.g. thyroid) SCC
Other
Connective tissue disease RA
SLE
Iatrogenic injury: thyroid, parathyroid surgery, carotid endarterectomy, patent ductus arteriosus (PDA) ligation Bilateral
Iatrogenic injury: bilateral thyroid
surgery, forceps delivery Neuromuscular
Myasthenia gravis