Chronic rhinosinusitis in children (original) (raw)

Particularities in the Child Chronic Rhinosinusitis

Romanian Journal of Pediatrics, 2016

Chronic rhinosinusitis is a rare pathology in pediatric pathology versus adult patients. Clinical manifestations are related, on the one hand, with the anatomical particularities and, on the other hand, with the immune response correlated with the age of the child. Allergy is the main cause in 50% of child rhinitis, 40% of them debuting early until the age of 6 years. The clinical expression of allergic rhinosinusitis in children can sometimes be accompanied by comorbidity manifestations or complications. Impaired mucociliary clearance can be induced by other rare pathological situations that produce mucus rheology modification, as in cystic fibrosis (CF). Through, the clinical heterogenicity of expression is in relation, on the one hand, with immunogenic response and anatomical particularities relative to age of the child, and secondly with the diversity of inducing factors (from very frequent like allergy to the least frequent, CF). It requires a correct diagnosis, early and appropriate treatment by a multidisciplinary team collaboration.

Chronic Rhinosinusitis: Adults and Children

All Around the Nose, 2019

25.1 Chronic Rhinosinusitis in Adults 25.1.1 Definition Chronic rhinosinusitis (CRS) could be briefly defined as a mucosal inflammation of the nasal cavity and paranasal sinuses that lasts 12 weeks or longer. Rhinosinusitis is the preferred term rather than using the phrase "sinusitis" as the inflammation of paranasal sinuses and the nasal cavity is almost always seen together. It is not a result of a single pathologic condition but more precisely should be seen as a combination of related disorders those have common clinical and histologic findings [1, 2]. Exact definition of CRS has been a controversial issue for many years. Many different classifications and management algorithms have been reported in the literature in order to standardize the whole process. CRS cannot be simplified as an untreated or persistant acute rhinosinusitis. Therefore, the diagnosis should be based on objective evidence of chronic mucosal inflammation. 25.1.2 Epidemiology Prevelance of CRS varies worlwide due to different diagnostic criteria of the disease. In many countries, it ranges from 7% to 27% due to subjective symptom-based diagnosis of the disease [3]. It is believed that the number is overestimated as the objective evidence-based diagnosis lacks in daily practice. CRS is commonly seen in adults, but it may also occur in children. The mean age is found to be 36-42 years in several studies. CRS has an annual health care cost of $8 billion in United States [4]. Repeated imaging techniques and medical treatments are mostly responsible for this economic burden.

Clinical consensus statement: pediatric chronic rhinosinusitis

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2014

To develop a clinical consensus statement on the optimal diagnosis and management of pediatric chronic rhinosinusitis (PCRS). A representative 9-member panel of otolaryngologists with no relevant conflicts of interest was assembled to consider opportunities to optimize the diagnosis and management of PCRS. A working definition of PCRS and the scope of pertinent otolaryngologic practice were first established. Patients of ages 6 months to 18 years without craniofacial syndromes or immunodeficiency were defined as the targeted population of interest. A modified Delphi method was then used to distill expert opinion into clinical statements that met a standardized definition of consensus. After 2 iterative Delphi method surveys, 22 statements met the standardized definition of consensus while 12 statements did not. Four statements were omitted due to redundancy. The clinical statements were grouped into 4 categories for presentation and discussion: (1) definition and diagnosis of PCRS, ...

Rhinosinusitis in Children

Pediatric ENT

Rhinosinusitis is the inflammation of the mucous membranes of nose and paranasal sinus(es). 5-13% of upper respiratory tract infections in children complicate into acute rhinosinusitis. Though not life threatening, it profoundly affects child's school performance and sleep pattern. If untreated, it could progress to chronic rhinosinusitis (CRS). The pathogens involved in perpetuation of CRS consist of multidrug-resistant mixed microflora. CRS is challenging to manage and could further extend to cause eye or intracranial complications. In children, CRS diagnosis is often either missed or incomprehensive. Due to this, morbidity and strain on healthcare budget are tremendous. Flexible fiberoptic endoscopy has revolutionized management of CRS. Its utility in children is being increasingly recognized. Optimal management entails specific appropriate antimicrobials as well as treatment of underlying causes. The aim is to normalize sinus anatomy and physiology and regain normal mucociliary function and clearance.

Pediatric chronic rhinosinusitis: a restropective review

American Journal of Otolaryngology, 2008

Purpose: Chronic rhinosinusitis (CRS) is a major cause of morbidity in the pediatric population and a difficult entity to treat with a poorly defined pathophysiology and diagnostic criteria. Functional endoscopic sinus surgery (FESS) has proven to be effective for these patients, but concerns remain regarding its possible interference with facial growth. Recently, stepwise treatment protocols, which include maxillary sinus irrigation followed by long-term intravenous (IV) antibiotics, have been demonstrated to be effective alternatives to FESS. However, long-term IV therapy is inconvenient and not without complications. The purpose of this study is to review one institution's experience in treating medically refractory pediatric CRS, specifically to describe the epidemiology of the affected population and estimate the success of a stepped treatment protocol using long-term double oral antibiotic therapy for its treatment. Materials and Methods: A retrospective review of the medical records of 23 patients who received treatment. Results: Mean age was 2.3 years. Clinical resolution was achieved in 96% of patients and in 78% without the use of IV antibiotics. Four patients who required IV antibiotics subsequently tested positive for immune deficiency. Long-term resolution rate was 78% overall and 86% for those that did not require IV antibiotics. No complications were reported, and no patients required FESS. Conclusions: A stepwise protocol that includes concurrent adenoidectomy and bilateral maxillary sinus irrigation followed by long-term double oral antibiotic therapy is safe and effective for the treatment of pediatric CRS. Patients with immunodeficiency may require long-term IV therapy to achieve symptom resolution.

Management of rhinosinusitis in children

International journal of pediatric otorhinolaryngology, 1999

The authors provide definitions for the different forms of pediatric rhinosinusitis, with an enumeration of the main symptoms and signs. They also provide the indications for CT scan examination and microbiological investigations. In addition, they emphasize the importance of concomitant systemic disease, such as allergy and immunological disorders. The adequate medical management, which is mandatory before any surgery, is considered and discussed, and the indications for surgery are provided.

Acute Rhinosinusitis in Children

Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the following symptoms: fever, rhinorrhea, nasal congestion, cough, postnasal drainage, and facial pain/headache. It often starts as an upper respiratory tract infection that is complicated by a bacterial infection in which the symptoms worsen, persist, or are particularly severe. The accurate diagnosis of acute rhinosinusitis is challenging because of the overlap of symptoms with other common diseases, heavy reliance on subjective reporting of symptoms by the parents, and difficulties related to the physical examination of the child. Antibiotics are the mainstay of treatment. There is no strong evidence for the use of ancillary therapy. Orbital and intracranial complications may occur and are best treated early and aggressively. This article reviews the diagnosis, pathophysiology, bacteriology, treatment, and complications of acute rhinosinusitis in children.

Guidelines for the Diagnosis and Treatment of Acute and Subacute Rhinosinusitis in Children

Journal of Chemotherapy, 2008

The importance of rhinosinusitis finally reached pediatricians' attention a few years ago, and it has now been demonstrated that it is medically important and has a considerable socioeconomic impact in childhood. These guidelines, which have been prepared with and approved by many Italian Scientific Societies, are based on the most recent findings in the fields of clinical symptoms, imaging and microbiology tests for the diagnosis of acute rhinosinusitis, and efficacy evidence concerning antibiotic treatment and non-antibiotic adjuvant treatment. A Pubmed search using the key words "sinusitis", "rhinosinusitis", "child" and "antibiotic treatment", and the limits "human studies" and "English language", led to the selection of more than 2,700 articles published between 1966 and 2007. These guidelines are based on the 125 that were considered truly relevant and reflect the most widely shared positions concerning the diagnosis and treatment of acute, subacute and recurrent rhinosinusitis in children.

Long-Term Follow-Up for Children Treated With Surgical Intervention for Chronic Rhinosinusitis

The Laryngoscope, 2006

Objectives/Hypothesis: The goal of this study is to retrospectively compare the long-term, 10 year, outcomes of surgical versus medical management of young children with chronic rhinosinusitis. Study Design: This is a retrospective, age-matched, cohort outcome study performed at a tertiary-care hospital. Methods: Two groups of young children (2-5 yr old) with chronic rhinosinusitis were treated with endoscopic sinus surgery or medically managed and evaluated 10 years after their initial therapy. Of the 131 eligible patients, 67 could be located and consented to participate in the study. Six symptoms (day cough, night cough, irritability or crankiness, headaches, nasal airway obstruction, and purulent rhinorrhea) were used to assess the outcome of their treatment. Results: Children undergoing endoscopic sinus surgery had more significant disease as noted on the computed tomography (CT) scans. Their symptom severity, however, was similar. When individual symptoms were compared, there were no statistically significant differences between the surgically and medically managed groups. When the mean was controlled for baseline symptom severity and CT severity, there was statistical improvement in nasal airway obstruction and decreased rhinorrhea. There was a trend toward improvement in cough, but this was not statistically significant. Parenteral assessment of improvement (change) in symptoms (P ‫؍‬ .001) and their degree of satisfaction with treatment (P ‫؍‬ .005) was significantly higher in the surgically managed group. Conclusions: Children who have chronic rhinosinusitis improve in their symptoms of nasal airway obstruction and purulent discharge if they undergo surgery. Parents of young children with chronic rhinosinusitis appear to be more satisfied with the outcome of surgical management than medical management when assessed 10 years later.