Chronic Sinusitis in Children

Abstract

Clinical practice guidelines for the management of acute sinusitis in children have been published by the American Academy of Pediatrics. Of note is that in this document, a brief discussion of chronic disease concluded that the pathogenesis and management are essentially unknown. Although there are insufficient data in the literature to develop evidence-based clinical guidelines, a careful review of the literature and clinical experience of experts who manage pediatric chronic sinusitis is presented in an effort to develop specific recommendations and to offer practical treatment options. Factors associated with chronic sinusitis should be addressed individually and include recurrent viral upper respiratory infections, allergic and nonallergic rhinitis, ciliary dyskinesia, cystic fibrosis, immunodeficiency, and anatomic abnormalities. Bacteriology includes the 3 pathogens associated with acute disease i.e., Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis but with chronic sinusitis also includes Staphylococcus aureus, anaerobic bacteria, and fungi. Medical interventions discussed include endoscopic sinus surgery, saline nasal irrigation, intranasal decongestant therapy, intranasal steroids, and oral antibiotics. Clinical ranking without regard to side effects and cost suggests that endoscopic sinus surgery and antral irrigation have the highest probability of substantial symptom improvement. Other issues discussed include identification and management of gastroesophageal reflux disease (GERD), allergy, and immune deficiency.

Predisposing Factors Associated With Chronic and Recurrent Rhinosinusitis in Childhood

“…We also found that children who were 4-6 years of age were not only the largest group in the entire study population, but also had the highest prevalence of chronic/recurrent RS. This finding is consistent with previous reports that children with chronic sinus disease were somewhat older than those with acute infections that respond to a single course of antibiotic treatment (4-7 vs. 1-5 years) 7,16. Although upper viral respiratory infections precede subsequent bacterial invasion and are common predisposing factors for RS,2,3,7 there was no difference in other factors associated with recurrent upper respiratory infections, such as daycare center attendance or having siblings.…”

The role of adenoids in pediatric rhinosinusitis

“…Sinusitis is characterized by inflammatory edema of the sinus mucosa, obstruction of the sinus ostia, and ineffective mucociliary activity. It is associated with recurrent upper respiratory infections, allergic and nonallergic rhinitis, cystic fibrosis, immunodeficiency, and anatomic abnormalities [7]. Chronic adenoid infection and hypertrophy, like sinusitis, are commonly seen in pediatric patients, and the symptoms and clinical feature are similar to rhinosinusitis.…”

Sinusitis

“…41 In numerous studies, 65% to 100% of children with chronic sinusitis have positive cultures of sinus aspirates. 41 In numerous studies, 65% to 100% of children with chronic sinusitis have positive cultures of sinus aspirates.…”