Erkrankungen der Nase und der Nasennebenhöhlen im Kindesalter

Abstract

Diseases of the pediatric nose and paranasal sinuses as well as neighboring anatomical structures encompass a variety of pathologies, especially of inflammatory nature. Congenital disease, such as malformations and structural deviations of the nasal septum, as well as systemic metabolic pathologies affecting the nose and sinuses, rarely require medical therapy from an Otolaryngologist. The immunological function of the mucosa and genetic factors play a role in the development of disease in the pediatric upper airway tract, especially due to the constantly changing anatomy in this growth phase. Disease description of the nose and nasal sinuses due to mid-facial growth must also take developmental age differences (infant, toddler, preschool, and school age) into account. Epidemiological examinations and evidence based studies are often lacking in the pediatric population. The wide range of inflammatory diseases of the nose and paranasal sinuses, such as the acute and chronic rhinosinusitis, the allergic rhinitis, and adenoid disease, play a role in the susceptibility of a child to infection. The susceptibility to infection depends on the pediatric age structure (infant, young child) and has yet to be well defined. The acute rhinosinusitis in children develops after a viral infection of the upper airways, also referred to as the "common cold" in the literature. It usually spontaneously heals within ten days without any medical therapy. Antibiotic therapy is prudent in complicated episodes of ARS. The antibiotic therapy is reserved for children with complications or associated disease, such as bronchial asthma and/or chronic bronchitis. A chronic rhinosinusitis is defined as the inflammatory change in the nasal mucosa and nasal sinus mucosa, in which the corresponding symptoms persist for over 12 weeks. The indication for CT-imaging of the nasal sinuses is reserved for cases of chronic rhinosinusitis that have been successfully treated with medication. A staged therapeutic concept is followed in CRS based on conservative and surgical methods. Nasal sinus surgery is considered nowadays as effective and safe in children. Based on the assumption that adenoids are a reservoir for bacteria, from which recurrent infections of the nose and nasal sinus originate, the adenoidectomy is still defined as a cleansing procedure in rhinosinusitis. 69.3% of the children had benefit from adenoidectomy. Comorbidities, such as pediatric bronchial asthma, presently play an even more important role in the therapy of rhinosinusitis; therefore, it is often wise to have the support of pediatricians. In western European countries 40% of children presently suffer from allergic rhinitis, in which pronounced nasal obstruction can cause disturbed growth in facial bones. An early therapy with SIT may prevent the development of bronchial asthma and secondary sensitization to other allergens. Therefore, SIT is recommended in treatment of allergic rhinitis whenever, if possible. The assessment of diagnostic tools is for the examiner not often possib...

Pädiatrische Rhinologie

“…Here, orbital complications are significantly more common than intracranial complications, especially in younger children. The inflammatory complications of the cranial bone (sinugenic osteomyelitis) is even less frequent in comparison [41]. For this reason, the present chapter focuses on orbital complications.…”

“…Hierbei sind orbitale Komplikationen deutlich häufiger als intrakranielle Komplikationen, vor allem bei jüngeren Kindern. Die entzündlichen Komplikationen des Schädelknochens (sinugene Osteomyelitis) ist im Vergleich nochmals seltener [41]. Aus diesem Grund befasst sich das vorliegende Kapitel mit der orbitalen Komplika tion.…”

Polypous pansinusitis with the deformation of the external nose in a 8 year-old child presenting with the primary ciliary dyskinesia syndrome

“…Е.В. СОРОКИНА 3 Представлено редкое наблюдение развития хронического полипозного пансинусита с деформацией наружного носа у ребенка 8 лет с синдромом первичной цилиарной дискинезии, неоднократно ранее оперированного. Решающим в постановке диагноза было исследование биоптата мерцательного эпителия слизистой оболочки полости носа и бронхов, а также выполнение диагностической эндоскопии полости носа и носоглотки, КТ-исследование.…”