Management of chronic rhinosinusitis

Abstract

: Chronic rhinosinusitis (CRS) in children is difficult to treat, with resultant frequent recurrences and failures. There are controversies in the treatment, mirroring the debate over the exact etiology of this disorder. The available medical treatments are antibiotics, topical nasal corticosteroids, and nasal lavage with saline solutions; though, there is no general agreement on the efficacy of the latter. The new technique of balloon sinuplasty allows ventilation to the sinuses to be restored with minimal risk and trauma to the tissues, and initial outcome seems promising, being successful in most treated children. Concerning the surgical approach, adenoidectomy is among the most frequent surgical procedures performed on children, but its therapeutic effect is controversial, because randomized studies have failed to prove that adenoidectomy alone is sufficient in curing CRS. Instead, functional endoscopic sinus surgery is a minimally invasive technique which restores the sinus ostia patency and can re-establish ventilation and drainage through the natural pathways. It is important that the effectiveness of any treatment is also evaluated by patient-reported outcomes (PROs) that refer to all health-related reports coming from the patients, without any involvement or interpretations by physician or others. Among PROs, health-related quality of life (HRQL) is the one most widely known and used. HRQL can be measured by means of validated questionnaires, which provide scores proportional to the degree of well-being perceived by patients. Concerning diseases of the upper airway including RS, there are numerous instruments specifically designed for children and caregivers, which allow to assess the effects of treatments in a more extensive and complete manner.

Impact of intranasal sodium hyaluronate on the short‐term quality of life of patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis

“…There is now mounting evidence that the patient's perspective on treatment outcomes is a crucial element for improving high‐quality care. Indeed, patient‐rated therapeutic outcomes in terms of symptoms can provide a much more realistic picture of the effectiveness of a treatment than those of clinician‐rated outcomes . For these studies, the impact of chronic diseases, including CRS, and the impact of medical and surgical care are determined and recorded either with the VAS or with validated symptom‐based questionnaires.…”

“…The available CRS medical treatments comprise antibiotics, corticosteroids, and topical therapy; however, their efficacy is still debated . Oral antibiotics are considered therapeutic options in CRS treatment, whereas oral steroids are strongly recommended for short‐time management of CRS with nasal polyps and in the perioperative period .…”

Effect of Sodium Hyaluronate Added to Topical Corticosteroids in Chronic Rhinosinusitis with Nasal Polyposis

“…4 The available medical treatments for CRSwNP comprise systemic and topical therapies, [5][6][7][8] but, for patients with medically resistant CRSwNP, the surgical approach represents the treatment of choice. 5,9 However, it is well known that both medical and surgical therapeutic strategies have high rates of recurrence as the result of severe inflammatory reactions during the mucosal healing period. 10 Recently, there is mounting evidence that sodium hyaluronate (SH), the major component of many extracellular matrices, including those in respiratory epithelial cells and gland serous cells of the nasal and trachea-bronchial mucosa, serves important biologic roles beyond its generally accepted function as a structural component of interstitial and connective tissues.…”

Clinical Characteristics Associated with Conjunctival Inflammation in Allergic Rhinoconjunctivitis

“…13,14 Allergic conjunctivitis, especially in pollen allergy, is the most frequent comorbidity of AR. Pathophysiologically, AR and conjunctivitis are triggered by the contact of the allergen with its specific IgE bound to mucosal mast cells.…”