Pediatric rhinosinusitis

Lusk, Rodney P.; Stankiewicz, James A.

doi:10.1016/s0194-5998(97)70008-1

Cited by 57 publications

(58 citation statements)

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“…This is explained by the similarity of physical findings in the patient with an uncomplicated viral rhinosinusitis and the patient with acute bacterial sinusitis. 2 In both instances, examination of the nasal mucosa may show mild erythema and swelling of the nasal turbinates with mucopurulent discharge. Facial pain is an unusual complaint in children.…”

Section: Recommendationmentioning

confidence: 99%

“…It may be difficult to distinguish children with uncomplicated viral upper respiratory infections or adenoiditis from those with an episode of acute bacterial sinusitis. 2 Most viral infections of the upper respiratory tract involve the nose and the paranasal sinuses (viral rhinosinusitis). 3 However, bacterial infections of the paranasal sinuses do not usually involve the nose.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Practice Guideline: Management of Sinusitis

2001

Pediatrics

374

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ABSTRACT. This clinical practice guideline formulates recommendations for health care providers regarding the diagnosis, evaluation, and treatment of children, ages 1 to 21 years, with uncomplicated acute, subacute, and recurrent acute bacterial sinusitis. It was developed through a comprehensive search and analysis of the medical literature. Expert consensus opinion was used to enhance or formulate recommendations where data were insufficient.A subcommittee, composed of pediatricians with expertise in infectious disease, allergy, epidemiology, family practice, and pediatric practice, supplemented with an otolaryngologist and radiologist, were selected to formulate the practice parameter. Several other groups (including members of the American College of Emergency Physicians, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Asthma, Allergy and Immunology, as well as numerous national committees and sections of the American Academy of Pediatrics) have reviewed and revised the guideline. Three specific issues were considered: 1) evidence for the efficacy of various antibiotics in children; 2) evidence for the efficacy of various ancillary, nonantibiotic regimens; and 3) the diagnostic accuracy and concordance of clinical symptoms, radiography (and other imaging methods), and sinus aspiration.It is recommended that the diagnosis of acute bacterial sinusitis be based on clinical criteria in children <6 years of age who present with upper respiratory symptoms that are either persistent or severe. Although controversial, imaging studies may be necessary to confirm a diagnosis of acute bacterial sinusitis in children >6 years of age. Computed tomography scans of the paranasal sinuses should be reserved for children who present with complications of acute bacterial sinusitis or who have very persistent or recurrent infections and are not responsive to medical management.There were only 5 controlled randomized trials and 8 case series on antimicrobial therapy for acute bacterial sinusitis in children. However, these data, plus data derived from the study of adults with acute bacterial sinusitis, support the recommendation that acute bacterial sinusitis be treated with antimicrobial therapy to achieve a more rapid clinical cure. Children with complications or suspected complications of acute bacterial sinusitis should be treated promptly and aggressively with antibiotics and, when appropriate, drainage. Based on controversial and limited data, no recommendations are made about the use of prophylactic antimicrobials, ancillary therapies, or complementary/alternative medicine for prevention and treatment of acute bacterial sinusitis.This clinical practice guideline is not intended as a sole source of guidance in the diagnosis and management of acute bacterial sinusitis in children. It is designed to assist pediatricians by providing an analytic framework for evaluation and treatment. It is not intended to replace clinical judgment or establish a protocol for all patients with this condition.ABBR...

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Section: Recommendationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Practice Guideline: Management of Sinusitis

2001

Pediatrics

374

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“…Algumas crianças apresentam crises recidivantes de sinusite aguda com total resolução dos sinais e sintomas entre as crises, e, em algumas, são episódios tão freqüentes que se torna muito difícil diferenciar uma rinossinusite crônica de uma recorrente 9 .…”

Section: Diagnóstico Clínicounclassified

“…Em relação à sinusite crônica, o tratamento com antibióticos por um período mais prolongado (3-4 semanas) parece apresentar um índice de cura mais satisfatório do que quando utilizado pelo tempo regular 9 .…”

Section: Tratamento Clínicounclassified

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Rhinosinusitis in children

Pignatari¹,

Weckx²,

Solé³

1998

J Pediatr (Rio J)

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IntroduçãoAs sinusites e rinites são processos inflamatórios da mucosa sinusal e nasal que, na população infantil, freqüen-temente se sobrepõem, impossibilitando a distinção clíni-ca entre essas afecções. Com muita freqüência, são decorrentes de infecções virais e dos processos alérgicos da via respiratória. Considerando-se as diminutas proporções das cavidades sinusais e nasal na criança, e a facilidade de os processos inflamatórios se estenderem pela mucosa respiratória, não é incomum denominar estes quadros de rinossinusites.É uma condição extremamente freqüente tanto na população adulta como na pediátrica, e uma das maiores dificuldades, ainda nos dias de hoje, é a distinção da sua etiologia, se viral ou bacteriana, o que muitas vezes acaba por levar o profissional da área de saúde infantil a tratá-los inadeqüadamente.Existem ainda muitas dúvidas e controvérsias em relação à história natural da rinossinusite crônica na criança; é considerada uma moléstia multifatorial e seus fatores predisponentes são considerados mais ou menos importantes dependendo da faixa etária. A imaturidade do sistema imunológico e as dimensões da cavidade nasal e dos seios paranasais, por exemplo, perdem sua importância com o crescimento. Vários são os fatores freqüentemente relacionados à rinossinusite aguda e crônica na criança, incluindo-se a poluição ambiental, freqüência a creches, alergia, infecção das vias aéreas superiores (IVAS), refluxo gastresofágico, hipertrofia de adenóides e/ou de amíg-dalas entre outros 1-3 . ResumoObjetivo: Rever os conceitos fisiopatogênicos da sinusite na criança e o seu tratamento.Método: Além da anmnese detalhada, o exame físico pode confirmar o comprometimento dos seios paranasais, pela presença de descarga mucopurulenta no meato médio e halitose importante. A avaliação por imagem confirma o diagnóstico de afeção sinusal.Resultados: O conhecimento dos agentes etiológicos envolvidos nos quadros de sinusite aguda e crônica é fundamental para permitir um melhor controle terapêutico desses pacientes.Conclusões: A rinossinusite é uma das doenças mais relatadas na população em geral, apresentando uma prevalência crescente nos últimos anos. Muitas questões sobre a etiologia, patofisiologia e tratamento continuam sem uma resposta adequada, principalmente na população infantil, o que a torna uma doença de alto custo e alta morbidade.J. pediatr. (Rio J.). 1998; 74 (Supl.1): S31-S36: sinuite, rinossinusite, radiologia, tomografia computadorizada, seios paranasais, antibióticos. AbstractObjetives: To review the pathogenic mechanisms and treatment of sinusitis in children.Methods: Mucopurulent secretion and halitosis are important signs and symptoms for the diagnose of sinusitis. The radiographic and computorized tomography investigations confirm the sinusal disease.Result: The identification of the main pathogens involved in the acute and chronic sinusitis is fundamental to give a better therapeutic control to these patients.Conclusions: Rhinosinusitis is one of the most reported diseases among the general ...

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Expression Profiling of Inflammatory Mediators in Pediatric Sinus Mucosa

Ghimbovschi

Aujla³

et al. 2009

Arch Otolaryngol Head Neck Surg

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Objective To evaluate gene expression by microarray analyses of inflammatory mediators in the sinus mucosa of children with or without chronic rhinosinusitis (CRS). Design Prospective molecular genetics analysis of sinus mucosa from pediatric CRS and control patients. Subjects Eleven CRS patients who underwent endoscopic sinus surgery and ten children who underwent craniofacial resection or neurosurgical procedures. Interventions Gene expression levels of sinus tissue from 6 CRS and 6 control patients were analyzed on Affymetrix HGU133 plus 2.0 array chips. mRNA expression levels of upregulated inflammatory/immune response genes, as well as cytokines of interest, were further evaluated by quantitative RT-PCR. Results Gene expression using the Plier algorithm yielded the most consistent grouping of samples. 96 genes were significantly up-regulated more than 2 fold, and 123 genes were down-regulated by at least 50% in the CRS sinus tissues compared with controls (p<0.05). GeneSpring analysis demonstrated significant changes in several ontology categories in the CRS samples, including inflammatory/immune response genes. The chemokines CXCL13 and CXCL5, serum amyloid A, serpinB4 and defensin B1 were highly upregulated (≥ 5-fold). Increased expression of these genes was validated by quantitative RT-PCR in an independent set of tissues. Expression levels of the cytokines IL5, IL6 and IL8 were similar in both cohorts; these results were validated by RT-PCR. Conclusions Microarray analyses of sinus mucosa in children with CRS showed an increased expression of inflammatory genes involved in innate and adaptive immune systems. This technology can be successfully used to identify genes implicated in the pathogenesis of pediatric CRS.

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Pediatric rhinosinusitis

Cited by 57 publications

References 0 publications

Clinical Practice Guideline: Management of Sinusitis

Clinical Practice Guideline: Management of Sinusitis

Rhinosinusitis in children

Expression Profiling of Inflammatory Mediators in Pediatric Sinus Mucosa

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