Stepwise Summary of Assessment Management and Management of Uncomplicated Chronic Pediatric Rhinosinusitis

Step 1: Thorough history and physical examination suggesting chronic rhinosinusitis

"Cardinal symptoms":18 chronic nasal congestion purulent nasal discharge, head, pain, cough, fetid breath, postnasal drainage, behavioral changes Boggy edematous turbinates with obstruction; polyposis; posterior pharyngeal cobbling; postnasal discharge; tender cervical adenopathy Symptom duration of 12 weeks or more

Step 2: Evaluation for predisposing factors and concomitant diseases, with treatment of positive findings Allergy/atopy Immune deficiency Cystic fibrosis Ciliary dyskinesia Enviromnent (smoking, day care) Gastroesophageal reflux

Step 3: Medical management of rhinosinusitis

Appropriate treatment of concomitant diseases/predisposing factors

At least one 4- to 6-week course of appropriate antibiotics

Limited (5-day) use of topical decongestant (weight-appropriate dosage) at initiation of therapy Daily nasal saline irrigations and nasal steroid sprays Antihistamines in atopic patients Room humidification

Judicious use of mucolytics, if patient is afforded symptomatic relief

Step 4: Adenoidectomy with concurrent nasal endoscopy and middle meatal culture

Step 5: With continued symptoms

Reevaluate diagnosis and possible predisposing factors Consider repeating STEP 3, using different antibiotic(s) Consider CT scan while medical treatment continues, if symptoms persist for > 6 months and the patient is a potential surgical candidate

If positive bony/mucosal derangements on CT with the above criteria met, carefully consider the possibility for limited FESS (depending on patient and parental expectations/desires)

CT, computed tomography; FESS, functional endoscopic sinus surgery.


Hubbell and Skoner—CHAPTER 69

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Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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