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.

REFERENCES

Hubbell and Skoner—CHAPTER 69

1. Gwaltney J, Philips C, Miller R, et al. Computed tomographic study of the common cold. N Engl J Med 1994;330:25-30

2. Lusk R, Stankiewicz, J. Pediatric rhinosinusitis. Otolaryngol Head Neck Surg 1997;117:S53-S57

3. Wald E. Rhinitis and acute and chronic sinusitis. In: Bluestone C, Stool S, Kenna M, eds. Pediatric Otolaryngology. 3rd Ed. WB Saunders: Philadelphia; 1996:843-858

4. Poole M. Pediatric endoscopic sinus surgery: the conservative view. Ear Nose Throat J 1994;73:221-227

5. Otten F, Van Aarem A, Grote J. Long-term follow-up of chronic maxillary sinusitis in children. Int J Pediatr Otorhino-laryngol 1991;22:81-84

6. April M, Zinreich S, Baroody F, Naclerio R. Coronal CT scan abnormalities in children with chronic sinusitis. Laryngoscope 1993;103:985-990

7. Parsons D, Wald E. Otitis media and sinusitis. Otolaryngol Clin North Am 1996;29:11-25

8. Aust R, Drettner B, Falck B. Studies of the effect of peroral phenylpropanolamine on the functional size of the human maxillary ostium. Acta Otolaryngol (Stockh) 1979;88:455

9. Ohashi Y, Nakai Y. Functional and morphological pathology of chronic sinusitis mucous membrane. Acta Otolaryngol (Stockh) 1983;397:11

10. Reimer A, von Mecklenburg C, Tormalm N. The mucociliary activity of the upper respiratory tract. III. A functional and morphological study of human and animal material with special reference to maxillary sinus disease. Acta Otolaryngol (Stockh) 1978;355:3

11. Giebink G. Criteria for evaluation of antimicrobial agents and current therapies for acute sinusitis in children. Clin Infect Dis 1992;14(suppl 2):S212-S215

12. Kennedy D, ed. Sinus Disease. Guide to First-Line Management. Philadelphia: Health Communications; 1994:1-44

13. Wald E, Gurerra N, Byers C. Upper respiratory tract infection in young children, duration of and frequency of complications. Pediatrics 1991;87:129-133

14. Wald E. Sinusitis in children. N Engl J Med 1992;326: 319-323

15. Stenfors L, Raisanen S. Abundant attachment of bacteria to nasopharyngeal epithelium in otitis-prone children. J Infect Dis 1992;165:1148-1150

16. Benninger M, Anon J, Mabry R. The medical management of rhinosinusitis. Otolaryngol Head Neck Surg 1997;117(suppl): S41-S49

17. Clement P, Bluestone C, Gordts F, et al. Management of rhinosinusitis in children. Consensus Meeting, Brussels, Belgium, September 13, 1996. Arch Otol Head Neck Surg 1998;124: 31-34

18. Parsons D, Phillips S. Functional endoscopic surgery in children: a retrospective analysis of results. Laryngoscope 1993; 103:899-903

19. Parsons D, Pransky S. Functional endoscopic sinus surgery in infants and young children. Instruct Courses Am Acad Otol Head Neck Surg 1992;5:159-164

20. Dolitsky J. Management of sinusitis in adolescent children. In: Schaefer S (ed). Rhinology and Sinus Disease. A Problem-Oriented Approach. St Louis, MO: CV Mosby; 1998: 135-142

21. Wilner A, Lazar R, Younis R, et al. Sinusitis in children: current management. Ear Nose Throat J 1994;73:45-90

22. Lusk R, Lazar R, Muntz H. The diagnosis and treatment of recurrent and chronic sinusitis in children. Pediatr Clin 1989;36:1411-1421

23. Otten F, Grote J. The diagnostic value of transillumination for maxillary sinusitis in children. Int J Pediatr Otorhinolaryn-gol 1989;18:9-11

24. Van Buchem F, Peeters M, Knottnerus J. Maxillary sinusitis in children. Clin Otolaryngol 1992;17:49-53

25. Wald E, Milmoe G, Bowen A, et al. Acute maxillary sinusitis in children. N Engl J Med 1981;304:749-754

26. Shapiro G, Furukawa C, Pierson W, et al. Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis. J Allergy Clin Immunol 1986;77:59-64

27. Gungor A, Corey J. Pediatric sinusitis: a literature review with emphasis on the role of allergy. Otolaryngol Head Neck Surg 1997;116:4-15

28. McAllister W, Herman T, Wippold F. Imaging of sinusitis in infants and children. In: Lusk R (ed). Pediatric Sinusitis. New York: Raven Press; 1992:15-42

29. Manning S. Pediatric sinusitis. Otolaryngol Clin North Am 1993;26:623-638

30. Van tier Veken P, Clement P, Buisseret T, et al. CT scan study of the incidence of sinus involvement and nasal anatomic variation in 196 children. Rhinology 1990;28:177-184

31. Diament M. Prevalence of incidental paranasal sinus opacification in pediatric patients. A CT study. J Comput Assist Tomogr 1987;11:426-431

32. Manning S. Paranasal sinus disease in children. Curr Opin Otolaryngol Head Neck Surg 1993;1:171-176

33. Zinreich S, Borders J, Eisele D, et al. The utility of magnetic resonance imaging in the diagnosis of intranasal meningoen-cephaloceles. Arch Otolaryngol Head Neck Surg 1992;118: 1253-1256

34. Duplechain J, Miller R. Pediatric sinusitis: diagnosis and treatment with endoscopic techniques. South Med J 1994;143: 7-13

35. Orobello P, Park R, Belcher R, et al. Microbiology of chronic sinusitis in children. Arch Otolaryngol Head Neck Surg 1991; 117:980-983

36. Lusk R, Polmar S, Muntz H. Endoscopic ethmoidectomy and maxillary antrostomy in immunodeficient patients. Arch Otolaryngol Head Neck Surg 1991;117:60-63

37. Shapiro G, Virant F, Furukawa C, et al. Immunologic defects in patients with refractory sinusitis. Pediatrics 1991;87: 311-316

38. Kurono Y, Fujiyoshi T, Mogi G. Secretory IgA and bacterial adherence to nasal mucosal cells. Ann Otol Rhinol Laryngol 1989;98:273-277

39. Ramsey B, Richardson M. Impact of sinusitis in cystic fibrosis. J Allergy Clin Immunol 1992;90:547-552

40. Drake-Lee A, Morgan D. Nasal polyps and sinusitis in children with cystic fibrosis. JLaryngol Otol 1989;103:753-755

41. Karja J, Nuutinen J. Immotile cilia syndrome in children. Int JPediatr Otorhinolaryngol 1983;5:275-279

42. Scheeren R, Keehnen R, Meijer C, et al. Defects in cellular immunity in chronic upper airway infections are associated with immunosuppressive retroviral p15E-like proteins. Arch Otolaryngol Head Neck Surg 1993;119:439-443

43. Koltai P. Effects of air pollution on the upper respiratory tract of children. Otolaryngol Head Neck Surg 1994;111:9-11

44. Clement P. Management of sinusitis in infants and young children. In: Schaefer S, ed. Rhinoloy and Sinus Disease: A Problem-Oriented Approach. St. Louis: CV Mosby; 1998:105-134

45. Hamilos D. Gastroesophageal reflux and sinusitis in asthma. Chin Chest Med 1995;16:683-697

46. Holinger L, Sanders A. Chronic cough in infants and children: an update. Laryngoscope 1991;101:596-605

47. Barbero G. Gastroesophageal reflux and upper airway disease: a commentary. Otolaryngol Clin North Am 1996;29:27-38

48. Parsons D. Chronic sinusitis: a medical or surgical disease? Otolaryngol Clin North Am 1996;29:1-9

49. Cook P, Nishioka G. Allergic rhinosinusitis in the pediatric population. Otolaryngol Clin North Am 1996;29:39-56

50. Furukawa C, Shapiro GG, Rachelefsky G. Children with sinusitis. Pediatrics 1983;71:133-134

51. Sharpe M, Furukawa C, Bierman C, et al. Allergic patients have more frequent sinus infections than nonallergic patients (abstract). J Allergy Clin Immunol 1992;751:332

52. Van der Veken P, Clement P, Buisseret T, et al. Age-related CT-scan study of the incidence of sinusitis in children. Am J Rhinol 1992;6:45-48

53. Iwens P, Clement P. Sinusitis in allergic patients. Rhinology 1994;32:65-67

54. Abdulrazzaq Y, Bener A, DeBuse P. Association of allergic symptoms in children with those in their parents. Allergy 1994;49:737-743

55. Williams P, Dolen W, Koepke J, et al. Comparison of skin testing and three in vitro assays for specific IgE in the clinical evaluation of immediate hypersensitivity. Ann Allergy 1992;68: 34-45

56. Polmar S. Sinusitis and immune deficiency. In: Lusk R, ed. Pediatric Sinusitis. New York: Raven Press; 1992:53-58

57. Sethi D, Leopold D. Diagnosis and management of chronic recurrent sinusitis and immunoglobulin deficiency. Curr Opin Otolaryngol Head Neck Surg 1995;3:21-25

58. Shwachman H, Kulczycki L, Mueller H, et al. Nasal polyposis in patients with cystic fibrosis. Pediatrics 1962;30:389-401

59. Brihaye P, Clement P, Dab I, et al. Pathological changes of the lateral nasal wall in patients with cystic fibrosis (mucoviscidosis). Pediatr Otorhinolaryngol 1994;28:141-147

60. Rosenfeld R. Sinusitis in children. In: Gates G, ed. Current therapy in otolaryngology head and neck surgery. 6th Ed. St. Louis: CV Mosby; 1998:354-358

61. Bjuggren G, Kraepelien S, Lind J, et al. Occult sinusitis in children. Acta Otolaryngol (Stockh) 1952;42:287-310

62. Lanza D, Kennedy D. Nose and sinus mucosal inflammation and infection, including medical therapy. Curr Opin Otolaryngol Head Neck Surg 1994;2:27-32

63. Brook I. Bacteriologic features of chronic sinusitis in children. JAMA 1981;246:967-969

64. Muntz H, Lusk R. Bacteriology of the ethmoid bullae in children with chronic sinusitis. Arch Otolaryngol Head Neck Surg 1991;117:179-181

65. Tinkelman D, Silk H. Clinical and bacteriologic features of chronic sinusitis in children. Am J Dis Child 1989;143:938-941

66. Lazar R, Youmis R, Gross C. Pediatric functional endonasal sinus surgery: review of 210 cases. Head Neck 1992;14:92-98

67. Haltom J, Cannon C. Functional endoscopic sinus surgery in children. J Miss State Med Soc 1993;34:1-6

68. Dunham M. New light on sinusitis. Contemp Pediatr 1994; 11:102-117

69. Wald E. Antimicrobial therapy of pediatric patients with sinusitis. J Allergy Clin Immunol 1992;90:469-973

70. Manning S. Surgical management of sinus disease in children. Ann Otol Rhinol Laryngol 1992 101(suppl 155):42-45

71. Pipkorn U, Proud D, Lichtenstein L, et al. Inhibition of mediator release in allergic rhinitis by pretreatment with topical glu-cocorticosteroids. N Engl J Med 1987;316:1506-1510

72. Ingels K, Meeuwsen F, Graamans K, et al. Influence of sympathetic and parasympathetic substances in clinical concentrations on human nasal ciliary beat. Rhinology 1992;30:149-160

73. Yaniv E, Oppenheim D, Fuchs C. Chronic rhinitis in children. Int J Pediatr Otorhinolaryngol 1992;23:51-57

74. Clement P, Van der Veken P, Iwens P, et al. X-ray, T-scan, MR-imaging. In: Mygind N, Nacleirio R, eds. Allergic and Nonallergic Rhinitis: Clinical Aspects. Copenhagen Munks-gaard; 1993:58-65

75. Vandenberg S, Heatley D. Efficacy of adenoidectomy in relieving symptom of chronic sinusitis in children. Arch Otolaryngol Head Neck Surg 1997;123:675-678

76. Takahashi H, Fujita A, Honjo I. Effect of adenoidectomy on otitis media with effusion, tubal function, and sinusitis. Am J Otolaryngol 1989;10:208-213

77. Rosenfeld R. Pilot study of outcomes in pediatric rhinosinusitis. Arch Otolaryngol Head Neck Surg 1995;121:729-736

78. Lusk R. Chronic sinusitis: surgical management. In: Bluestone C, Stool S, Kenna M, eds. Pediatric otolaryngololgy. 3rd Ed. Philadelphia: WB Saunders; 1996:859-865

79. Lee D, Rosenfeld R. Adenoid bacteriology and sinonasal symptoms in children. Otolaryngol Head Neck Surg 1997;116: 301-317

80. Muntz H, Lusk R. Nasal antral windows in children: a retrospective study. Laryngoscope 1990;100:643-646

81. Lund V. Fundamental considerations of the design and function of intranasal antrostomies. Rhinology 1985;23:231-236

82. Lund V. Inferior meatal antrostomy. Fundamental considerations of design and function. JLaryngol Otol 1988;15(suppl):1-18

83. Maes J, Clement P. The usefulness of irrigation of the maxillary sinus in children with maxillary sinusitis on the basis of the Water's X-ray. Rhinology 1987;25:259-264

84. Lusk R, Lazar R, Muntz H. The diagnosis and treatment of recurrent and chronic sinusitis in children. Pediatr Clin North Am 1989;36:1411-1485.

85. Younis R, Lazar R. Criteria for success in pediatric functional endonasal sinus surgery. Laryngoscope 1996;106:869-873

86. Manning S, Wasserman R, Silver R, et al. Results of endoscopic sinus surgery in pediatric patients with chronic sinusitis and asthma. Arch Otolaryngol Head Neck Surg 1994;120:1142-1145

87. Walner D, Falciglia M, Willging J, et al. The role of second-look nasal endnscopy after pediatric functional endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg 1998;124: 425-428.

88. Mitchell B, Pereira K, Younis R. et al. Pediatric functional endoscopic sinus surgery: is a second-look necessary? Laryngoscope 1997;107:1267-1269

89. Lund V, Neijens H, Clement P, et al. Symposium. The treatment of chronic sinusitis: a controversial issue. Int J Pediatr Otolaryngol 1995; 32(suppl):S21-S35

90. Lusk R, Muntz H. Endoscopic sinus surgery in children with chronic sinusitis: a pilot study. Laryngoscope 1990;100: 654-658

91. Hebert R, Bent J. Meta-analysis of outcomes of pediatric functional endoscopic sinus surgery. Laryngoscope 1998;108: 796-799

How To Bolster Your Immune System

How To Bolster Your Immune System

All Natural Immune Boosters Proven To Fight Infection, Disease And More. Discover A Natural, Safe Effective Way To Boost Your Immune System Using Ingredients From Your Kitchen Cupboard. The only common sense, no holds barred guide to hit the market today no gimmicks, no pills, just old fashioned common sense remedies to cure colds, influenza, viral infections and more.

Get My Free Audio Book


Post a comment