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From clinical practice to guidelines: how to recognize rhinosinusitis in children
S Esposito1, S Bosis, M Bellasio
1Institute of Pediatrics, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy. Susanna.Esposito@unimi.it
Insights
Acute bacterial rhinosinusitis in children is diagnosed by persistent purulent drainage for at least 10 days. Antibiotics are recommended for specific symptom combinations, guiding pediatricians in diagnosis and treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Rhinosinusitis is a frequent childhood respiratory illness, with 5-13% of viral infections complicated by bacterial sinusitis.
- Accurate diagnosis is crucial for appropriate management and preventing complications.
Purpose of the Study:
- To provide guidelines for diagnosing acute bacterial rhinosinusitis in children.
- To clarify the role of imaging in diagnosis and management.
Main Methods:
- Clinical diagnosis based on duration and characteristics of nasal/post-nasal drainage.
- Assessment of associated symptoms like fever and localized sinus inflammation signs.
- Guidelines for the judicious use of imaging studies.
Main Results:
- Diagnosis is supported by purulent drainage lasting ≥10 days, or shorter duration with fever and localized signs in ill-appearing children.
- Imaging is generally not required for clinical diagnosis but useful for complex or recurrent cases.
- Computed tomography is the preferred imaging modality when indicated.
Conclusions:
- Clinical criteria are sufficient for diagnosing most cases of acute bacterial rhinosinusitis in children.
- Imaging should be reserved for diagnostic uncertainty, suspected complications, or chronic/recurrent rhinosinusitis.
- These guidelines aid pediatricians in managing this common condition effectively.
Abstract:
Rhinosinusitis is a common childhood respiratory infection. Children have approximately six to eight viral infections of the upper respiratory tract each year, 5-13% of which may be complicated by a secondary bacterial infection of the paranasal sinuses. The diagnosis of acute bacterial rhinosinusitis in children is established by the persistence of purulent nasal or post-nasal draining lasting at least 10 days, especially if accompanied by supporting symptoms and signs, at which point antibiotic treatment has to be recommended. Appropriate antibacterial therapy should also be recommended if the draining has been present for less time, but is concomitantly associated with significant fever and localized signs of sinus inflammation in a child who appears ill. Imaging studies are not necessary to confirm the diagnosis of clinical rhinosinusitis for the purposes of treatment, but should be reserved for cases in which the diagnosis is in doubt or a complication is suspected, and for patients with recurrent or chronic rhinosinusitis. Under these circumstances, computed tomography is the preferred evaluation. Together with their clinical judgment, these suggestions may be useful for pediatricians in diagnosing this common condition.
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