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Diagnosis and management of acute rhinosinusitis in children
Gualtiero Leo1, Francesca Mori, Cristoforo Incorvaia
1Pediatric Allergy and Respiratory Pathophysiology Unit, Vittore Buzzi Children's Hospital, Istituti Clinici di Perfezionamento, Via Castelvetro 32, 20154 Milan, Italy. gualtiero.leo@icp.mi.it
Insights
Acute rhinosinusitis in children often presents with common symptoms like nasal blockage and facial pain. Early diagnosis and appropriate treatment, including antibiotics for bacterial cases and topical corticosteroids, are crucial for effective management.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
Background:
- Rhinosinusitis is a prevalent pediatric condition frequently underestimated.
- Key symptoms include nasal congestion, discharge, facial pain, headache, and altered smell.
Purpose of the Study:
- To outline diagnostic and management strategies for acute rhinosinusitis in children.
- To emphasize appropriate antibiotic use and the role of other treatments.
Main Methods:
- Clinical symptom assessment.
- Diagnostic utility of nasal fibroendoscopy.
- Imaging recommendations, favoring CT over plain X-rays for complex cases.
Main Results:
- CT scans are preferred for diagnosing complications or persistent pediatric rhinosinusitis.
- Antibiotics are indicated for severe or persistent acute bacterial rhinosinusitis.
- Topical corticosteroids can alleviate nasal edema and improve sinus drainage.
Conclusions:
- Accurate diagnosis and judicious use of antibiotics are vital for pediatric rhinosinusitis.
- Nasal fibroendoscopy and CT imaging aid diagnosis.
- Topical corticosteroids offer a beneficial adjunct treatment.
Abstract:
Rhinosinusitis is a common disease in children that is often overlooked. The clinical symptoms of acute rhinosinusitis are nasal blockage or congestion, nasal discharge or postnasal drip (often mucopurulent), facial pain, headache, and reduction in/loss of smell. Direct vision by nasal fibroendoscopy may aid the diagnosis. Regarding imaging criteria, recent consensus documents state that plain sinus x-rays are of limited utility, and CT remains the technique of choice, particularly in children with complications or very persistent or recurrent infections that are unresponsive to medical management. Antibiotics are the primary form of medical treatment for acute bacterial rhinosinusitis, but they should be used when acute bacterial rhinosinusitis presents as persistent or severe disease. This will minimize the number of children with uncomplicated viral upper respiratory tract infections who are treated with antimicrobials. Topical corticosteroids may reduce nasal edema and improve ostial drainage and ventilation of the sinus.
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