Medical management of pediatric chronic rhinosinusitis

Pediatric chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease with multifactorial etiology. CRS is less prevalent in children than in adults, but it substantially affects the patient's quality of life with significant diagnostic and therapeutic challenges.

This review gives an overview of the pathophysiology, diagnostic approach, and current medical treatment strategies for pediatric CRS.

As a first-line medical treatment, standard management includes intranasal corticosteroids and saline irrigation. Short-course antibiotics or systemic corticosteroids are prescribed only when clearly indicated and limited to selected cases. Target therapies as monoclonal antibodies, are considered salvage options for children who do not respond adequately to standard medical or surgical treatments. Dupilumab and tezepelumab are currently the only biologics approved for adolescents with CRS, while other monoclonal antibodies are still under consideration in pediatric CRS. Regulatory approvals are largely based on results extrapolated from adults or from clinical studies conducted in other respiratory diseases. Data on the efficacy and safety of novel therapies are still limited, because pediatric-specific randomized clinical trials are limited. Future studies should focus on the early identification of comorbidities, the development of personalized treatment strategies, and improved safety.