Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-13T04:44:59.516Z Has data issue: false hasContentIssue false
  • English
  • Français

Current concepts in the management of paediatric rhinosinusitis

Published online by Cambridge University Press:  29 June 2007

N. S. Jones
N. S. Jones*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Nottingham, UK.
*
Address for correspondence: N. S. Jones, Department of Otorhinolaryngology– Head and Neck Surgery, University Hospital, Nottingham NG7 2UH.
Get access Rights & Permissions [Opens in a new window]

Abstract

It is well recognized that adenoid hypertrophy and allergic rhinitis are common in children and that recurrent upper respiratory tract infections are a fact of life. The main causes of symptoms associated with rhinosinusitis in children are rhinorrhoea, nasal obstruction, mouth breathing, hyponasal speech and snoring. Most children grow out of adenoid hypertrophy and recurrent colds by the age of eight to 10 and this means that the main treatment strategy should therefore be conservative and not surgical. An explanation to anxious parents, simple non-invasive measures such as teaching nose-blowing, the use of saline sprays or a trial of allergen avoidance and age-appropriate topical nasal anti-inflammatory sprays should be tried before surgery is even contemplated. Because repeated infections are so common, antibiotics given for chronic nasal discharge often have only short-lived effects.

Rhinosinusitis in children is not a surgical disease and ‘watchful waiting’ is advised. Any treatment should first of all be safe, as even without any intervention the problem usually resolves with time. It is likely that growth and maturation of the immunological response to pathogens play a major role in resolution of the disease. There are few exceptions to this principle: nasal polyps (indicating possible cystic fibrosis), and periorbital cellulitis where an assessment of vision, parenteral antibiotics, and if there is concern about the possibility of a subperiosteal abscess, computerized tomography (CT) and drainage of any pus is indicated.

Keywords

ChildRhinitisSinusitisSurgeryendoscopicRadiology
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 113 , Issue 1 , January 1999 , pp. 1 - 9
Copyright
Copyright © JLO (1984) Limited 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aberg, N., Hesselmar, B., Aberg, B., Eriksson, B. (1995) Increase of asthma, allergic rhinitis and eczema in Swedish schoolchildren between 1979 and 1991. Clinical and Experimental Immunology 25(9): 815–819.Google ScholarPubMed
Astarita, C., Harris, R. I., de Fusco, R., Franzese, A., Biscardi, D., Mazzaoca, F. R. M., Altucci, P. (1988) An epidemiological study of atopy in children. Clinical Allergy 18: 341–350.CrossRefGoogle ScholarPubMed
Bahna, S. (1992) Factors determining development of allergy in infants. Allergy Proceedings 13: 21–26.CrossRefGoogle ScholarPubMed
Band, B. C., Mukherjee, A. L., Bang, F. B. (1967) Human nasal mucous flow rates. Johns Hopkins Medical Journal 121: 38–48.Google Scholar
Barbero, G. J. (1996) Gastroesophageal reflux and upper airway disease: a commentary. Otolaryngologic Clinics of North America 29: 27–38.CrossRefGoogle Scholar
Bolger, W. E., Butzin, C. A., Parsons, D. S. (1991) Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 101 (1 pt 1): 56–64.CrossRefGoogle ScholarPubMed
Breborowicz, A., Burchardt, B., Pieklik, H. (1995) Asthma, allergic rhinitis and atopic dermatitis in schoolchildren. Pneumonologia I Alergologia Polska 63(3–4): 157–161.Google ScholarPubMed
Bruijnzzeels, M. A., Foets, M., Van Der Wouden, J. C., Van Den Heuvel, W. J. A. (1998) Everyday symptoms in childhood: occurrence and general practitioner consultation rates. British Journal of General Practice 48: 880–884.Google Scholar
Burr, M., Butland, B. K., King, S., Vaughan-Williams, E. (1989) Changes in asthma prevalence: two surveys 15 years apart. Archives of Disease in Childhood 64: 1452–1456.CrossRefGoogle ScholarPubMed
Calhoun, K. H., Waggenspack, G. A., Simpson, C. B. (1991) Evaluation of the paranasal sinuses in symptomatic and asymptomatic populations. Otolaryngology-Head and Neck Surgery 104: 480–483.CrossRefGoogle ScholarPubMed
Carson, J. L., Calber, A. (1985) Acquired ciliary defects in nasal epithelium of children with acute viral upper respiratory infections. New England Journal of Medicine 312: 464–468.CrossRefGoogle ScholarPubMed
Chapel, H. M. for the Consensus Panel for the Diagnosis and Management of Primary Antibody Deficiencies (1994) Consensus on diagnosis and management of primary antibody deficiencies. British Medical Journal 308: 581–585.CrossRefGoogle ScholarPubMed
Cooke, L., Hadley, D. (1991) MRI of the paranasal sinuses: incidental abnormalities and their relationship to symptoms. Journal of Laryngology and Otology 105: 278–281.CrossRefGoogle ScholarPubMed
Dahl, R., Pedersen, B., Larsen, B. (1995) Intranasal levocabastine for the treatment of seasonal allergic rhinitis: A multicentre, double-blind, placebo-controlled trial. Rhinology 33: 121–125.Google ScholarPubMed
Davidson, T. M., Murphy, C., Mitchell, M., Smith, C., Light, M. (1995) Management of chronic sinusitis in cystic fibrosis. Laryngoscope 105: 354–358.CrossRefGoogle ScholarPubMed
Department of Health (1995) Health effects of exposures to mixtures of air pollutants. London, Advisory group on the medical aspects of air pollution episodes: fourth report.Google Scholar
Diament, M. J. (1992) The diagnosis of sinusitis in infants and children: X-ray, computed tomography and magnetic resonance imaging. Journal of Allergy and Clinical Immunology 90: 442–444.CrossRefGoogle ScholarPubMed
Diament, M. J., Senac, M. O., Gilsanz, V. (1987) Prevalence of incidental paranasal sinus opacification in pediatric patients: a CT study. Journal of Computerised Assisted Tomography 11: 426–431.CrossRefGoogle ScholarPubMed
Dohlman, A. W., Hemstreet, M. P., Odrezin, G. T., Bartolucci, A. A. (1993) Subacute sinusitis: are antimicrobials necessary? Journal of Allergy and Clinical Immunology 91: 1015–1023.Google ScholarPubMed
Dold, S., Wjst, M., von Mutius, E., Reitmeir, P., Stiepel, E. (1992) Genetic risk factors for asthma, allergic rhinitis and atopic dermatitis. Archives of Disease in Childhood 76: 1018–1022.CrossRefGoogle Scholar
Dotterud, L., Kvammen, B., Bolle, R., Falk, E. S. (1994) A survey of atopic diseases among school children in Sor-Varanger community. Acta Dermato-Venereologica (Oslo) 74: 124–128.CrossRefGoogle ScholarPubMed
Druce, H. M., Slavin, R. G. (1991) Sinusitis: a critical need for further study. Journal of Allergy and Clinical Immunology 88(4): 675–677.CrossRefGoogle ScholarPubMed
Durham, S. R. (1997) Mechanisms and treatment of alleric rhinitis. In Scott-Brown's Otolaryngology. (Mackay, I., Bull, T. R., eds.) Butterworth-Heinemann, Oxford, pp 4/6/1–4/6-16.Google Scholar
Eibl, M. M., Wedgewood, R. J. (1989) Intravenous immunoglobulin: a review. Immunological Reviews (Copenhagen) (Suppl): 1–42.Google ScholarPubMed
Evans, F. O., Sydnor, J. B., Moore, W. E. C. (1975) Sinusitis of the maxillary antrum. New England Journal of Medicine 293: 735–739.CrossRefGoogle ScholarPubMed
Fascenelli, F. W. (1969) Maxillary sinus abnormalities: Radiographic evidence in an asymptomatic population. Archives of Otolaryngology–Head and Neck Surgery 90: 98–101.CrossRefGoogle Scholar
Fireman, P. (1992) Diagnosis of sinusitis in children: Emphasis on the history and physical examination. Journal of Allergy and Clinical Immunology 90: 433–436.CrossRefGoogle ScholarPubMed
Garcia, D. P., Corbett, M. L., Eberly, S. M., Joyce, M. R., Le, H. T., Karibo, J. M., Pence, H. L., Nguyen, K. L. (1994) Radiographic imaging studies in pediatric chronic sinusitis. Journal of Allergy and Clinical Immunology 94: 523–530.CrossRefGoogle ScholarPubMed
Glasier, C. M., Mallory, G. B., Steele, R. W. (1989) Significance of opacification of the maxillary and ethmoid sinuses in infants. Journal of Pediatrics 114: 45–50.CrossRefGoogle ScholarPubMed
Gungor, A., Corey, J. P. (1997) Pediatric rhinosinusitis: a literature review with emphasis on the role of allergy. Otolaryngology–Head and Neck Surgery 116: 4–15.Google Scholar
Gwaltney, J. M., Phillis, C. D., Miller, R. D., Riker, D. K. (1994) Computed tomographic study of the common cold. New England Journal of Medicine 330: 25–30.CrossRefGoogle ScholarPubMed
Hattevig, G., Kjellman, N. -I.M. (1990) Development of atopic disease in relation to family history and cord blood IgE levels. Eleven-year follow-up in 1,654 children. Paediatric Allergy and Immunology 1: 14–20.Google Scholar
Havas, T. E., Motbey, J. A., Gullane, P. J. (1988) Prevalence of incidental abnormalities on computed tomographic scans of the paranasal sinuses. Archives of Otolaryngology–Head and Neck Surgery 114: 856–859.CrossRefGoogle ScholarPubMed
Hibbert, J. (1987) Tonsils and adenoids. In Scott-Brown's Paediatric Otolaryngology. (Evans, J. N. G., ed.) Vol 6, Butterworths, London pp 368–383.Google Scholar
Hibbert, J., Whitehouse, G. H. (1978) The assessment of adenoidal size by radiological means. Clinical Otolaryngology 3: 43–47.CrossRefGoogle ScholarPubMed
Holt, G. R. (1996) Effect of air pollution on the upper aerodigestive tract. Otolaryngology–Head and Neck Surgery 114: 201–204.CrossRefGoogle ScholarPubMed
Hopp, R., Cooperstock, M. (1997) Medical management of sinusitis in pediatric patients. Current Problems in Pediatrics 27(5): 178–186.CrossRefGoogle ScholarPubMed
Jensen, C., Von Sydow, C. (1987) Radiography and ultrasonography in paranasal sinusitis. Acta Radiologica (Copenhagen) 28: 31–34.CrossRefGoogle ScholarPubMed
Jones, N. S., Strobl, A., Holland, I. (1997) CT findings in 100 patients with rhinosinusitis and 100 controls. Clinical Otolaryngology 22: 47–51.CrossRefGoogle ScholarPubMed
Kaliner, M. A., Osguthorpe, J. D., Fireman, P., Anon, J., Georgitis, J., Davis, M. L., Naclerio, R., Kennedy, D. (1997) Sinusitis: Bench to bedside. Journal of Allergy and Clinical Immunology 99: S829–848.Google ScholarPubMed
Katcher, M. L. (1996) Cold, cough, and allergy medications: uses and abuses. Pediatric Reviews 17: 12.CrossRefGoogle Scholar
Kobayashi, T., Baba, S. (1992) Topical use of antibiotics for paranasal sinusitis. Rhinology 14(Suppl): 77–81.Google ScholarPubMed
Kovatch, A. L., Wald, E. R., Ledesma-Medina, J., Chiponis, D. M., Bedingfield, B. (1984) Maxillary sinus radiographs in children with non-respiratory complaints. Pediatrics 73: 306–308.CrossRefGoogle Scholar
Lazar, R. H., Younis, R. T. (1992) The current management of sinusitis in children. Clinical Pediatrics (Philadelphia) 31: 30.CrossRefGoogle ScholarPubMed
Lazar, R. H., Younis, R. T., Parvey, L. S. (1992) Comparison of plain radiographs, coronal CT, and intraoperative findings in children with chronic sinusitis. Otolaryngology–Head and Neck Surgery 107: 29–34.CrossRefGoogle ScholarPubMed
Lazar, R. H., Younis, R. T., Long, T. E. (1993) Functional endonasal sinus surgery in adults and children. Laryngoscope 103: 1–5.CrossRefGoogle ScholarPubMed
Lesserson, J. A., Kieserman, S. P., Finn, D. G. (1994) The radiographic incidence of chronic sinus disease in the pediatric population. Laryngoscope 104: 159–166.CrossRefGoogle ScholarPubMed
Lloyd, G. A. (1990) CT of the paranasal sinuses: study of a control series in relation to endoscopic sinus surgery. Journal of Laryngology and Otology 104(6): 477–481.CrossRefGoogle ScholarPubMed
Lusk, R. P., Lazar, R. H., Muntz, H. R. (1989) The diagnosis and treatment of recurrent and chronic sinusitis in children. Pediatric Clinics of North America 36: 1411–1421.CrossRefGoogle ScholarPubMed
Lusk, R. P., McAlister, B., el Fouley, A. (1996) Anatomic variation in paediatric chronic sinusitis. Otolaryngologic Clinics of North America 29(1): 75–91.CrossRefGoogle ScholarPubMed
Lusk, R. P., Muntz, H. R. (1990) Endoscopic sinus surgery in children with chronic sinusitis: a pilot study. Laryngoscope 100: 654–658.CrossRefGoogle ScholarPubMed
Lusk, R. P., Stankiewick, J. A. (1997) Pediatric rhinosinusitis. Otolarynology–Head and Neck Surgery 117(3): S53–S57.CrossRefGoogle ScholarPubMed
Mackay, I., Durham, S. (1997) The classification and diagnosis of rhinitis. Allergy and Allergic Disease. (Kay, A. B., ed.) Vol 2. Blackwell Science, Oxford, pp 1293–1299.Google Scholar
Mair, E. A., Bolger, W. E., Breisch, E. A. (1995) Sinus and facial growth after pediatric endoscopic sinus surgery. Archives of Otolaryngology–Head and Neck Surgery 121: 547–552.CrossRefGoogle ScholarPubMed
Majima, Y., Sakakura, Y., Matsubara, T. (1983) Mucociliary clearance in chronic sinusitis: related human nasal clearance and in vitro bullfrog palate clearance. Biorheology 20: 251–262.CrossRefGoogle ScholarPubMed
Mann, W., Jonas, I. (1981) Untersuchungen zur Spontanheilung der Sinusitis maxillaris. HNO (Berlin) 29: 92–94.Google Scholar
Manning, S., Biavati, M. J., Phillips, D. L. (1996) Correlation of clinical sinusitis signs and symptoms to imaging findings in pediatric patients. International Journal of Pediatric Otorhinolaryngology 37: 65–74.CrossRefGoogle ScholarPubMed
Maresh, M. M., Washburn, A. H. (1940) Paranasal sinuses from birth to late adolescence: clinical and roentographic evidence of infection. American Journal of Diseases of Children 60: 841–861.CrossRefGoogle Scholar
Maw, A. R., Jeans, W. D., Fernando, D. J. J. (1981) Interobserver variability in the clinical and radiological assessment of adenoid size and the correlation with adenoid volume. Clinical Otolaryngology 6: 317–322.CrossRefGoogle ScholarPubMed
McAlister, W. H., Lusk, R., Muntz, H. R. (1989) Comparison of plain radiographs and coronal CT scans in infants and children with recurrent sinusitis. American Journal of Roentgenology 153: 1259–1264.CrossRefGoogle ScholarPubMed
Moloney, J. R., Badham, N. J., McRae, A. (1987) The acute orbit. Journal of Laryngology and Otology (Suppl 12): 1–18.CrossRefGoogle ScholarPubMed
Muntz, H. R., Lusk, R. P. (1991) Bacteriology of the ethmoid bullae in children with chronic sinusitis. Archives of Otolaryngology–Head and Neck Surgery 117: 179–181.CrossRefGoogle ScholarPubMed
Newton, D. A. (1996) Sinusitis in children and adolescents. Primary Care: Clinics in Office Practice 23(4): 701–717.CrossRefGoogle ScholarPubMed
Ninan, T., Russell, G. (1992) Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart. British Medical Journal 304: 873–875.CrossRefGoogle ScholarPubMed
Okuma, M. (1994) Prevalence rate of allergic diseases among school children in Okinawa. Arerugi-Japanese Journal of Allergology 43(3): 492–500.Google ScholarPubMed
Orobello, P. W., Park, R. I. (1991) Microbiology of chronic sinusitis in children. Archives of Otolaryngology-Head and Neck Surgery 117: 980–983.CrossRefGoogle ScholarPubMed
Otten, F. W. A., Aarem, A. V., Grote, J. J. (1992) Long-term follow-up of chronic therapy resistant purulent rhinosinusitis. Clinical Otolaryngology 17: 32–33.CrossRefGoogle Scholar
Otten, F. W. A., Grote, J. J. (1988) Treatment of chronic maxillary sinusitis in children. International Journal of Pediatric Otorhinolarynology 15: 269–278.CrossRefGoogle ScholarPubMed
Otten, F. W. A., van Aarem, A., Groote, J. J. (1991) Longterm follow-up of chronic maxillary sinusitis in children. International Pediatric Otorhinolaryngology 22: 81–84.CrossRefGoogle ScholarPubMed
Parsons, D. S., Phillips, S. E. (1993) Functional endoscopic surgery in children. Laryngoscope 103: 899–903.CrossRefGoogle ScholarPubMed
Royal College of Radiologists Working Party (1995) Making the Best Use of a Department of Clinical Radiology: Guidelines for Doctors. Royal College of Radiologists, London, pp 1–96.Google Scholar
Polmar, S. H. (1992) The role of the immunologist in sinus disease. Journal of Allergy and Clinical Immunology 90(3): 511–515.CrossRefGoogle ScholarPubMed
Poole, M. D. (1992) Pediatric sinusitis is not a surgical disease. ENT Journal 71(12): 622–623.Google Scholar
Rachelefsky, C. S., Goldberg, M., Katz, R. M. (1978) Sinus disease in children with respiratory allergy. Journal of Allergy and Clinical Immunology 61: 310–314.CrossRefGoogle ScholarPubMed
Ramsey, B. W., Dorkin, H. L., Eisenberg, J. D. (1993) Efficacy of aerosolized Tobramycin in patients with cystic fibrosis. New England Journal of Medicine 328: 1740–1746.CrossRefGoogle ScholarPubMed
Rosenfield, R. M. (1995) Pilot study of outcomes in pediatric rhinosinusitis. Archives of Otolaryngology–Head and Neck Surgery 121: 729–736.CrossRefGoogle Scholar
Seigel, J. D. (1987) Diagnosis and management of acute sinusitis in children. Pediatric Infectious Disease Journal 6: 95–99.CrossRefGoogle Scholar
Shapiro, G. G., Furukawa, C. T., Pierson, W. E. (1986) Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis. Journal of Allergy and Clinical Immunology 77: 59–65.CrossRefGoogle ScholarPubMed
Shapiro, G. G., Rachelefsky, G. S. (1992) Introduction and definition of sinusitis. Journal of Allergy and Clinical Immunology 90: 417–418.CrossRefGoogle ScholarPubMed
Shapiro, G. G., Virant, F. S., Furukawa, C. T., Person, W. E., Bierman, W. (1991) Immunological defects in patients with refractory sinusitis. Pediatrics 87(3): 311–316.CrossRefGoogle ScholarPubMed
Shopfiner, C. E., Rossi, J. O. (1973) Roentogen evaluation of the paranasal sinuses in a child. American Journal of Roentgenology 118: 176–186.CrossRefGoogle Scholar
Sibbald, B., Rink, E. (1991) Epidemiology of seasonal and perennial rhinitis: clinical presentation and medical history. Thorax 46: 895–901.CrossRefGoogle ScholarPubMed
Silverman, F. N. (1985) The face and individual cranial structures. Caffey's Pediatric X-Ray Diagnosis. 8th Edition, F. N. Ed. Silverman, Chicago, pp 97–98.Google Scholar
Van Arsdel, P., Motulsky, A. (1959) Frequency and hereditability of asthma and allergic rhinitis in college students. Acta Geneticae Medicae et Gemellologicae (Roma) 9: 101–114.Google ScholarPubMed
van Buchem, F. L., Peeters, M. F., Knottnerus, J. A. (1992) Maxillary sinusitis in children. Clinical Otolaryngology 17: 49–53.CrossRefGoogle ScholarPubMed
Van Der Veken, P. J., Clement, P. A. R., Buisseret, T., Desprechins, B., Kaufman, L., Derde, M. P. (1992) Age related CT scan study of the incidence of sinusitis in children. American Journal of Rhinology 6(2): 45–48.CrossRefGoogle Scholar
Viner, A. S., Jackman, N. (1976) Retrospective survey of 1,271 patients diagnosed as perennial rhinitis. Clinical Allergy 6: 251–259.CrossRefGoogle Scholar
Wald, E. R. (1992a) Sinusitis in children. New England Journal of Medicine 326(5): 319–323.Google ScholarPubMed
Wald, E. R. (1992b) Antimicrobial therapy of pediatric patients with sinusitis. Journal of Allergy and Clinical Immunology 90: 469–473.CrossRefGoogle ScholarPubMed
Wald, E. R. (1992c) Microbiology of acute and chronic sinusitis in children. Journal of Allergy and Clinical Immunology 90: 452–460.CrossRefGoogle ScholarPubMed
Wald, E. R. (1993) Radiographic sinusitis: illusion or delusion? Pediatric Infectious Disease Journal 12: 792–793.Google ScholarPubMed
Wald, E. R. (1995) Chronic sinusitis in children. Journal of Pediatrics 127(3): 339–347.CrossRefGoogle ScholarPubMed
Wald, E. R., Dashefsky, B., Guerra, N., Byers, C. (1988) Frequency and severity of infections in day care. Journal of Pediatrics 112: 540–546.CrossRefGoogle ScholarPubMed
Wald, E. R., Guerra, N., Byers, C. (1991a) Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics 87: 129–133.CrossRefGoogle ScholarPubMed
Wald, E. R., Guerra, N., Byers, C. (1991b) Frequency and severity of infections in day care: three-year follow-up. Journal of Pediatrics 118: 509–514.CrossRefGoogle ScholarPubMed
Wald, E. R., Milmoe, G. J., Bowen, A. (1981) Acute maxillary sinusitis in children. New England Journal of Medicine 304: 749–754.CrossRefGoogle ScholarPubMed
Weiland, S., Mundt, K., Ruckmann, A., Keil, U. (1994) Self reported wheezing and allergic rhinitis in children and traffic density on street of residence. Annals of Epidemiology 4: 243–247.CrossRefGoogle ScholarPubMed
Willner, A., Choi, S. S., Vezina, L. G., Lazar, R. H. (1997) Intranasal anatomic variations in pediatric sinusitis. American Journal of Rhinology 11(5): 355–360.CrossRefGoogle ScholarPubMed
Willner, A., Lazar, R. H., Younis, R. T., Beckford, N. S. (1994) Sinusitis in children: current management. Ear Nose Throat Journal 73: 485–491.CrossRefGoogle ScholarPubMed
Wolf, G., Greistorfer, K., Jebeles, J. A. (1995) The endoscopic endonasal surgical technique in the treatment of chronic recurring sinusitis in children. Rhinology 33: 97–103.Google ScholarPubMed
Woodstock, A., Custovic, A. (1998) Avoiding exposure to indoor allergens. British Medical Journal 316: 1075–1078.CrossRefGoogle Scholar
Wright, A., Holberg, C., Martinez, F. D., Halonen, M., Morgan, W., Taussig, L. M. (1994) Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics 94(6): 895–901.CrossRefGoogle ScholarPubMed
Younis, R. T., Lazar, R. H. (1990) The approach to acute and chronic sinusitis in children. Ear, Nose and Throat Journal 70(1): 35–39.Google Scholar
Zieger, R. S. (1992) Prospects for ancillary treatment of sinusitis in the 1990s. Journal of Allergy and Clinical Immunology 90: 478–495.CrossRefGoogle Scholar