Challenges and opportunities in the treatment of chronic rhinosinusitis in children

Abstract

Paediatric chronic rhinosinusitis (PCRS) is a common disease in children. It is defined as continuing inflammation of the nasal cavity and sinuses for ≥12 weeks. Because of the compound aetiology and pathophysiology of this disease in children, it is extremely important for the physician to consider the differential diagnosis before planning treatment. The aim of the review was to present the guidelines from The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) and promising treatment options of CRS in the paediatric population. The authors of the guidelines proposed a new division of chronic sinusitis (CRS). Chronic sinusitis has a greater impact on deteriorating the quality of life of patients than acute sinusitis. CRS is a syndrome with a multifactorial aetiology, resulting from an abnormal interaction between particular environmental factors and the host's immune system. The mucosa is chronically penetrated by the inflammatory process, which in many cases leads to tissue remodelling and clinical symptoms. EPOS 2020 recommendations are based on the use of proper nasal hygiene, sinus saline irrigations and topical corticosteroids. Surgical intervention is considered for patients with CRS who have failed appropriate medical therapy. However, there are new promising therapies on the horizon. The EPOS 2020 guidelines signaled the impact of immunomodulation on the development of the disease. In addition to the standard therapy recommended by EPOS 2020, new therapeutic options, such as low-dose macrolide (LDM) therapy and biological treatment, that may have a potential impact on improving CRS treatment in children, should be investigated.