Leczenie zapalenia zatok przynosowych u dzieci

Abstract

Acute rhinosinusitis (ARS) is most often viral in aetiology and self-limited. Antibiotic therapy seems to accelerate resolution of ARS in children but whether an acceleration of improvement of the antimicrobial symptoms with antibiotics in these children is worth the increased risk of resistance remains to be determined. Intranasal steroids might have a beneficial ancillary role in the treatment of ARS. There is really no good evidence to support the use of ancillary therapies decongestants (oral or intranasal), antihistamines, and nasal irrigation in the treatment of ARS in children. Therefore available data does not justify the use of short-term oral antibiotics, intravenous antibiotics alone for the treatment of chronic rhinosinusitis (CRS) in children. There might a place for longer-term antibiotics for the treatment of CRS in children. Nasal corticosteroid treatment is a first line treatment in CRS with and without nasal polyps in children. We reserve the use of antihistamines and leukotriene modifiers for children with documented allergic rhinitis. The most supported surgical approach to the child with CRS who has failed maximal medical therapy probably consists of an initial attempt at an adenoidectomy with a maxillary sinus wash plus/minus balloon dilation followed by FESS in case of recurrence of symptoms. An exception to this statement are children with cystic fibrosis, nasal polyposis, antrochoanal polyposis, or AFS where FESS to decrease disease burden is the initial favoured surgical option.