Management of Pediatric Chronic Rhinosinusitis

Abstract

Chronic pediatric rhinosinusitis is a common entity, with an annual incidence of 4% in the US schoolchildren’s population. The predominant contributing factor in younger children is adenoid pathology and in older children, allergic rhinitis. Recent research on sinus microbiome, biofilm, inflammatory response, and therapeutic alternatives is providing new insights in this prevalent disease. Adenoid size does not correlate with the severity of the disease suggesting that it is due to the biofilms observed in both adenoiditis and hypertrophic adenoids. There is new consensus among the experts on the definition and clinical diagnosis of pediatric chronic rhinosinusitis (PCRS). In PCRS, inflammation is mediated by helper T lymphocyte type 2 with limited glandular hyperplasia or fibrosis observed histologically. Both innate and adaptive immunity contribute to the heterogeneous inflammatory pathogenesis of PCRS that is driven by genetic, environmental, and microbiome factors. Medical treatment includes nasal hygiene, anti-inflammatory, and antibiotic therapy. When medical treatment fails, adenoidectomy is the surgical treatment of choice in children less than 6 years old, adenoidectomy plus possible endoscopic endonasal surgery (EES) between ages 6 and 12, and EES for children 12 and older. Balloon sinuplasty has been reported to be effective between 70 and 80% in older children. This review focuses on the most recent PCRS consensus statements, novel research in histopathology and microbiome, and the evolving medical and surgical therapeutic options for this challenging disease.