Paediatric issues in sinus surgery

Abstract

Rhinorrhoea, snoring, mouth breathing, nasal obstruction and hyponasal speech are very common symptoms in childhood. Children with these symptoms should not be labelled as having either having ‘rhinitis’ or ‘sinusitis’ but rhinosinusitis, as the nasal mucosa is a continuous lining which runs between the nasal passages and the paranasal sinuses in continuity, and one is rarely affected without the other. This is illustrated by Gwaltney’s findings that 95 per cent of subjects with a history of a recent viral upper respiratory tract infection, with no preceding problems, had changes in their sinuses on computed tomography (CT)1 (Fig. 16.1). One fundamental problem is the lack ofagreement about the definition of ‘sinusitis’ in children, as it is neither a clinical or a pathological distinct entity, and it is likely that factors which cause prolonged nasal secretion and/or mucosal hypertrophy are very pertinent to their management. Wald said in 1995, ‘The primacy of infection as the pathophysiologic explanation for continued inflammation of the paranasal sinuses is quite unlikely’, and that remains the case today.2