Acute Rhinosinusitis In Children Research Articles

Experience of using a combination of herbal preparations in the treatment of acute rhinosinusitis in children

Experience of using a combination of herbal preparations in the treatment of acute rhinosinusitis in children

Acute rhinosinusitis in children requiring hospitalization between 2016 and 2022 - retrospective analysis

Bevezetés: A rhinosinusitis az orr- és orrmelléküregek nyálkahártyájának váladékképződéssel és ödémás duzzanattal járó gyulladása. Az akut bakteriális rhinosinusitis főként szövődményes eseteiben gyakran szükséges fekvőbeteg-intézménybe való felvétel. Célkitűzés: A Szegedi Tudományegyetem Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinikájának fekvőbetegosztályára 2016 és 2022 között akut rhinosinusitis miatt felvett gyermekek anyagának retrospektív elemzése, illetve annak megállapítása, hogy a COVID–19-járvány befolyással volt-e a felvételt igénylő esetek arányára. Módszer: Demográfiai és klinikai adatok gyűjtése, az eredmények összehasonlítása hazai és nemzetközi irodalmi adatokkal. Eredmények: 497 gyermekből 471 beteg kezelése kizárólag ambulánsan történt. 26 gyermek, 17 fiú és 9 lány került felvételre (1 fő 2 alkalommal). Az átlagéletkor 7,65 év volt. A felvételek 52%-a a három téli hónapban, az összes felvétel 89%-a a novembertől áprilisig terjedő időszakban történt. 19 esetben akut ethmoiditis, 5 esetben akut sinusitis maxillaris, 2 esetben akut pansinusitis, 1 alkalommal akut sphenoiditis volt a felvételi diagnózis. A felvétel oka 19 gyermeknél a következményes szemhéjödéma, 7 esetben az alkalmazott terápia melletti progresszió volt, 1 betegnél intracranialis szövődmény igazolódott. Az átlagos hospitalizáció 4,2 nap volt. 16 esetben amoxicillin-klavulánsav, 11 esetben cefuroxim parenteralis adása történt. 9 esetben (8 orbitalis, 1 intracranialis szövődmény) elkerülhetetlen volt a műtét. Minden betegnél funkcionális endoszkópos beavatkozás történt. 2 alkalommal, orbitatályog miatt, külső megnyitásra is szükség volt, az intracranialis szövődménynél idegsebészeti műtét is történt. Megbeszélés: A vizsgált paraméterek korrelálnak az irodalmi adatokkal, a COVID–19-járványnak tulajdonítható esetszámváltozást nem tapasztaltunk. Következtetés: Az akut rhinosinusitis konzervatív terápiával általában gyógyítható, de előfordulhatnak súlyos, életet veszélyeztető szövődmények. Bár a kórházi felvételt igénylő esetek száma csökkent, a szövődmények aránya nem változott, ezért nagyon fontos azok gyors felismerése és hatékony kezelés. Orv Hetil. 2024; 165(19): 747–753.

Problems of polypragmasia and drug interaction in the treatment of uncomplicated acute rhinosinusitis

This publication discusses polypragmasia and drug interactions in the treatment of uncomplicated acute rhinosinusitis in children and adults. Treatment of rhinosinusitis on an outpatient basis in multimorbid patients may be accompanied by multiple prescriptions, which increases the risk of drug interactions. The article reflects the most significant inappropriate combinations of both medicines and biologically active additives, herbal preparations. The advantages of using drugs with proven effectiveness, in particular intranasal glucocorticosteroids, are considered.

Intranasal corticosteroids reduced acute rhinosinusitis in children with allergic rhinitis: A nested case–control study

BackgroundChildren with allergic rhinitis (AR) have substantially more acute rhinosinusitis than children without AR. We evaluated whether intranasal corticosteroids (INCS), second-generation antihistamines (SGH), and/or intranasal antihistamines (INH) for AR affect acute rhinosinusitis in children with AR aged 2–18 years. MethodsBy using the National Health Research Institutes Database 2005 of Taiwan, a cohort of patients with AR aged 2–18 years treated with AR medications between 2002 and 2018 was made, within which a nested case–control study was performed. Risk settings for acute rhinosinusitis cases matched controls for age, sex, and comorbidities. Current users of INCS, INH, and/or SGH were compared with remote and recent users of any AR medications and current users of INCS with and without SGH were compared with current users of SGH. ResultsCurrent users of SGH and/or INCS had a higher risk of acute rhinosinusitis than remote users of AR drugs, and current users of SGH had a higher risk of acute rhinosinusitis than recent users; however, no difference in the risk of acute rhinosinusitis was found between current users of INCS and recent users of AR drugs. Current users of INCS with and without SGH had a lower risk of acute rhinosinusitis than current users of SGH alone. ConclusionsTreatment of INCS with and without SGH diminished the risk of acute rhinosinusitis compared with treatment using SGH alone. Adequate INCS treatment for patients with AR is important to reduce the incidence of acute rhinosinusitis.

Issues of systemic and topical antibiotic therapy of acute rhinosinusitis in a child

This article discusses the use of antibacterial therapy in the treatment of acute rhinosinusitis in children. The main problems causing the need for maximum rationalization of the use of systemic antibiotics in the treatment of respiratory pathology are listed. Indications for systemic and topical antibacterial therapy for acute rhinosinusitis in children indicated in Russian clinical guidelines were noted. The possibilities of using the combined drug thiamphenicol and N-acetylcysteine in the treatment of acute rhinosinusitis in children are considered separately. As an example, a model of the clinical situation at the outpatient stage of treatment, in which the use of inhalation therapy is advisable, is given. It is concluded that inhalation therapy with a combination drug of thiamphenicol and N-acetylcysteine in the treatment of acute rhinosinusitis is a reasonable choice in case the doctor doubts the need for systemic antibacterial therapy. Taking into account the high frequency of such situations in the practice of a pediatrician and a pediatric otorhinolaryngologist, the decision in favor of topical antibacterial therapy carries significantly less costs compared to the decision to prescribe systemic antibacterial therapy. But an obligatory element of the therapeutic tactics of acute rhinosinusitis with the use of topical antibacterial drugs should be monitoring the dynamics of the patient's condition during 3-4 days of therapy. In the absence of positive changes, the doctor is obliged to reconsider the need for systemic antibacterial therapy.

Interdisciplinary care in orbital complications of acute rhinosinusitis in children.

Orbital cellulitis is a serious condition with potentially severe complications. Treatment requires interdisciplinary care and early introduction of antimicrobial therapy. In our tertiary center, a team of pediatricians, pediatric ophthalmologists, and otorhinolaryngologists successfully participated in the management of pediatric periorbital/orbital cellulitis. This study aimed to demonstrate our interdisciplinary approach and to investigate clinical profile and management of pediatric periorbital/orbital cellulitis. A retrospective chart review was performed of all pediatric patients hospitalized for periorbital and orbital cellulitis in a tertiary hospital center from September 15, 2016, to March 15, 2020. A total of 26 children-median age 2.7 years (range 0.5-12)-were treated during the study period. Disease presentation was unilateral, mainly during winter (n = 12) and autumn (n = 12), without ophthalmoplegia/proptosis. Seven patients had orbital cellulitis (Chandler classification of ≥III) and were older (6.5 years, P = 0.011) with sinusitis (P < 0.001), required surgery (P = 0.004), underwent longer antimicrobial treatment (13 days, P < 0.001), and had a longer length of hospital stay (13.43 days, P = 0.001). Orbital cellulitis occurred in a median of three days (range 1-12) of acute rhinosinusitis. Radiological survey was performed in 11 patients, whereas six patients were treated surgically. All intraoperatively collected cultures (sinus swabs) were positive, whereas Streptococcus pyogenes and Peptostreptococcus were isolated in five cases. All patients fully recovered. No recurrence was documented. Sinusitis is associated with severe orbital cellulitis and surgical management. Orbital cellulitis occurred early in the course of acute rhinosinusitis, as a distinctive presentation of rhinosinusitis. Interdisciplinary care and early management are crucial in treatment of pediatric periorbital/orbital cellulitis.

Clinical Markers of Need for Surgery in Orbital Complication of Acute Rhinosinusitis in Children: Overview and Systematic Review.

Background: Although they can occur at all ages, orbital (OC) and periorbital cellulitis (POC) prevail in the pediatric population. Acute rhinosinusitis (ARS) is the most frequent predisposing factor of OC. Recent literature has suggested a medical management approach for OC and POC, with surgery reserved only for more severe cases. However, there is still a lack of consensus on the clinical markers of a need for surgery. The aim of this systematic review was to identify clinical markers of a need for surgery in children with OC. Our systematic review, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process, yielded 1289 articles finally screened. This resulted in 31 full texts that were included in a qualitative analysis. The results of this review suggest that in children aged over 9 years, large subperiosteal orbital abscesses (SPOAs), impaired vision, ophthalmoplegia, proptosis, elevated C-reactive protein (CRP) and absolute neutrophil counts (ANC), hemodynamic compromise, no clinical improvement after 48/72 h of antibiotic therapy, and a Chandler III score or higher are clinical markers of the need for surgery. However, most of the studies are observational and retrospective, and further studies are needed to identify reliable and repeatable clinical markers of the need for surgery.

Acute Rhinosinusitis in Children with Inhalant Allergies.

Rhinosinusitis is an essential medical problem in pediatric populations. Due to a lack of studies considering allergy impact on pediatric rhinosinusitis, it seems legitimate to investigate this subject. The aim of this paper was to assess the influence of inhalant allergy on acute rhinosinusitis in children. The study involved 100 pediatric patients aged between 3 and 17 years who were admitted to the Chair and Department of Pediatric Otolaryngology, Phoniatrics and Audiology of the Medical University of Lublin due to acute rhinosinusitis. The control group consisted of 50 children without allergy, and the study group consisted of 50 children suffering from inhalant allergy. The methodology employed in this study involved medical history and laryngological examination, as well as laboratory and radiological testing. Dust mite allergy was the most common allergy among patients in the study group. Patients with allergies presented at the hospital later than patients without allergy, and their hospitalization lasted longer due to more severe sinus disease, higher inflammatory parameters, multiple sinus involvement, more frequent fever or rhinosinusitis complications, especially orbital occurrence. Most children in the control group required only pharmacological treatment. Inhalant allergy, especially dust mite allergy, contributes to more severe acute rhinosinusitis in children.

Local antibiotic therapy options for treating acute rhinosinusitis in children

The article presents various types of acute rhinosinusitis progression in pediatric practice depending on the duration of the disease, based on the available modern consensus papers and clinical guidelines. The main clinical terminology of the nosological forms of rhinosinusitis was determined, and aspects of their differential diagnosis and stages of the treatment were studied. The authors provided insight into disease pathogenesis, taking into account literature review data on the spectrum of the most common bacterial agents of the nose and paranasal sinuses pathologies. The available data on the treatment of rhinosinusitis are summarized from the perspective of consensus papers and modern clinical guidelines of the Ministry of Health of the Russian Federation, the use of which for the prescription of treatment is the most important quality criterion for medical care provided. A clinical case of the treatment of acute bacterial uncomplicated rhinosinusitis in a 12-year-old child is described. In this case, an aerosolized form of topical antibiotic therapy combined with a mucolytic component was used as a drug of choice alongside with the standard irrigation-elimination therapy and nasal decongestants, which gives an advantage in achieving the maximum effective concentration of the active substance at the site of inflammation. A drug with a mucoactive effect helps to decrease mucus viscosity and discharge, and at the same time facilitates the entry of an active substance into the tissues and inhibits bacterial adhesion to the epithelium of the respiratory tract. Antibacterial component – thiamphenicol, a derivative of chloramphenicol with a mechanism of action associated with inhibition of bacterial protein synthesis has a broad spectrum of action and a maximum degree of accumulation and action in the site of inflammation due to the method of delivery to the epithelium of the respiratory tract.

New opportunities of halotherapy in the prevention and medical rehabilitation of children

The article is devoted to new possibilities of using halotherapy in the prevention, treatment and medical rehabilitation of children. In recent years, active work has been carried out to develop new effective methods of reproducing the aerodispersed medium in the form of haloingalation therapy or by group method — in the conditions of a halochamber. The therapeutic effect of halotherapy is determined by the biophysical properties of a dry highly dispersed aerosol of sodium chloride. The paper presents the biophysical properties of the main active factor of halotherapy, i.e. a dry highly dispersed aerosol of sodium chloride, and reveals some aspects of the formation of the mechanism of therapeutic action. The anti-inflammatory, draining, mucolytic, immunomodulatory, sanogenetic effect of haloaerosol is shown. In pediatric practice, haloaerosol therapy is used for medical rehabilitation of children with respiratory diseases (bronchial asthma, bronchitis), ENT pathology (rhinosinusitis, tonsillitis, pharyngitis), skin diseases. Halotherapy is the method of choice in the prevention of acute respiratory diseases and improving the health of children in general education institutions. The high efficiency of the complex application of halotherapy in various diseases in children has been established. A promising direction for the development of halotherapy is the development of combined exposure technologies. The high efficiency of the use of haloingalation therapy in combination with magnetic therapy in the treatment of acute rhinosinusitis in children has been proven. Based on the conducted studies, a favorable effect of the use of halotherapy and flutter therapy on clinical and functional parameters in children with bronchial asthma was revealed. The data on the possibility of combined use of halotherapy with a pulsed low-frequency electrostatic field in the medical rehabilitation of children suffering from bronchial asthma are presented. Simplicity, safety, the possibility of personalization of exposure and good tolerability by children expands the possibilities for using halotherapy in pediatric practice.

Topical antibiotics for acute rhinosinusitis in children

The authors presented an overview of the existing data on inhalation therapy with antibacterial drugs in acute rhinosinusitis and exacerbation of chronic rhinosinusitis in children. The overview includes general information about the etiology and features of the course of acute rhinosinusitis. It also contains indications for systemic and topical antibiotic therapy in acute rhinosinusitis specified in the Russian clinical guidelines. The advantages of using a combination preparation of thiampheni-col and N-acetylcysteine by inhalation therapy for acute rhinosinusitis in children and adults are considered separately. A clinical case of a 15-year-old female patient with complaints of persistent rhinitis over the past 4-5 years is discussed. Historical information: a patient had a runny nose over the last 4-5 years: persistent, viscous nasal discharge with moderate nasal congestion. Nasal symptoms worsened with episodes of acute respiratory illness, and nasal discharge became mucopurulent. The child was preliminarily diagnosed with chronic rhinosinusitis (incomplete remission), moderate course. To reduce the severity of the symptoms of the disease, which were present at the time of examination, the following were recommended: daily one-to-two irrigation of the nasal cavity with slightly hypertonic (1.5-3%) solutions of sea water, followed by a toilet of the nasal cavity; in case of episodes of colds with the appearance of mucopurulent secretions, inhalation therapy in a pulsating mode of the inhaler with a solution of thiamphenicol and N-acetylcysteine at a dose of 500 mg once a day (in the first half of the day) for the next 10 days and further; the use of a nasal spray of mometasone furoate, 200 mcg per day during inhalation therapy for another 3 weeks. At the follow-up examination after 10 days of treatment, the patient reported a significant decrease in the severity of nasal symptoms, which coincided with an improvement in the rhinoscopic status. It can be concluded that the use of topical antibacterial drugs by inhalation therapy for acute rhinosinusitis, despite all its advantages, is not an equivalent substitute for systemic antibiotic therapy in the treatment of severe and especially complicated forms of the disease. The inhalation therapy is recommended in the presence of indications for systemic antibiotic therapy, since it is an auxiliary method of treatment, the action of which is aimed at enhancing the effect of systemic antibiotics.

Functional endoscopic sinus surgery (FESS) with navigation system in childhood – our experience. Presentation of clinical cases

Introduction: Functional endoscopic sinus surgery (FESS) is the gold minimally invasive standard in diagnosing and surgically treating many diseases of the nose and paranasal cavities. An advantage of FESS is the possibility of application in all age groups. Materials and methods: We observed pediatric patients attended the Otorhinolaryngology Clinic in the University Hospital “Dr. Georgi Stranski” – Pleven in 2021. FESS surgery was performed in the “Integrated interdisciplinary operating unit with navigation and telesurgery systems” at the Center of competence on personalised medicine, 3D and telemedicine, robotic and minimally invasive surgery „Leonardo da Vinci” in Medical University – Pleven. Clinical cases: Case 1: A 7-year-old male patient with orbital complication of rhinosinusitis, with left orbital preseptal cellulitis, without ophthalmoplegia or loss of vision, + ptosis of the eyelid and data on pansinuitis from CT images. Performed FESS found lysis of lamina papyracea with involvement of anterior and posterior ethmoidal cells. Postoperative treatment was done with Ceftriaxone 1g/12h i.v. for 7 days, nasal glucocorticoids and antihistamines. Case 2: A 17-year-old female patient with suggested primary ciliary dyskinesia with a recurrent rhinosinusitis, persistent nasal obstruction, and thick viscous secretions that did not respond to conservative treatment. Sweat test for cystic fibrosis (-). FESS reshaping of the natural openings of the maxillary sinuses and anterior ethmoidectomy were performed bilaterally. Conclusion: FESS is a minimally invasive method, which is suitable for application in pediatric patients. When applied by trained professionals, FESS with an integrated navigation system is optimal for the diagnosis and surgical treatment of chronic and acute rhinosinusitis in children.

Management of post-septal complications of acute rhinosinusitis in children: A 14-year experience in a tertiary hospital

IntroductionAcute rhinosinusitis accounts for most of the cases of orbital infections and is the most common cause of periorbital oedema in children. Up to 10% of patients with orbital complications of acute rhinosinusitis may experience vision loss and other complications such as meningitis, intracranial abscess or even death. Therefore, these patients require prompt diagnosis and proper treatment. ObjectivesThis study aims to report the clinical presentation and management of post-septal orbital complications of acute rhinosinusitis in the paediatric population. Materials and methodsA retrospective medical chart review of all children aged under 18 years old who were diagnosed with post-septal orbital complications of acute rhinosinusitis at a tertiary academic hospital, between 01/2007 and 12/2020. Patients were grouped according to the Chandler Classification (groups 2–5). ResultsFifty-five children (mean age of 6.91 ± 4.61 years) fulfilled the entry criteria for post-septal orbital complications of acute rhinosinusitis, based on clinical evaluation by an otorhinolaryngologist and CT-scan findings. Forty (72.72%) patients were also evaluated by an ophthalmologist. Most patients were male (76.36%). Twenty-four patients had post-septal cellulitis (43.63%), 21 patients had a subperiosteal abscess (38.18%) and 10 patients had an orbital abscess (18.18%). Eyelid swelling was the most frequent sign, followed by fever. Microbiology varied considerably and gram-positive agents were clearly predominant. Eighteen (32.73%) patients had been treated with oral antibiotics prior to hospital admission, exhibiting a significantly higher risk of recurrence of orbital infection (p = 0.020). Ethmoid and maxillary sinuses were the most involved paranasal sinuses (90.91%). Thirty-three patients (60%) were successfully treated medically, and 22 patients (40%) required surgical drainage. Seven patients (12.73%) developed further complications and six recovered without sequelae. The mean length of hospital stay was 8.0 ± 5.0 days and recurrence of orbital infection occurred in six patients (10.91%). The absolute neutrophil blood count was significantly different amongst Chandler groups (p = 0.021), with higher counts in patients with subperiosteal abscess. The duration of hospitalization was significantly higher in patients submitted to surgery (p < 0.001). ConclusionPost-septal orbital complications of acute rhinosinusitis are infrequent but dangerous events in the paediatric population. Close collaboration with Ophtalmology is paramount, as the child's vision is at risk. Eyelid swelling and proptosis are early signs. CT-scan imaging plays an invaluable role in the diagnosis and decision-making. Predictive indicators for surgery were not found. However, emergency endoscopic nasal surgery with abscess drainage should be considered whenever vision is at risk, if there is no improvement after aggressive medical treatment, and in cases of intracranial complications.

Терапия нарушенного носового дыхания при острых риносинуситах у детей с гиперплазией лимфоглоточного кольца

Актуальность. Основным местом скопления и роста возбудителей в детском возрасте является лимфоидная ткань носоглотки. Часто развитие риносинусита начинается с аденоидита. Наиболее уязвимыми в этой ситуации оказываются дети дошкольного возраста с гиперплазией лимфоглоточного кольца. В этой группе отмечается рекуррентное течение заболеваний верхних отделов респираторного тракта. Цель исследования: оптимизация программы терапии острых риносинуситов у детей с гиперплазией лимфоглоточного кольца. Материалы и методы. Под наблюдением находилось 100 пациентов в возрасте от 2 до 6 лет, случайно распределенных в 2 группы по 50 детей в каждой. Режим применения 0,05% раствора ксилометазолина: по одному впрыскиванию в каждый носовой ход два раза в сутки. Натрия хлорид 0,9% применялся в виде носового душа у детей первой группы два раза в сутки перед использованием ксилометазолина. Клинический метод состоял из оценки данных анамнеза, клинической картины, общеклинических методов исследования. Брался мазок для цитоморфологического анализа слизистой оболочки носа; проводилось окрашивание препаратов разведенным раствором Гимзы с последующей микроскопией, количественное определение секреторного IgA (sIgA) в слюне методом иммуноферментного анализа. Результаты обрабатывались посредством критерия Манна — Уитни, критерия Фишера. Результаты. Применение 0,05% ксилометазолина в сочетании с носовым душем NaCl 0,9% оказывало статистически значимое регенерирующее и санирующее действие на слизистую оболочку носа. Использование ксилометазолина с предварительным носовым душем натрия хлоридом 0,9% в отличие от применения ксилометазолина без подготовки полости носа не сопровождается снижением уровня sIgA в слюне, а приводит к его некоторому повышению. Заключение. Использование 0,05% раствора ксилометазолина с предварительным носовым душем раствором натрия хлорида 0,9% в программе терапии острых риносинуситов у детей с гиперплазией лимфоглоточного кольца имеет существенные преимущества перед применением ксилометазолина без предварительной подготовки полости носа.

Метод ирригационно-элиминационной терапии гипертоническими солевыми растворами при лечении риносинуситов у детей

В работе рассмотрен метод местной терапии острого риносинусита у детей, механизмы его действия, эффективность и безопасность. Представлены данные о показаниях к применению и характеристиках препарата. Показаны преимущества гипертонических солевых растворов морской воды.

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A Swedish population-based study of complications due to acute rhinosinusitis in children 5–18 years old

BackgroundThere are few population-based studies of complications due to acute rhinosinusitis in children. The aim was to clarify the admission and complication rate and analyze bacterial cultures in children five to 18 years old in Stockholm, Sweden. MethodsThis was a population-based observational cohort study with retrospectively collected data from individual medical records, from 1 July 2003 to 30 June 2016 in Stockholm, Sweden. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed. ResultsIncidence of admission due to acute rhinosinusitis was 7.8 per 100 000 children per year (boys 9.2, girls 6.2) and 61% of the admitted children were boys. A severe – postseptal orbital, intracranial or osseous – complication, was present in 34% of admissions (postseptal orbital 28%, intracranial 6%, osseous 4%), resulting in an incidence of 2.6 severe complications per 100 000 children per year (boys 3.6, girls 1.6). Orbital preseptal cellulitis was present in 88% of admissions. Incidence of surgery was 1.3 per 100 000 per year (boys 1.8, girls 0.8) and the percentage of admitted children that had surgery increased with age. S. pyogenes was the most common pathogen found in the whole cohort (29 admissions), while S. milleri was the most common pathogen found among the children with severe complication and surgery. ConclusionsThere is a relative high risk of severe complications in children between five to 18 years that are admitted due to acute rhinosinusitis. There is a need for prospective studies to further analyze the pathogens involved in complications due to acute rhinosinusitis.

Outcome of Orbital Complications of Acute Rhinosinusitis in Children

Background: Acute bacterial rhinosinusitis occurs commonly as a sequel to a viral upper respiratory tract infection. Spread of infection outside the sinuses to the surrounding brain and orbit results in complicated sinusitis. Complications are more common in children than adults due to anatomical and immunological factors. Objective: To identify the correlation of orbital manifestations with computed tomography (CT) scan findings in diagnosing and classifying the disease, the efficacy of various treatment modalities and the outcome of these complications in children. Methods: A prospective study of 16 patients who presented with orbital swelling and features of acute rhinosinusitis was conducted in the Otorhinolaryngology Department at Al-Imamein Al-Kadhimein Medical City from April 2014 to October 2015. A full history, ear, nose and throat (ENT) examination including naso-endoscopic examination (if possible), ophthalmological assessment and CT scan of nose and paranasal sinuses were done. Patients were classified to have either pre-or postseptal infection depending on CT findings. All patients were admitted to the ENT ward, received intravenous broad-spectrum antibiotics and supportive measures and kept under close observation with monitoring of ophthalmological manifestations and vital signs. Some patients responded to medical treatment and others required surgical intervention. All patients after recovery were discharged home on oral antibiotics for 2 weeks and followed up monthly for a total duration of 3 months. Results: The majority of patients were males (62.5%). Mean ages of patients was 8.9±2.9 years with a range (4 to 15) year. Preseptal cellulitis was more common (62.5% vs. 37.5%). Impaired visual acuity, impaired extraocular movement and proptosis were significantly associated with postseptal infections as the P values were 0.01, 0.003 and 0.003 respectively. Preseptal cellulitis responded well to medical treatment. Postseptal abscesses required surgical drainage using an external, endoscopic or combined approach. 94% of patients had complete recovery without any sequel. Conclusion: Orbital manifestations are strongly correlated with CT findings. Medical treatment is very effective for preseptal infection. The choice of surgical approach for managing postseptal infection will depend upon, the site and extension of the abscess and the state of the nasal cavity. Early and accurate management can reduce morbidity and mortality. Keywords: Orbital complications of sinusitis, pediatric rhinosinusitis, ethmoiditis Citation: Al-Hassani JMK. outcome of orbital complications of acute rhinosinusitis in children. Iraqi JMS. 2021; 19(1): 90-98. doi: 10.22578/IJMS.19.1.12

Topical antibiotics for acute rhinosinusitis in children

Rhinitis or nasopharyngitis are the most common manifestations of acute respiratory viral infection (ARVI) in children. Inflammation of the mucous membrane in the nasal cavity develops in more than 70% of ARVI cases, and rhinovirus infection is the most common etiological factor for these conditions. In this article, the authors present a short review of the existing data on the use of combined drugs based on N-acetylcysteine and tuamingheptan in the treatment of acute rhinological pathology in children. The authors present generalized data on the nature of the course of acute rhinitis, as the main manifestation of acute respiratory viral infection in children, and modern views on the tactics of treating this condition. The main theses on symptomatic treatment of nasal obstruction in acute rhinitis using nasal decongestants are presented. However, the use of nasal vasoconstrictor drugs as monotherapy to treat acute rhinitis may be less effective, as a buildup of thick discharge in the nasal cavity, which a patient is not always able to blow out from the nose (especially in childhood), prevents the drug injected into the nasal cavity from contacting the mucous membrane. The main pathogenetic grounds for the use of mucolytics in the treatment of acute rhinitis and acute rhinosinusitis are presented. The use of N-acetylcysteine-based drugs in otorhinolaryngological practice has been substantiated. N-acetylcysteine is a direct mucolytic agent. Its action is associated with the ability of its free sulfhydryl groups to break intra- and intermolecular disulfide bonds of acidic mucopolysaccharides of a thick discharge. As conclusions, the authors talk about the prospect of using combined drugs based on N-acetylcysteine and tuamingheptan both in the symptomatic treatment of acute rhinitis and as an adjunct treatment for acute rhinosinusitis in children.

The use of decongestants for the treatment of runny nose symptom in children: the clinical and pharmaceutical analysis of the pharmaceutical market of Ukraine

The rational treatment of acute rhinosinusitis of infectious or allergic origin is an urgent task of both therapeutic and pediatric practice. This problem is of particular importance in connection with its prevalence in children, with a large list of drugs for the symptomatic treatment, the presence of significant side effects in active pharmaceutical ingredients, the peculiarities of the use of dosage forms, as well as a wide range of OTC drugs, including those approved for use in children.Aim. To develop recommendations for introducing changes or additions to the peculiarities of using decongestants for topical use in diseases of the nasal cavity (sympathomimetics, corticosteroids, antihistamines, etc.) in children (under 15 years of age) in the Protocol of the Pharmacist “Symptomatic treatment of rhinitis”.Materials and methods. To achieve the goal, the clinical and pharmaceutical analysis of decongestants for local use in diseases of the nasal cavity (sympathomimetics, corticosteroids, antihistamines, etc.), registered and marketed inUkraine was performed.Results. As a result of the study it has been found that in February 2020 there are 146 decongestants for local use in diseases of the nasal cavity registered at the Ukrainian market. 87.7 % of the drugs are OTC and can be used by patients/patient representatives independently. 12.3 % of the drugs (18 items, mainly from the group of corticosteroids) are dispensed by prescription. The analysis of the composition of decongestants has been performed; it has been found that agents based on oxymetazoline (21.2 %) and xylometazoline and its combinations (39 %) prevail. When studying the prescribing information it has been found that 136 of 146 trade names can be used in the case of a cold in children under the age of15. In addition, depending on the age, the ranking of their active pharmaceutical ingredients (APIs) can be presented by the following sequence: sodium chloride (0.65 %), phenylephrine hydrochloride (0.125 %), oxymetazoline hydrochloride (0.01 %). Clinical and pharmacological evaluation of undesirable effects of APIs and the ways of their prevention have been performed.Conclusions. The range and presence of undesirable effects of APIs of modern decongestants requires a cautious approach to responsible self-medication and a careful selection of the drug for the symptomatic treatment of acute rhinosinusitis in children. It is recommended to clarify the Protocol of the Pharmacist “Symptomatic treatment of rhinitis” on the possibility of using decongestants for topical use in diseases of the nasal cavity in children of different ages.