Chronic Rhinosinusitis In Children Research Articles

Pädiatrische Rhinologie.

The following review article highlights key topics in pediatric rhinology that are currently the focus in research and at conferences as well as in the interdisciplinary discussion between otorhinolaryngologists and pediatricians. In particular, congenital malformations such as choanal atresia or nasal dermoid cysts are discussed, followed by statements on the current procedures for sinogenic orbital complications as well as on the diagnosis and therapy of chronic rhinosinusitis in children. Furthermore, updates on the role of the ENT specialist in the care for children with cystic fibrosis and primary ciliary dyskinesia are provided.

Comorbidities of chronic rhinosinusitis in children and adults.

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and paranasal sinuses lasting ≥12weeks. CRS may exist with (CRSwNP) or without (CRSsNP) nasal polyps. The aim was to evaluate conditions associated with CRS in a randomized hospital cohort. We hypothesized that comorbidities and surgical procedures differ between pediatric and adult patients. This study consisted of hospital registry data of a random sample of rhinosinusitis patients (age range 0-89years) with the diagnosis of J32 or J33, correspondingly, registered during outpatient visits from 2005 to 2019 (n=1461). The covariates of interest were collected from electronic health records based on ICD-10 codes and keyword searches. Among pediatric patients (n=104), the relative proportions of CRSsNP and CRSwNP were 86% and 14% respectively. The relative proportions of adult patients (n=1357) with CRSsNP and CRSwNP were 60% and 40%, respectively. The following comorbidities significantly differed (p<0.05) between pediatric and adult populations: allergy, chronic otitis media, and tonsillar diseases. In total, 41 % of the children and 46% of the adults underwent baseline endoscopic sinus surgery (ESS). Additional surgeries of the ear, nose and pharynx were significantly more common among children compared with adults. Risk of revision after baseline ESS was associated (p<0.05) with allergy, asthma, eosinophilia, CRSwNP, immunodeficiency or its suspicion, non-steroidal anti-inflammatory drug exacerbated respiratory disease, and number of any diseases ≥2. Our study showed that comorbidities differ between pediatric and adult rhinosinusitis patients, as allergy, asthma and allergy, chronic otitis media, mental health disorders, and tonsils disease were significantly more prevalent among pediatric patients. Children and adults were equally treated with ESS. Notably, children underwent additional surgery on adenoids and tonsils more frequently. The effectiveness of ESS in multimorbid adults should be assessed at an individual level.

Efficacy of triple targeted therapy against chronic rhinosinusitis in children with cystic fibrosis (case series)

Introduction. Chronic rhinosinusitis (CRS) with underlying cystic fibrosis (CF) is one of the most challenging inflammatory diseases of the paranasal sinuses (PNS). The treatment of CF in general and CF-associated CRS in particular keeps developing exponentially: special drug delivery systems have been invented, drugs purpose-developed for the treatment of patients with CF (dornase alfa) are used, and radicality of surgical intervention is increasing. In recent years, CF innovative targeted therapy has been introduced. It aims to improve the course of the bronchopulmonary infectious and inflammatory process, nutritional status and pancreatic function, but its efficacy in relation to the PNS condition is still insufficiently studied.Aim. To evaluate the efficacy of ivacaftor/elexacaftor/tezacaftor therapy for CF sinonasal manifestations in children and to determine possible parallels of the CRS course vs other characteristics of the CF course.Materials and methods. A total of 15 children with CF receiving triple targeted therapy were included in the first series of observations. Computed tomography (CT) scans were assessed using the Lund-Mackay scores (LMS) before and 7.6 ± 3.0 months after starting the therapy. In addition, the changes in sweat chloride levels and pulmonary function test results were taken into account. The control group included 11 patients with comparable initial radiographic data who did not receive such therapy.Results and discussion. The treatment group showed a significant improvement in the PNS condition in the form of a decrease in the LMS scores from 15.6 ± 4.5 to 2.1 ± 3.0 (p = 0.001) with inhomogeneous changes vs different PNS groups. A certain parallelism between changes in the CT view and the level of sweat chlorides and pulmonary function test results was reported. In the control group, a nonsignificant deterioration in the course of CRS was observed (from 12.3 ± 6.3 to 14.6 ± 4.9 scores according to LMS; p = 0.108).Conclusions. The study demonstrated high efficacy of CF triple targeted therapy with ivacaftor/elexacaftor/tezacaftor in relation to the severe CRS with a rapid onset of effect in the form of PNS pneumatization restoration according to CT findings.

111 Long-term effects of lumacaftor-ivacaftor on chronic rhinosinusitis in children with cystic fibrosis detected with MRI

111 Long-term effects of lumacaftor-ivacaftor on chronic rhinosinusitis in children with cystic fibrosis detected with MRI

Longitudinal Magnetic Resonance Imaging Detects Onset and Progression of Chronic Rhinosinusitis from Infancy to School Age in Cystic Fibrosis.

Rationale: Chronic rhinosinusitis (CRS) contributes to morbidity in patients with cystic fibrosis (CF). However, longitudinal data on CRS onset and progression is lacking. Objectives: To longitudinally evaluate CRS in CF from infancy to school age with paranasal sinus magnetic resonance imaging (MRI). Methods: A total of 64 children with CF (mean age at baseline, 1.1 ± 1.6 yr; range, 0-5 yr) underwent a mean of 5.8 ± 2.2 (range, 3-11 yr) subsequent annual MRI examinations. Additional 24 children (9.2 ± 4.4 yr; range, 3-17 yr) homozygous for the F508del mutation underwent MRI before and at least 2 months after starting lumacaftor/ivacaftor. MRI was assessed using the previously evaluated CRS-MRI score. Results: In infancy, 65-87% of paranasal sinuses were opacified, and mucosal swelling was the dominant abnormality (58-97%). At preschool age (1-5 yr), 79-94% of sinuses were opacified (P < 0.05 vs. infancy), and mucosal swelling was the most dominant abnormality (79-94%; P < 0.05). At school age (at least 6 yr), almost all sinuses were opacified (71-99%; P < 0.001-0.357 vs. preschool age), and mucopyoceles were the dominant abnormality in maxillary and frontal sinuses (53-56%; P < 0.05-0.808). The CRS-MRI sum score increased from 22.4 ± 9.6 in infancy to 34.2 ± 9.6 in preschool age (P < 0.001) and was 34.0 ± 5.7 in school age (P = 0.052). In children under lumacaftor/ivacaftor therapy, the CRS-MRI sum score (-0.5 ± 3.3; P < 0.05) and maxillary sinus subscore (-0.5 ± 1.5; P < 0.05) improved. Conclusions: Longitudinal paranasal sinus MRI detects an early onset and progression of the severity of CRS from infancy to school age, and response to lumacaftor/ivacaftor therapy in children with CF. Our data support its role in the comprehensive noninvasive monitoring of CRS in children with CF. Clinical trial registered with www.clinicaltrials.gov (NCT02270476).

Changes in Pre- and Post-adenoidectomy Bacterial Profile in Children With Chronic Rhinosinusitis.

We aimed to investigate the difference between the bacterial profiles of the nasal cavities and adenoid surfaces of children with chronic rhinosinusitis (CRS). We also intended to determine and analyze the potential correlation between the pre- and post-adenoidectomy differences in the nasal bacterial profile and clinical prognosis. The clinical information of pediatric patients was collected. All the children underwent adenoidectomy (with or without tonsillectomy), and swab samples were collected during the operation. Visual analog scales (VAS) were used at 3, 6, and 12months postoperatively. At the 12-month follow-up examination, swab samples were collected again. PCR amplification was performed of the v3-v4 variable regions of 16S rRNA of the collected specimens, as well as high-throughput sequencing using the Illumina platform. The species information was obtained by OTUs clustering, species annotation, and α-diversity analysis. Twenty-two male and eight female pediatric patients were included in the investigation The most abundant genus level bacterial representatives on the nasal surface before adenoidectomy were Moraxella catarrh, Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus, whereas on the surface of adenoids, they were Streptococcus pneumonia, Haemophilus influenza, Nucleobacter, and Moraxella catarrhalis. One year postoperatively, the bacteria with the highest abundance on the nasal surface at the genus level were Moraxella catarrhalis, Streptococcus pneumonia, Staphylococcus aureus, and non-culturable Dolosigranulum. One year postoperatively, the bacterial richness in the nasal cavity was significantly higher than at baseline (P < .05). Furthermore, the subjective nasal score of all children significantly decreased at 3, 6, and 12months postoperatively (P < .01). The preoperative bacterial abundance of the nasal cavity and the adenoid surfaces was similar, showing a clear correlation. No single specific bacterium was established to be a dominant species associated with the development of CRS in children. The post-adenoidectomy bacterial richness in the nasal cavity was significantly increased, which may be closely related to the relief of postoperative sinusitis symptoms.

Medical Therapies for Adult Chronic Sinusitis: A Systematic Review

Chronic sinusitis is an inflammatory disease of the paranasal sinuses that usually manifests as chronic sinonasal symptoms.. Since the pathophysiology of chronic rhinosinusitis in children and adults varies significantly, as do the medical and surgical treatments, this review exclusively discusses adult chronic rhinosinusitis and explores the medical therapies used to treat chronic sinusitis in adult patients. A systematic review was performed involving studies of medical therapies used to treat chronic sinusitis in adult patients between 2016 and 2022. The PubMed and Google scholar databases were used to explore studies regarding our subject. The keywords included &amp;quot;Medical therapy, treatment, chronic, sinusitis, rhinosinusitis, and adult&amp;quot; and were used in various combinations. Original research reporting medical therapies used in treating chronic sinusitis in adult patients and full-text publications served as the inclusion criterion. Though 166 articles were obtained, only eight met the inclusion criteria. The studies included 2884 participants; all the studies were clinical trials. The review found Dupilumab to be well-tolerated and provided rapid, significant, and clinically meaningful improvements for patients with chronic sinusitis and nasal polyposis (CRSwNP). In addition, it produced rapid and sustained improvement in the sense of smell, alleviating a cardinal symptom of severe CRSwNP. Furthermore, Dupilumab improved upper and lower airway outcome measures and health-related quality of life in patients with severe CRSwNP and comorbid asthma. Another therapy was Omalizumab, which produced positive outcomes on all endpoints in participants who switched from placebo to Omalizumab through week 52. In addition, endoscopic sinus surgery, combined with medical therapy, it was found to be more efficacious than medical therapy alone in patients with CRSwNP.

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.

Challenges and opportunities in the treatment of chronic rhinosinusitis in children

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.

Эфирные масла лекарственных растений в коррекции микробиоценоза верхних дыхательных путей у детей с риносинуситом

In this review, we analyzed the results of our studies aimed to provide a rationale for the use of ‘Dyshi’ oil for the treatment of rhinosinusitis in children. Literature data suggests high incidence of rhinosinusitis and, importantly, its frequent transition into chronic disease. The microbiota of the upper respiratory tract (URT) mucosa in healthy individuals and rhinosinusitis patients has been extensively investigated. Dysbiosis of the URT is known to have a crucial role in the pathogenesis of rhinosinusitis. It was found that opportunistic microorganisms inhabiting the URT have a number of biological properties that allow them to persist on the mucosa for a long time in case of dysbiosis. Particular attention should be paid to their abilities to form biofilms and to inactivate lysozyme, which hinders effective antimicrobial therapy of rhinosinusitis and triggers the development of chronic rhinosinusitis. This necessitates the search for alternative treatments, for example essential oils of medicinal plants. We found that ‘Dyshi’ oil can decrease the persistence potential of etiologically significant opportunistic microorganisms by inhibiting biofilm formation and suppressing lysozyme-inactivating activity at the population level. Our findings contribute to a better understanding of the mechanisms underlying antimicrobial activity of essential oils and demonstrate the efficacy of ‘Dyshi’ oil for the treatment and prevention of acute and chronic rhinosinusitis in children. Key words: essential oils, microbiota of the upper respiratory tract, rhinosinusitis, treatment, children.

Chronic rhinosinusitis in children

Chronic rhinosinusitis in children

Chronic rhinosinusitis and endoscopic sinus surgery in children admitted for pulmonary exacerbations of cystic fibrosis

ObjectiveNon-surgical management of chronic rhinosinusitis (CRS) in children with cystic fibrosis (CF) has been increasing over the last decade. This study examines inpatient children with pulmonary exacerbation of CF who were also diagnosed with CRS and underwent endoscopic sinus surgery (ESS). Study designWe used the 2003 to 2016 Kids Inpatient Database to perform a cross-sectional analysis of inpatients (ages 0–21 years) diagnosed with CF and CRS in the United States from 2003 to 2016. Demographics and CF-associated comorbidities were recorded and rates of CRS and ESS in children with CF were examined. Results49,110 children were included in the study. A total of 9334 (19%) were diagnosed with CRS. The average age was 13 (SD 5.9) years; the majority were female (56%), and White (67%). The prevalence of CRS increased from 2003 to 2016 (14%–23%, p < 0.001) while the rate of ESS decreased (20%–11%, p < .001). Patients with CRS that underwent ESS more commonly had CF-associated comorbidities including GI manifestations (15%–25%, p < .001) and liver disease (15%–30%, p < .001). ConclusionThe diagnosis of CRS in children with CF hospitalized for pulmonary exacerbation has increased while ESS has decreased in the last decade. Patients with CRS that underwent ESS more commonly had CF-associated comorbidities. Studies to determine whether children with CF-associated comorbidities are more likely to benefit from ESS are needed.

Clinical Evidence and Biomarkers Linking Allergy and Acute or Chronic Rhinosinusitis in Children: a Systematic Review.

Purpose of the ReviewWe provide a systematic review of experimental and clinical evidences linking allergy to acute, including common cold, and chronic rhinosinusitis in children. Furthermore, we questioned if anti-allergy treatment may prevent the occurrence of rhinosinusitis or improve outcomes of its specific management.Recent FindingsAllergic rhinitis is a common childhood disease in industrialized countries that is responsible for a major impact on quality of life and healthcare resources. Over the years many authors tried to correlate allergy with comorbidities and in particular to the onset of rhinosinusitis including common cold, even though conflicting results are frequently reached. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process. Our search yielded 7103 that were finally screened. This resulted in 25 publications of which the full texts were assessed and included in a qualitative analysis per different phenotypes of rhinosinusitis.SummaryThe evidence suggests that allergy may lead to overall impairment of mechanical and immunological defense function of the nasal mucosa against viruses and that anti-allergy treatment may significantly decrease the number and severity of upper respiratory tract infections including common colds in children. It was not possible to perform the analysis for allergy and post-viral acute rhinosinusitis, bacterial acute rhinosinusitis, and recurrent acute rhinosinusitis because of paucity and heterogeneity of data. Although there is no definitive proof of causation linking allergy to chronic rhinosinusitis, studies lead to suppose that anti-allergy treatment may improve outcomes of specific CRS treatments.

Chronic Rhinosinusitis in Pediatric Immunodeficiency

Chronic rhinosinusitis and other sinopulmonary infections can be a hallmark of impaired immunity in children. Rhinosinusitis in the setting of immunodeficiency can often be chronic and refractory, and involve opportunistic pathogens. We review the evaluation and management of pediatric chronic rhinosinusitis in the context of primary immunodeficiency diseases. Immunodeficiencies found to be associated with chronic rhinosinusitis include common variable immune deficiency, X-linked agammaglobulinemia, antibody deficiencies, hyper-IgM syndrome, hyper-IgE syndrome, Wiskott–Aldrich syndrome, activated PI3K disease, DiGeorge syndrome, and chronic granulomatous disease. Chronic rhinosinusitis in children may be a clinical manifestation of immunodeficiency. The evaluation and diagnosis of immunodeficiencies are essential for initiating appropriate therapeutic strategies, including antibiotics, prophylaxis, topical therapy, surgery, and immunoglobulin replacement.

Adenoidal Disease and Chronic Rhinosinusitis in Children-Is there a Link?

Adenoid hypertrophy (AH) is an extremely common condition in the pediatric and adolescent populations that can lead to various medical conditions, including acute rhinosusitis, with a percentage of these progressing to chronic rhinosinusitis (CRS). The relationship between AH and pediatric CRS has been extensively studied over the past few years and clinical consensus on the treatment has now been reached, allowing this treatment to become the preferred clinical practice. The purpose of this study is to review existing literature and data on the relationship between AH and CRS and the options for treatment. A systematic literature review was performed using a search line for “(Adenoiditis or Adenoid Hypertrophy) and Sinusitis and (Pediatric or Children)”. At the end of the evaluation, 36 complete texts were analyzed, 17 of which were considered eligible for the final study, dating from 1997 to 2018. The total population of children assessed in the various studies was of 2371. The studies were categorized as surgical-observational, microbiological, genetic-immunological, and radiological. The analysis of the studies confirms the relationship between AH and CRS and supports the existing consensus on medical and surgical therapy. Furthermore, these studies underline the necessity to adapt medical and surgical treatment considering age, comorbidities including asthma and, if present, the Computed Tomography (CT) score.

Chronic rhino-sinusitis treatment in children with cystic fibrosis: A cross-sectional survey of pediatric pulmonologists and otolaryngologists

ObjectivesChildren with cystic fibrosis (CF) have a high incidence of chronic rhinosinusitis (CRS); however, no clinical care guidelines currently exist for the management of CRS in these patients. As a result, there is variation in the treatment of CRS in children, especially when it comes to the frequency of surgery for nasal polyposis. MethodsA 28-question survey was sent to pediatric otolaryngologists (POs) and pulmonologists (PPs) who care for pediatric CF patients. Questions assessed the level of agreement that practitioners had with various approaches to CRS care in pediatric CF patients. ResultsResponses from 114 POs and 50 PPs were included in our final analysis. Each group demonstrated significantly different approaches to the medical and surgical management of CRS in pediatric CF patients. POs prefer multi-modal approach while PPs prefer single-modal approaches. With respect to medical management, PPs incline towards IV antibiotics while POs tend toward oral steroids. ConclusionPOs and PPs strongly agree that CRS has an impact on overall disease state and quality of life of pediatric CF patients. However, POs and PPs significantly differ in their approach to treating CRS, demonstrating a potential need for clinical care guidelines for the management these common sequelae of CF.

Сравнительная эффективность операций на верхнечелюстной пазухе при хроническом риносинусите у детей с использованием SNOT-20

Сравнительная эффективность операций на верхнечелюстной пазухе при хроническом риносинусите у детей с использованием SNOT-20

The effectiveness and safety of FESS in chronic rhinosinusitis in children

The effectiveness and safety of FESS in chronic rhinosinusitis in children

Precise diagnosis and treatment of chronic rhinosinusitis in children

Precise diagnosis and treatment of chronic rhinosinusitis in children

Chronic Rhinosinusitis in Children

Pediatric chronic rhinosinusitis (CRS) is a common condition that is often misdiagnosed and can be challenging to treat. This review aims to 1) Review definitions, presentation, complications, and management of CRS in children. 2) Highlight the paucity of evidence in the management of pediatric CRS. There are few studies supporting the usual recommended medical therapy for pediatric CRS (antibiotics, nasal saline irrigations, intranasal steroid). Adenoidectomy remains a mainstay of surgical treatment, but recent evidence demonstrates the utility of balloon sinuplasty and functional endoscopic sinus surgery (FESS) for patients who fail adenoidectomy alone. Pediatric CRS is distinct from ARS and adult CRS. It is a common problem that is poorly studied, in part because of significant symptomatic overlap with related conditions. Recent evidence supports the use of surgical treatment in children who fail medical management. However, further outcome studies are needed to better evaluate the effectiveness of current medical and surgical management protocols.