Management Of Sinusitis In Children Research Articles

Chronic sinusitis in children

Clinical practice guidelines for the management of acute sinusitis in children have been published by the American Academy of Pediatrics. Of note is that in this document, a brief discussion of chronic disease concluded that the bacterial pathogens causing disease, pathogenesis and management are essentially unknown. Although there are insufficient data in the literature to develop evidence-based clinical guidelines, a careful review of the literature and clinical experience of experts who manage pediatric chronic sinusitis is presented in an effort to develop specific recommendations and to offer practical treatment options. It is apparent that anaerobic bacteria play a major role in this infection thereby influencing the natural history of disease and directing, to a great degree, medical management.

A prospective randomized open trial of saline nasal irrigation and decongestant for sinusitis in children

Purpose: The management of sinusitis in children is controversial. Antibiotic is known as the most essential management. Despite nasal irrigation and nasal decongestant have been used as adjunctive treatments of sinusitis, it is still unclear whether these are effective on sinusitis. Therefore, we used antibiotics with each or both nasal irrigation and an oral nasal decongestant and tried to estimate the outcome of each case. Methods: This study was conducted with the sinusitis patients who visited our pediatric respiratory disease clinic. They were randomized into 4 groups as follows: Group 1 were treated with a high dose of amoxicillin only; Group 2 were treated with nasal irrigation and a high dose of amoxicillin; Group 3 were treated with a nasal decongestant and a high dose of amoxicillin; and Group 4 were treated with nasal irrigation, an oral nasal decongestant, and a high dose of amoxicillin. Responses to treatment were estimated more than 4 days after the beginning of the therapy in acute or subacute sinusitis, and more than 7 days into the cases of chronic sinusitis. Results: The different responses to the treatments among the 4 groups were not comparable. A favorable therapy was not found, regardless of whether a patient had suppurative rhinorrhea, nasal stuffness, typical findings of PNS plain radiograph, or adenoid hypertrophy. Conclusion: The use of nasal irrigation or a oral nasal decongestant as an additional therapy to antibiotics for the symptoms of pediatric sinusitis showed no additional effects on sinusitis.

The management of sinusitis in children

Sinusitis is a common medical problem in children. The prevalence of penicillin-resistant S. pneumoniae infection has been increased during the last decade. The medical management is based on the choice of antimicrobial agents. This article reviews current literatures on the management of acute bacterial sinusitis and chronic sinusitis, with an emphasis on penicillin-resistant S. pneumoniae infection. This article also explores the potential pathophysiologic mechanisms of chronic sinusitis.

Diagnosis and therapeutic management of sinusitis in children

OBJECTIVE: The authors review the main aspects related to the diagnosis and management of sinusitis in children, according to the medical literature. METHODS: Literature review. RESULTS: Clinical criteria, microbiology, image diagnosis, medical and surgical management are presented, whenever sinusitis is considered. CONCLUSIONS: The standardization of the clinical approach in children's sinusitis allows optimization of the diagnosis and the appropriate subsidiary exams, as well the correct use of antimicrobials and others drugs, or surgery in selected cases.

Management of chronic sinusitis in children with cystic fibrosis

Management of chronic sinusitis in children with cystic fibrosis

Sinusitis in Children Infected with HIV: A Retrospective Review of 180 cases 820

The clinical presentations, radiological and laboratory investigations, treatment and risk factors of acute sinusitis in a cohort of 180 HIV-infected children were evaluated. Information was compiled retrospectively from out-patient visits over a period of 18 months. Acute sinusitis affected 39% of our cohort. Most patients presented in winter months with nonspecific chronic symptoms (cough and rhinorrhea, 70 and 82% respectively). Symptoms more specific to acute sinusitis were reported less frequently. Imaging studies were used to confirm the diagnosis of sinusitis in 51% of cases. Maxillary and ethmoid sinuses were most commonly affected. Single oral antibiotic therapy with a mean duration of 21 days appeared sufficient for complete resolution of symptoms in 80% of episodes. However, 37% of patients with a first episode had two or more recurrences during the study period. This group was more likely to require multiple antibiotics over a longer period of time and had a greater tendency to relapse. Sinus surgery, including aspiration for culture, was not performed on any of the children. We found no association between the presence of sinusitis and advanced immunosuppression. CD 4 lymphocyte and absolute neutrophil counts in children with and without sinusitis did not differ. Concurrent allergic rhinitis and asthma/reactive airway disease (RAD)were identified as predisposing risk factors for acute sinusitis. Neither monthly intravenous immunoglobulin (IVIG) prophylaxis nor three times weekly Trimethoprim-Sulphamethoxazole (TMP/SMZ) prophylaxis for Pneumocystis carinii pneumonia (PCP) conferred protection from the subsequent development of sinusitis. New prophylactic and therapeutic modalities are needed in the management of sinusitis in children.

Diagnosis and management of sinusitis in children

Acute bacterial sinusitis is a common clinical problem. The usual predisposing events are either viral upper respiratory infection or allergic inflammation. Patients present with either persistent or severe respiratory symptoms. Subacute and chronic sinusitis are characterized by very protracted respiratory symptoms that include nasal discharge, cough, or both. A precise diagnosis of bacterial sinusitis is made when sinus aspiration is performed and yields pus and bacteria in high colony count. Images, either plain radiographs or computer tomographic scans, can be used to confirm the diagnosis of bacterial sinusitis in patients whose signs and symptoms suggest the diagnosis. Streptococcus pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis are the usual pathogens retrieved from patients with acute, subacute, and recurrent acute sinusitis. These same pathogens cause acute exacerbations of chronic sinusitis. In patients with chronic persistent sinusitis, the role of bacterial agents is less clear. The prescription of antimicrobials is the backbone of the medical management of acute bacterial sinusitis. Clinical improvement is prompt in nearly all children treated with an appropriate agent.

Impact of sinusitis in cystic fibrosis

The cause of cystic fibrosis has been determined to be faulty ionic transport of chloride across the apical membrane of epithelial cells lining exocrine glands. The subnormal ionic transport leads to dehydration of extra cellular fluids and the development of thickened inspissated mucous secretions. The vast majority of patients with cystic fibrosis develop sinus disease with panopacification of the sinuses present in 90% to 100% of patients older than 8 months of age. Indications for surgical management of sinusitis in children with cystic fibrosis include (1) chronic nasal obstruction with mouth breathing, (2) chronic purulent draining nasal secretions unresponsive to medical treatment, and (3) persistent headaches thought to be related to sinusitis. Operative therapy is based on computerized tomographic scan findings and can be performed endoscopically. Postoperative management is critical for ensuring successful surgical results. Antibiotics, topical steroids, and cleansing of the surgical fields must be performed on a regular basis to ensure adequate healing. The impact of sinusitis on the cystic fibrosis population is significant. Approximately 20% of patients will eventually require surgical treatment of their sinuses. Chronic sinusitis may cause deformities of the external nasal skeleton, a loss of the sense of smell, and headaches.

The Current Management of Sinusitis in Children

The paranasal sinuses are common sites of infection in children. The diagnosis of sinusitis may be challenging because the sinus cavities are small and variably contoured, the clinical manifestations are often nonspecific, and the radiologic findings may be equivocal. Because many local and systemic factors contribute to sinusitis in children, the therapeutic regimens vary. In addition to conventional medical approaches, new surgical procedures and improved anesthetic techniques have made functional endonasal sinus surgery an excellent management tool for selected patients with chronic or recurrent disease.

Diagnosis and management of acute sinusitis in children.

Diagnosis and management of acute sinusitis in children.

Management of sinusitis in children.

Management of sinusitis in children.