Pediatric Chronic Sinusitis Research Articles

A mini-update on chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is an inflammatory disorder of the paranasal sinuses and the nasal cavity lasting longer than 12 weeks. This disease is a common clinical syndrome with significant monetary burden due to the high costs of medical visits, diagnostic tests, medications, and surgical therapies. CRS without nasal polyposis (CRSsNP) is the most common subtype of CRS, accounting for about 70% of all patients. Other subtypes include CRS with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS). CRSwNP has the worldwide prevalence of 2% to 4% and is often accompanied by type 2 inflammation and asthma as a comorbid condition. Pediatric chronic sinusitis is distinct from adult chronic sinusitis and is currently considered an infectious process, characterized by persistent inflammation representing an exaggerated immune response to an external stimulus. The medical and surgical management of CRS has been remarkably modified in the past two decades. The aim of this study was to present an update on CRS based on the recent years’ literature.

Causal associations between pediatric asthma and united airways disease: a two-sample Mendelian randomization analysis.

Prior observational research has indicated a potential link between pediatric asthma and united airways disease (UAD). However, these findings could be subject to confounding factors and reverse causation. Therefore, our study utilizes Mendelian randomization (MR) method to further investigate the causal relationship between pediatric asthma and UAD. We conducted a comprehensive two-sample Mendelian randomization (MR) analysis to investigate the association between pediatric asthma and seven groups of UAD, including chronic sinusitis, chronic rhinitis, nasopharyngitis and pharyngitis, chronic diseases of tonsils and adenoids, chronic laryngitis and laryngotracheitis, chronic bronchitis, bronchiectasis, chronic obstructive pulmonary disease (COPD). The present study employed a range of methods for two-sample MR analysis, including inverse variance weighted (IVW), MR-Egger regression, Simple mode, weighted median, and weighted models. The conclusion of the MR analysis primarily relies on the IVW results, while other analytical methods are utilized as supplementary evidence to ensure result robustness in this MR analysis. And sensitivity analyses were conducted, including heterogeneity test, horizontal pleiotropy test, MR-PRESSO test, and leave-one-out analysis to validate the results. The results of the MR analysis indicate significant causal effects of pediatric asthma on chronic rhinitis, nasopharyngitis and pharyngitis (IVW: OR = 1.15, 95%CI: 1.05-1.26, p-value = 0.003), chronic diseases of tonsils and adenoids (IVW: OR = 1.07, 95%CI: 1.00-1.15, p-value = 0.038), chronic bronchitis (IVW: OR = 1.51, 95%CI: 1.42-1.62, p-value <0.001), bronchiectasis (IVW: OR = 1.51, 95%CI: (1.30-1.75), p-value <0.001), and COPD (IVW: OR = 1.43, 95%CI: 1.34-1.51, p-value <0.001). However, no significant causal association was observed between pediatric asthma and chronic sinusitis (IVW: OR = 1.00, 95%CI: 1.00-1.00, p-value = 0.085), chronic laryngitis and laryngotracheitis (IVW: OR = 1.05, 95%CI: 0.90-1.21, p-value = 0.558). Our findings support a potential causal relationship between pediatric asthma and UAD, suggesting that pediatric asthma may be a potential risk factor for various UAD.

Pediatric Unilateral Chronic Sinusitis: Clinical and Radiological Patterns Compared to Adults.

Upper respiratory tract infections and sinusitis are more prevalent in children than in adults. Unilateral sinusitis is not uncommon disease. Our aim was to analyze the disease characteristics in children with unilateral sinusitis and compare them with those of adults. This study included 124 patients with unilateral chronic sinusitis divided according to age into two groups: pediatric group ≤18 years (66 cases) and adult group >18 years (58 cases). The groups were compared in terms of demographic data, side, clinical manifestations and radiological findings. In pediatric patients, the most common inflammatory pathology was antrochoanal polyps, followed by allergic fungal sinusitis. On the other hand, chronic sinusitis without nasal polyps is the most common in adults, followed by antrochoanal polyps. The mean duration of clinical manifestations before diagnosis in pediatric patients was significantly shorter than that in adults (P=0.001). The most common symptoms in both pediatric and adult patients were anterior nasal discharge and nasal obstruction. Proptosis was significantly higher in pediatric group than in adult group (P=0.015). On computed tomography (CT), the most commonly affected sinus in both pediatric and adult patients was the maxillary sinus followed by the anterior ethmoid sinus. Bone expansion, erosion and involvement of adjacent structures were significantly higher in pediatric patients (P=0.028, 0.027 respectively). Pediatric patients have a high incidence of antrochoanal polyps and allergic fungal sinusitis as unilateral inflammatory lesions. These lesions require surgical management. Inflammatory paranasal sinus lesions in pediatric patients have a shorter duration of clinical manifestations and a higher incidence of bone erosion and involvement of adjacent structures; therefore, early diagnosis and management prevent complications.

Pediatric chronic sinusitis: diagnosis and management.

Review the diagnosis and management of pediatric chronic sinusitis given recent advances in both surgical and medical management. Balloon catheter dilation (BCD) of the sinuses has been used as an adjunct to adenoidectomy or in lieu of traditional endoscopic sinus surgery. BCD has been shown to be a safe technique in children although its efficacy compared to maxillary sinus irrigation or traditional sinus surgery cannot be determined based on current studies. New advances in BCD and biologics may serve as useful adjuncts in surgical and medical therapy respectively with additional research needed to better delineate the optimal indications for each in the treatment continuum.

The Impact of Adenoid Hypertrophy on Pediatric Chronic Maxillary Sinusitis

Background:The hypertrophied adenoids lay a role in rhinosinusitis, which is not fully unknown. The present view proposed that the hypertrophied adenoids perform as a bacterial pool and restricts the nasal mucociliary clearance. Obstructive adenoids may lead to stasis of nasal secretions with subsequent infection. Aim of the Work:The current work aimed to assess the impact of adenoid enlargement on pediatric chronic maxillary sinusitis [PCMS]. Patients and Methods:This study included 60 Children. The size of adenoid was graded through endoscopic examination. The Clemens grading system was used. Paranasal sinuses were radiologically investigated by computerized axial tomography scan. The radiological and endoscopic data were correlated. Additionally, all adenoid samples were cultivated for bacteriological growth. Result:The highest incidence of adenoid hypertrophy was seen in the age group 3-6 years old [60%], with similar male to female affection rate [1:1]. The positive computed tomography [CT] scan findings among children with hypertrophied adenoid were [55%]. The highest incidence of positive CT findings was found in grade-III adenoids, which is the highest grade of size [33.3%]. Adenoidectomy was performed for all patients and specimens were examined for bacteriological growth. 20% of adenoid tissue had multiple growth and 80.0% showed single organism. The frequency of isolated organism were H. Influenzae, S. Pneumoniae, S. Pyogenes, S. Aureus and Methicillin Resistant Staphylococcus Aureus. Conclusion: The endoscopically graded adenoid hypertrophy is significantly correlated to positive CT scan signs of rhinosinusitis in children. Isolation of bacteria from adenoid tissue supports the inflammatory mechanism of adenoid in pathogenesis of rhinosinutis in addition to its obstructive action. Early initiation of empirical antibiotic therapy is crucial and adenoidectomy provides a cure for adenoid hypertrophy and rhinosinusitis.

Review and Analysis of Research Trends in Surgical Treatment of Pediatric Chronic Sinusitis.

Background Chronic sinusitis is a common otolaryngologic complaint with a significant impact on patients’ quality of life. There is current debate and differences in quality of evidence regarding the best surgical management approach to pediatric chronic sinusitis. Objective To investigate changes in publishing trends over time in surgical management of pediatric chronic sinusitis. Methods A systematic literature review was conducted in January 2019 using Embase, PubMed, and Web of Science, of all articles that included surgical treatments for pediatric chronic sinusitis. Publications were grouped into 3 time periods: pre-1998, 1999–2008, and 2009–2018. In addition, a subgroup of publications pertaining to endoscopic sinus surgery, balloon sinuplasty, and adenoidectomy were grouped into 2-year periods since 1988 to compare the number of publications on each topic and to examine overall trends. Results A total of 327 abstracts were included in the data collection and analysis. There was an overall significant increase in total number of publications ( P &lt; .0001), total number of authors ( P = .001), and comparison studies ( P = .003) from pre-1989 to 2018. Relative number of prospective studies, systemic review, and case studies/expert opinions have not significantly increased over time when comparing decades ( P &gt; .05). Among the surgery types, functional endoscopic sinus surgery has the most amount of publications regardless of year despite a statistically significant increase in publications pertaining to balloon sinuplasty in the pediatric literature from 1999–2008 to 2009–2018 ( P = .001). Conclusions Studies on pediatric chronic sinusitis have increased significantly during each of the last 2 decades with an increase in the concomitant number of authors and comparison studies. Although most publications are still Level C or D evidence, there has been a nonsignificant increase in Level A evidence in the past decade. Endoscopic sinus surgery still remains the most studied procedure despite the recent increase in publications on balloon sinuplasty.

Long-Term Effectiveness of Balloon Catheter Sinuplasty in Pediatric Chronic Maxillary Sinusitis.

The objective of our study was to assess the long-term effectiveness of balloon catheter sinuplasty in the treatment of pediatric chronic maxillary sinusitis following failed first-line medical and surgical management with adenoidectomy. Pediatric patients younger than 12 years were reviewed for having failed previous adenoidectomy and undergone a balloon catheter sinuplasty between August 2006 and March 2011 for chronic rhinosinusitis. Demographic data and clinical characteristics were recorded in patients who met inclusion criteria. Outcomes were assessed by need for functional endoscopic sinus surgery and persistence of chronic infection within at least 5 years of follow-up. Failure was defined by any child who was rediagnosed with chronic sinus disease after balloon catheter sinuplasty or who required endoscopic sinus surgery within 5 years. Sixty-two children were reviewed, with 38 patients meeting inclusion criteria (prior adenoidectomy, a preoperative Lund-Mackay score of ≥5, and balloon catheter sinuplasty). The mean age (standard deviation) was 6.76 (2.27) years with an age range of 2 to 11 years. Eight children (21.1%, P < .01) continued to have chronic sinus complaints following balloon procedure, with 5 (13.1%) individuals requiring eventual endoscopic surgery within 5 years. Age, asthma, allergy, and gender did not have any statistically significant impact on outcome. Balloon catheter sinuplasty is an effective long-term alternative for the treatment of chronic rhinosinusitis in pediatric patients, hoping to avoid further infections and eventual endoscopic surgery.

Diagnosis and treatment of Chronic Rhinosinusitis in Children according European Position Paper on Rhinosinusitis and nasal Polyps –EPOS-2012 and American Academy Otolaryngology-Head and Neck Surgery 2014

Pediatric rhinosinusitis is defined as a presence of two or more symptoms and one of them should be either nasal blockage or nasal discharge and headache/facial pain or cough. Chronic rhinosinusitis - CRS is recognized when the four most common symptoms as cough, rhinorrhea, nasal congestion and post nasal drip with a slightly higher predominance of chronic cough are presented for more than 12 weeks and influence the quality of life. CRS should be considered in respect of unique conditions because of the differences in predisposing factors (immunological and others) and the anatomy of the sinuses between children and adults. The adenoids are a prominent contributor to CRS in young children, both from bacteriologic and immunologic status. The older children suffer from CRS in the same manner as adults. During evaluation a child with symptoms of CRS , one should always consider the possibility of underlying disease as a contributing factor. Diseases impacting sinuses and nasal function include CF, primary ciliary dyskinesia (PCD) and a variety of normal immune deficiencies, including the still-developing immature immunity of healthy young children. Surgical intervention for rhinosinusitis is usually considered for patients with CRS who have failed maximal pharmacological treatment. There are two important consensus statements for pediatric chronic sinusitis (CRS): European Position papers on Rhinosinusitis and Nasal Polyps -EPOS 2012 and Clinical Consensus Statement: Pediatric Chronic Sinusitis American Academy Otolaryngology-Head Neck Surgery 2014. Both of them contain necessary information and recommendation for diagnosis and treatment of CRS in children.

An Overview of Surgical Approaches to Pediatric Chronic Sinusitis for Primary Care Providers

Pediatric chronic rhinosinusitis is a common condition amongst pediatric patients. Despite its prevalence, debate continues regarding the best treatment strategies. The current paper examines the literature as it pertains to the surgical management of pediatric chronic rhinosinusitis. Adenoidectomy remains the mainstay in the initial surgical management. Both maxillary sinus irrigation and balloon dilation of the sinuses have been studied with disagreement as to the timing and patient selection for those procedures. Functional endoscopic sinus surgery is an accepted treatment modality, especially in initial surgical failures. Further studies will be needed to better delineate patient selection and timing of specific surgical techniques.

Do Adult Forms of Chronic Rhinosinusitis Exist in Children and Adolescents?

Pediatric chronic sinusitis is currently designated as pediatric chronic rhinosinusitis. In most pediatric cases, sinusitis is considered as infectious. In the adult literature, a wider repertoire of chronic rhinosinusitis conditions is recognized. In this review, the adult forms of chronic rhinosinusitis are used as a framework for identifying and defining the potential spectrum of pediatric chronic rhinosinusitis that exists beyond the most recognized condition, pediatric infectious chronic rhinosinusitis.

Pediatric Chronic Sinusitis: What Art Thou?

Pediatric chronic sinusitis has been re-termed, pediatric chronic rhinosinusitis, largely following the adult nomenclature. However, other large areas of medical management of the process have remained largely uninvestigated. This opinion piece discusses the gaps in our current knowledge of pediatric rhinosinusitis pathophysiology and limitations of current management protocols.

In reference to Improved outcomes after low-concentration hypochlorous acid nasal irrigation in pediatric chronic sinusitis.

In reference to Improved outcomes after low-concentration hypochlorous acid nasal irrigation in pediatric chronic sinusitis.

Improved outcomes after low-concentration hypochlorous acid nasal irrigation in pediatric chronic sinusitis.

We aimed to evaluate the effectiveness of low-concentration hypochlorous acid (HOCl) nasal irrigation compared to isotonic normal saline for pediatric chronic rhinosinusitis. This was a randomized, prospective, active-controlled study. This study investigated the effectiveness of 4 weeks of low-concentration hypochlorous irrigation by analyzing five categorized subjective symptoms and x-ray findings in pediatric patients with rhinosinusitis. Thirty-seven patients were enrolled, and 26 patients successfully completed the study. Total symptom scores significantly improved with both HOCl and normal saline nasal irrigation, but there was no difference between the two groups. X-ray scores also improved in both groups; improvement was much greater in the HOCl group than the placebo group. Nasal irrigation with HOCl is an effective adjuvant treatment compared to isotonic normal saline for pediatric sinusitis. 1b.

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.

Successful Surgery in Pediatric Chronic Nasal Obstruction

Objective: 1) To validate a minimally invasive surgical approach including endoscopic fiberdiodelaser-assisted turbinoplasty, RFQ adenoidectomy, and sinus washes, as a first-line treatment for children with chronic nasal obstruction and noncomplicated recurrent sinusitis that failed at maximal medical treatment. Method: A prospective study of 50 children aged 3 to 13 years with persistent sinonasal symptoms was conducted in a tertiary private setting. Surgery under general anesthesia was done. The survey included NOSE instrument, child behavior, use of sinonasal medication and parent satisfaction at entry, 1, 6, and at least 24 months after surgery. Results: Significant improvement in NOSE score was observed 1 month after the procedure, and remains unchanged after 6 and 24 months of follow-up. Basal NOSE 92.5% ± 9.4 vs NOSE 1 month 7.2 % ± 12, NOSE 6 month 8.3 ± 15.2; 24 months 6.3 ± 10.3 (ANOVA P = .0001) .Patients used significantly less sinonasal medications. None remained with altered behavior ( P .001 McNemar’s test). Parent satisfaction was very high (Likert scale) with 95.8% at 6 months and 93% at 24 months. Conclusion: Laser-assisted turbinoplasty RFQ adenoidectomy and sinus washes are a successful approach for treating pediatric chronic nasal obstruction and sinusitis.

Effect of comprehensive treatment and nursing on pediatric chronic sinusitis

Objective To investigate the effect of comprehensive treatment and nursing on pediatric chronic sinusitis.Methods 232 children with chronic sinusitis were divided into treatment group and control group.The control group was given routine treatment and the treatment group was given comprehensive treatment consisting of nasal irrigation,nebulization and low energy laser based on routine treatment.Results The effective rate was 93.97％ in the treatment group and 79.30％ in the control group,there was significant difference between the two groups ( x2 =10.76,P ＜ 0.05 ).Conclusions Comprehensive treatment is a safe and effective adjunctive therapy of pediatric chronic sinusitis and should be extended in clinical application. Key words: Sinusitis; Pediatric; Nursing; Comprehensive treatment

The relationship between anatomical variations of the sino-nasal region and chronic sinusitis extension in children

To report the prevalence of paranasal sinus anatomic variations and their relationship with the extent of chronic sinusitis in pediatric population. This is a prospective study of all the cases of persistent pediatric chronic sinusitis despite medical therapy that presented to the otolaryngology clinics of King Abdullah University Hospital in Irbed, Jordan, and had coronal computed tomography examination of the nose and paranasal sinuses as part of their diagnostic or preoperative work up, between the periods of April 2006 and August 2007. Sixty-five cases met inclusion criteria and were analyzed. Cases were further subdivided into three groups according to age. Group 1: with ages from 5 to 7 years; group 2: ages 8-12; and group 3: above 12 years. The scans were analyzed for the presence of anatomical variations, and disease extension. Correlation between anatomical variations and disease extension was the primary outcome measure. There were 30 boys and 35 girls with an average age of 11.4 (age ranges from 5 to 16). The maxillary sinus was the most commonly involved sinus, followed by the ethmoid, sphenoid, and frontal sinuses. Agger nasi cell was the most common anatomical variation, followed by concha bullosa of middle turbinate. The frequency of most of these variants differed widely between groups 1 and 2, groups 1 and 3, but not between groups 2 and 3. No significant correlation was found between these anatomical variants and the extent of chronic sinusitis. Anatomical variations in the nose and paranasal sinuses are common in children with chronic sinusitis. Although the prevalence of these variations changes during childhood development they are unlikely to predict the extent and severity of chronic rhinosinusitis in pediatric age group.

Rhinosinusitis in children

Clinical practice guidelines for the management of acute bacterial rhinosinusitis in children were published by the American Academy of Pediatrics in 2001. Changes in the antibiotic susceptibility patterns for the common pathogens causing both acute and chronic rhinosinusitis warrant a reevaluation and update of these recommendations. In addition, there was only a very brief discussion of chronic disease in this publication, with the conclusion that the pathogenesis and management of recurrent or prolonged infection were essentially unknown. Although there are still insufficient data in the literature to develop evidence-based clinical guidelines, a careful review of recent literature and the clinical experience of experts who manage pediatric chronic sinusitis are presented in an effort to provide some specific recommendations and to offer practical treatment options. Factors associated with chronic rhinosinusitis should be addressed individually and include environmental pollution, recurrent viral upper respiratory infections, allergic and nonallergic rhinitis, ciliary dyskinesia, cystic fibrosis, immunodeficiency, gastroesophageal reflux, and anatomic abnormalities.

Immunohistochemical Analyses of MUC5AC Mucin Expression in Sinus Mucosa of Children with Sinusitis and Controls

The purpose of this study was to analyze MUC5AC protein expression in sinus mucosal specimens of children with and without chronic sinusitis. Morphometric, histologic, and immunohistochemical analyses were carried out on sinus mucosa of 7 children with chronic sinusitis and 6 children without sinusitis. MUC5AC protein was expressed in a subset of goblet cells in the surface epithelium, but not in the submucosal glands in either pediatric population. The number of goblet cells that expressed MUC5AC mucin was not significantly different in patients with and without chronic sinusitis. All specimens had similar numbers of goblet cells in the surface epithelium. The data demonstrate that neither goblet cell hyperplasia nor increased MUC5AC expression occurs in the sinus mucosa of children with chronic sinusitis. This suggests that in contrast to asthma, in which goblet cell hyperplasia is present in the lower respiratory tract, mucus hypersecretion in pediatric chronic sinusitis may involve other secretory cells, eg, submucosal glandular cells, and mucins secreted by these glandular cells.

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 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. Factors associated with chronic sinusitis should be addressed individually and include recurrent viral upper respiratory infections, allergic and nonallergic rhinitis, ciliary dyskinesia, cystic fibrosis, immunodeficiency, and anatomic abnormalities. Bacteriology includes the 3 pathogens associated with acute disease i.e., Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis but with chronic sinusitis also includes Staphylococcus aureus, anaerobic bacteria, and fungi. Medical interventions discussed include endoscopic sinus surgery, saline nasal irrigation, intranasal decongestant therapy, intranasal steroids, and oral antibiotics. Clinical ranking without regard to side effects and cost suggests that endoscopic sinus surgery and antral irrigation have the highest probability of substantial symptom improvement. Other issues discussed include identification and management of gastroesophageal reflux disease (GERD), allergy, and immune deficiency.