Wednesday, November 21, 2012

Diagnosing sinusitis in children

Diagnosing sinusitis in children

Sinusitis in children requires a different approach for the diagnosis and treatment due to various reasons. For instance, the number of children whose computed tomography (CT) scans are abnormal is very high, thus the scan should not be used to decide whether surgery of the sinus is required or not. Mainly abnormality in the scan is due to self-limiting common bacterial and viral infections or inflammatory changes that occur after the infection and do not relate to a specific group of symptoms.
Dr. Michael D. Poole suggested considering the number of the following common sinus “syndromes” to classify the pediatric chronic sinusitis patients. The syndromes include:
  1. “ relatively normal rhinosinustis with an excessively concerned family
  2. frequently recurrent rhinosinusitis (day-care syndrome)
  3. purulent rhinosinusitis unresponsive to empirically selected oral antimicrobials
  4. rhinosinusitis associated with posterior nasal obstruction (adenoid enlargement)
  5. sinusitis with reflux and
  6. significant component of IgE-mediated rhinitis/sinusitis.”

Although in many parts of the world plain films and ultrasounds are used to diagnose pediatric sinusitis, but these are ineffective methods for various reasons. For example, the films and ultrasound capture images of the maxillary sinus but several studies have observed that one-fourth children’s ethmoid sinuses are affected, so they have ethmoid disease.
The nasal cavity cultures are not used frequently for children because the patients do not comply with doctor’s guidelines and obtaining culture specimen free of contamination is difficult.
Since several factors, including age, immature immune system and defective ciliary function, are related to chronic sinusitis, defining the pathophysiology is problematic. The sinusitis cases are high in young children, especially they suffer from maxillary sinusitis. The immune system of children is immature, thus they are more prone to viral infections of upper respiratory tract and related acute sinusitis. The viral infections result in mucosal edema. The edema blocks the ostium, increasing chances of bacterial infection developing within the sinuses. The viral infection adversely affects the ciliary function that causes bacterial infection within the sinuses.
Many studies state that allergies and sinusitis in children are related. However, this has not been credibly demonstrated. So many professionals do not agree with it.
Gastroesophageal reflux disease (GERD) is not found in children as per the available information. Thus, chronic sinusitis in children cannot be related to GERD. GERD and related sinusitis is rare. However, scientific data is required to throw light on how GERD is related to chronic sinusitis.
Diagnosing sinusitis in children is a challenge because of overlapping symptoms of common cold, nasoadenoidal symptoms and other related diseases, and sinusitis. These interpretational issues make pediatric sinusitis management difficult. Conservative approach consists of no intervention to minimal intervention.  The conservative approach believes that chronic sinusitis in children resolves spontaneously. Other experts advocate surgery at early stage. However, surgical treatment is mired in various controversies. Scientific research work is required to compare surgical and medical treatments and create standardized guidelines.

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