Pediatric perspectives of rhinosinusitis

Abstract

The diagnosis of bacterial AR in children should be made based on clinical grounds, but CT should be considered if the child is very ill or if extranasal complications are suspected. 2. Duration of symptoms is the most important factor in differentiating viral from bacterial disease. 3. When bacterial RS is suspected, antibiotics should be chosen that address S. pneumoniae and be given in appropriately higher doses to cover penicillinresistant strains. Follow-up evaluation is recommended if the patient fails to improve, because there is a 10% to 20% expected failure rate when less invasive beta-lactamase-producing bacteria such as H. influenzae and M. catarrhalis are responsible for the disease. 4. Children with chronic or recurrent sinusitis who fail to respond to medical therapy should undergo CT (coronal cuts) to locate the location and nature of the persistent disease or to identify anatomic anomalies or tumors. 5. Full evaluation should be done prior to elective surgery to identify coexisting adenoid hypertrophy or allergy, to rule out basic immune abnormalities (especially failure of the child to have been adequately immunized with the S. pneumoniae vaccine), and to determine if the child has the genes for cystic fibrosis (including homozygous and heterozygous states). Treatment of identified abnormalities should be considered before sinus surgery, including adenoidectomy, allergy control, and booster vaccination. 6. CT and/or MRI with contrast imaging of the sinuses and orbit and brain should be obtained in ill children who have severe disease, and the child should be promptly referred to appropriate specialists if orbital or neurological signs of complication are present. © 2008 Springer Science+Business Media, LLC. All rights reserved.