Rinosinusitis

Pediatric Allergy and Immunology

REVIEW ARTICLE

Diagnosis of acute rhinosinusitis
Susanna Esposito, Paola Marchisio, Rossana Tenconi, Laura Tagliaferri, Giada Albertario, Maria Francesca Patria & Nicola Principi
` Department of Maternal and Pediatric Sciences, Universita degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

To cite this article:Esposito S, Marchisio P, Tenconi R, Tagliaferri L, Albertario G, Patria MF, Principi N. Diagnosis of acute rhinosinusitis in children. Pediatr Allergy Immunol 2012: 23 (Suppl. 22): 17–19.

Keywords acute rhinosinusitis; antibiotics; respiratory tract infections; children Correspondence Susanna Esposito, MD, Department of Maternal and Pediatric Sciences, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena’’, Via Commenda 9, 20122 Milano, Italy. Tel.: +39 02 50320227 Fax: +39 02 50320206 E-mail: susanna.esposito@unimi.it Accepted for publication 11 April 2012 DOI:10.1111/j.1399-3038.2012.01319.x

Abstract Rhinosinusitis is almost always a complication of a viral infection involving the upper respiratory tract. A common cold is thefirst symptom of rhinosinusitis, but infectious processes involving the nose inevitably affect the paranasal sinuses because of their anatomical contiguity. The symptoms remain those of a common cold as long as nasal phlogosis is moderate and the ostia between the nose and sinuses are patent. If the inflammation is intense, edema may obliterate the ostia and isolate the sinuses, thus stopping theremoval of the exudates. The duration of symptoms makes it possible to distinguish acute (10–30 days) from subacute (30– 90 days) and chronic rhinosinusitis (>90 days). The diagnosis of rhinosinusitis should only be based on anamnestic and clinical criteria in children with serious or persistent symptoms of upper respiratory tract infection, or which appear within a short time of an apparent recovery.Computed tomography and magnetic resonance images of the paranasal sinuses should be reserved for children reasonably considered to be candidates for surgery. Antibiotics are recommended in cases of mild acute bacterial rhinosinusitis as a means of accelerating the resolution of symptoms. The use of antibiotics is mandatory in severe acute bacterial rhinosinusitis to cure the disease and avoid thepossible onset of severe complications.

The importance of rhinosinusitis (RS) finally reached pediatricians’ attention a few years ago (1–3). Until the late 1980s, it was considered a rare childhood disease because the paranasal sinuses (too small or even undetectable in children) were thought to have no pathological relevance, but it is now known that RS may also occur even in very youngpediatric patients because the maxillary and ethmoidal sinuses are consistently present from birth (4). The sphenoid sinuses are pneumatized at the age of about 5 yr, and the frontal sinuses appear between the ages of 7 and 8 yr. Moreover, the paranasal sinuses are easily infected because of their contiguity with the structures frequently involved in the common mild or severe infectious processes ofthe first years of life. RS is almost always a complication of a viral infection involving the upper respiratory tract (1–3). Children have at least 6–8 respiratory infections per year especially in the first years of life, and as 5–13% of these evolve into acute bacterial RS, it is not difficult to understand its medical importance and socio-economic impact.

Clinical findings RS is defined as theinflammation of one or more paranasal sinuses. The most common cause of RS is an infection. RS is classified on the basis of the duration of symptoms and/or the involved sinus. A common cold is the first symptom of RS, but infectious processes involving the nose inevitably affect the paranasal sinuses because of their anatomical contiguity (2–4). The symptoms remain those of a common cold as long as...