SINUSITIS IN CHILDRENPRESENTED BY:A.PRIYADHARSHINI, M.Sc(N),LECTURER,JAI INSTITUTE OF NURSING ANDRESEARCH,GWALIOR.
DEFINITION: Sinusitis is the inflammation of sinuses.
EPIDEMIOLOGY Although the exact incidence of sinusitis in the pediatric population is unclear, it is diagnosed commonly, most often following a viral URTI. Approximately 5-13% of URTIs are complicated by bacterial sinusitis. It affects only 1% of infants and 5% of children aged 5-9 years, while 15% of the adolescent population is affected. Allergic rhinitis is one of the most common predisposing factors for sinusitis.
CAUSES: Acute and subacute pathogens Streptococcus pneumoniae - 20-30% Haemophilus influenzae - 15-20% Streptococcus pyogenes (beta-hemolytic) - 5% Staphylococcus aureus Anatomical abnormalities: Several anatomical abnormalities of the lateral nasal wall can predispose to sinusitis. Deviated septum
CONTD… GER may lead to inflammation of the eustachian tube orifices or sinus ostia secondary to mucosal irritation. Polypoid mass or mucosal changes associated with allergic fungal sinusitis
CLINICAL MANIFESTATIONS: ACUTE SINUSITIS URTI symptoms persisting longer than 7-10 days suggest acute sinusitis. Daytime cough and rhinorrhea are the 2 most common symptoms. Other common signs and symptoms include the following: Nasal congestion Infrequent low-grade fever Otitis media (50-60% of patients) Irritability Headache
CONTD… Subacute sinusitis: This condition is defined as signs and symptoms lasting between 30-90 days. Chronic sinusitis: Chronic sinusitis is defined as low-grade persistence of signs and/or symptoms lasting longer than 90 days without improvement. Nighttime cough is more prevalent.
DIAGNOSTIC EVALUATION: Head and neck examination Otoscopy Anterior rhinoscopy Nasal endoscopy CT scan Plain radiography MRI Ultrasonography can be used to evaluate the maxillary sinuses
CONTD.. Maxillary sinus puncture-This test is the criterion standard for obtaining maxillary sinus cultures. Middle meatal swab Cultures
MEDICAL MANAGEMENT: Antibiotic therapy for acute sinusitis -Because of the growing problem of bacterial resistance, do not administer antibiotics indiscriminately or without confirmation of history by physical examination. Treat for 10-14 days or for 1 week
CONTD.. Saline sinus irrigation has demonstrated efficacy in the treatment of acute and chronic sinusitis. It mechanically clears secretions, decreases bacterial counts, and clears allergens and environmental irritants from the nose. Nasal steroids are essential for patients with concurrent allergic rhinitis. Nasal decongestants are variably effective. Topical decongestants may improve patients level of comfort.
CONTD.. Mucolytics are variably effective. Antihistamines Immunotherapy is effective for patients with known specific allergies who have symptoms not responsive to other forms of traditional medical therapy.
SURGICAL MANAGEMENT: Adenoidectomy Functional endoscopic sinus surgery Balloon sinuplasty Consider surgery as a last resort in the pediatric population.
SUPPORTIVE MANAGEMENT: Patients with GER should eliminate caffeine, chocolate, and acidic beverages from their diets. Also, patients should not lie supine after meals, and no food should be consumed for 2 hours before bedtime. With food allergies, which are common in the pediatric population, appropriate restrictions are necessary.
COMPLICATIONS: Osteomyelitis Orbital infection Abscesses Meningitis