Sinusitis in children


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Sinusitis in children

  2. 2. DEFINITION: Sinusitis is the inflammation of sinuses.
  3. 3. 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.
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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.
  8. 8. 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
  9. 9. CONTD.. Maxillary sinus puncture-This test is the criterion standard for obtaining maxillary sinus cultures. Middle meatal swab Cultures
  10. 10. 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
  11. 11. 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.
  12. 12. 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.
  13. 13. SURGICAL MANAGEMENT: Adenoidectomy Functional endoscopic sinus surgery Balloon sinuplasty Consider surgery as a last resort in the pediatric population.
  14. 14. 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.
  15. 15. COMPLICATIONS: Osteomyelitis Orbital infection Abscesses Meningitis
  16. 16. THANK YOU