Northeast Florida Medicine
Vol. 66, No. 1 2015
17
Otolaryngology
• Recurrent acute bacterial sinusitis: Recurrent episodes
of bacterial sinusitis lasting less than 30 days and with at
least 10 symptom free days between episodes. Authors
often require four or more episodes per year or three in
six months.
• Chronic bacterial sinusitis: Bacterial sinusitis lasting 90
days or longer.
When considering recurrent acute or chronic bacterial
sinusitis underlying conditions should be ruled out includ-
ing allergic and non-allergic rhinitis, immune deficiency,
gastroesophageal reflux, cystic fibrosis and ciliary dysmotility.
Imaging of the sinuses may be helpful in the management
of recurrent and chronic sinusitis, but is not recommended
in the setting of acute sinusitis unless there is concern for
complications such as orbital or intracranial involvement. CT
remains the study of choice as bony detail is most helpful.
There is legitimate concern about the cumulative long term
effect of repeated radiation exposure via CT scans beginning
in childhood. For this reason CT scanning a child for chronic
or recurrent sinusitis shouldbe reserved for those patients who
have failedmedical therapy and forwhomsurgical intervention
is being considered.
16
Medical treatment of acute bacterial sinusitis should in-
clude antibiotic therapy.
16
Judicious use of adjuvant therapies
including nasal saline, antihistamines, decongestants, mu-
colytics, and intranasal steroids offer symptomatic relief and
shorter duration of illness. For the prevention of recurrent or
chronic sinusitis medial options include nasal steroid sprays,
allergy therapy if applicable, and nasal saline irrigations. A
comprehensive allergy workup should be recommended for
these children of an appropriate age with appropriate ther-
apy to follow. Long term prophylactic antibiotics have been
shown to be effective but the risk of bacterial resistance may
outweigh the benefits.
Surgical options for chronic or recurrent sinusitis refractory
to medical therapy include adenoidectomy with or without
maxillary sinus lavage for children and possible tonsillecto-
my. Endoscopic sinus surgery may be considered in older
children. Age is important when considering sinus surgery of
any kind due to the progressive development of the sinuses.
Most children are born with small, but existing maxillary
and ethmoid sinuses. The sphenoid sinus develops around
six years of age, and the frontal may not be present until the
second decade of life.
Balloon sinuplasty and children
A new, and often advertised, treatment for chronic sinusitis
is balloon sinuplasty. Results have shown to be effective in
adults, but less so for children, however, it is no more than an
alternative surgical instrument to perform endoscopic sinus
surgery.Much like themultiple techniques available to remove
tonsils, this is also true for sinus surgery. Balloon technology is
considerably more expensive and long term results, especially
in children, are still pending. When used in adult patients
the procedure can be done in the office leading to a net cost
savings but this is not an option for children.
Conclusion
Pediatric Otolaryngology has seen significant advance-
ments during the last decade that have occurred in concert
with progress in other medical specialties, basic sciences and
biotechnology. Recent guidelines have helped to clarify indi-
cations and focus attention on reducing complications and
ultimately improvingoutcomes formanyof themost common
medical treatments and surgical procedures in children.Those
questions that remain unanswered and the continued need
for additional, high quality, research is also highlighted. As
with all medical specialties, improving the health of children
requires access to specialized care and treatment. Addressing
disparities in access to pediatric care will be increasingly im-
portant as science and technology continue to advance.
v
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