Management approach to acute rhinosinusitis: a pediatrician's perspective
DOI: 10.32364/2587-6821-2023-7-8-11
N.G. Kolosova1, S.I. Shatalina1,2
1I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
2Research Clinical Institute of Childhood, Moscow, Russian Federation
Acute rhinosinusitis (ARS) is common in children and most often occurs in upper respirato-ry tract infections. Meanwhile, a disease duration of more than 7–10 days suggests a bacterial infec-tion and requires a change in the treatment approach to sinusitis. Any local condition preventing normal sinus drainage (i.e., inflammation) predisposes the patient to infection. ARS diagnosis is difficult because of the overlap between its clinical manifestations and symptoms of other common diseases, strong dependence on the subjective perception of symptoms by parents, and difficulties in physical examination of the child. The disease history, nature of symptoms, and duration are the basis for establishing a clinical diagnosis. In most patients, ARS resolves spontaneously, and in an uncomplicated course, antibiotics are not indicated. Intranasal steroids, irrigations, decongestants, and mucolytics are used as adjuvant therapy. However, data supporting the efficacy of these adju-vant therapies in children are scarce, and no strong formal recommendations on their use are avail-able. This paper discusses the key issues of ARS diagnosis and management in pediatric practice.
Keywords: acute rhinosinusitis, ARS, children, diagnosis, treatment, decongestants, acetyl-cysteine, tuaminoheptane sulfate.
For citation: Kolosova N.G., Shatalina S.I. Management approach to acute rhinosinusitis: a pediatrician's perspective. Russian Medical Inquiry. 2023;7(8):537–542 (in Russ.). DOI: 10.32364/2587-6821-2023-7-8-11.
About the authors:
Natal'ya G. Kolosova — C. Sc. (Med.), associate professor of Department of Child Diseases of the N.F. Filatov Clinical Institute for Child Health, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0001-5071-9302.
Svetlana I. Shatalina — C. Sc. (Med.), assistant of Department of Child Diseases of the N.F. Filatov Clinical Institute for Child Health, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; researcher of the Division of Pediatrics, Research Clinical Institute of Childhood; 62, Bol'shaya Serpukhovskaya str., Moscow, 115093, Russian Federation; ORCID iD 0000-0003-2085-0021.
Contact information: Natal'ya G. Kolosova, e-mail: kolosovan@mail.ru.
Financial Disclosure: the publication is supported by "Zambon Pharmа".
There is no conflict of interest.
Received 07.07.2023.
Revised 01.08.2023.
Accepted 24.08.2023.
2. Arcimowicz M. Acute sinusitis in daily clinical practice. Otolaryngol Pol. 2021;75(4):40–50. DOI: 10.5604/01.3001.0015.2378.
3. Fokkens W.J., Lund V.J., Hopkins C. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(S29):1–464. DOI: 10.4193/Rhin20.600.
4. Принципы этиопатогенетической терапии острых синуситов: методические рекомендации. Под ред. Рязанцева С.В. СПб.: Полифорум Групп; 2014. [Principles of etiopathogenetic therapy of acute sinusitis: guidelines. Riazantseva S.V., ed. St. Petersburg: Polyforum Group; 2014 (in Russ.)].
5. Nocon C.C., Baroody F.M. Acute rhinosinusitis in children. Curr Allergy Asthma Rep. 2014;14(6):443. DOI: 10.1007/s11882-014-0443-7.
6. Болезни уха, горла и носа в детском возрасте. Национальное руководство. Под ред. М.Р. Богомильского. М.: ГЭОТАР-Медиа; 2021. [Diseases of the ear, throat and nose in childhood. National Leadership. Bogomilsky M.R., ed. M.: GEOTAR-Мedia; 2021 (in Russ.)].
7. Абдрахманова С.Т., Абелевич М.М., Алискандиев А.М. и др. Острые инфекции дыхательных путей у детей. Диагностика, лечение, профилактика. Клиническое руководство (2-е изд., перераб. и дополн.). М.: МедКомПро; 2020. [Abdrakhmanova S.T., Abelevich M.M., Aliskandiev A.M. et al. Acute respiratory tract infections in children. Diagnosis, Treatment, prevention. Clinical Guidelines (2nd edition, revised and expanded). M.; MedComPro; 2020 (in Russ.)].
8. Геппе Н.А., Карпова Е.П., Тулупов Д.А. и др. Резолюция консенсуса по назальной обструкции у детей от 0 до 3 лет. Вопросы практической педиатрии. 2023;18(1);144–152. DOI: 10.20953/1817-7646-2023-1-144-152. [Geppe N.A., Karpova E.P., Tulupov D.A. et al. The consensus of resolution on nasal obstruction in children 0 to 3 years old. Clinical Practice in Pediatrics. 2023;18(1):144–152 (in Russ.)]. DOI: 10.20953/1817-7646-2023-1-144-152.
9. Гуров А.В., Юшкина М.А., Мужичкова А.В. Поствирусный риносинусит, фокус на патогенетическую терапию. Вестник оториноларингологии. 2023;88(3):38–43. DOI: 17116/otorino20228803138. [Gurov A.V., Yushkina M.A., Muzhichkova A.V. Postviral rhinosinusitis, focus on pathogenetic therapy. Vestnik Oto-Rino-Laringologii. 2023;88(3):38–43 (in Russ.)]. DOI: 17116/otorino20228803138.
10. Ramadan H.H., Chaiban R., Makary C. Pediatric Rhinosinusitis. Pediatr Clin North Am. 2022;69(2):275–286. DOI: 10.1016/j.pcl.2022.01.002.
11. Wald E.R., Applegate K.E., Bordley C. et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262–280. DOI: 10.1542/peds.2013-1071.
12. Brietzke S.E., Shin J.J., Choi S. et al. Clinical consensus statement: pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2014;151(4):542–553. DOI: 10.1177/0194599814549302.
13. Wilson M.T., Hamilos D.L. The nasal and sinus microbiome in health and disease. Curr Allergy Asthma Rep. 2014;14(12):485. DOI: 10.1007/s11882-014-0485-x.
14. Cronin M.J., Khan S., Saeed S. The role of antibiotics in the treatment of acute rhinosinusitis in children: a systematic review. Arch Dis Child. 2013;98(4):299–303. DOI: 10.1136/archdischild-2012-302983.
15. Колосова Н.Г., Дронов И.А. Простудные заболевания у детей. Карманные рекомендации по педиатрии. Под ред. Захаровой И.Н. М.: ООО «Группа Ремедиум»; 2019. [Kolosova N.G., Dronov I.A. Colds in children. Pocket recommendations for pediatrics. Zakharova I.N., ed. M.: LLC "Remedium Group"; 2019 (in Russ.)].
16. Крюков А.И., Кунельская Н.Л., Ивойлов А.Ю., Мачулин А.И., Яновский В.В. Применение топической терапии в лечении риносинусита у детей. РМЖ. 2017;19:1357–1359. [Kryukov A.I., Kunelskaya N.L., Ivoylov A.Yu. et al. The topical therapy in the treatment of rhinosinusitis in children. RMJ. 2017;19:1357–1359 (in Russ.)].
17. Малахов А.Б., Шаталина С.И., Дронов И.А. и соавт. Топические деконгестанты в комплексе терапии острых респираторных инфекций у детей (обзор литературы). Медицинский совет. 2015;14;26–28. [Мalakhov A.B., Shatalina I.S., Dronov I.A. et al. Topical decongestants in combination therapy of acute respiratory infections in children (a literature review). Medical Council. 2015;14;26–28 (in Russ.)].
18. Морозова С.В., Биданова Д.Б. Возможности комбинированной ингаляционной терапии инфекционно-воспалительных заболеваний верхних отделов дыхательных путей. РМЖ. 2018;10(II):50–53. [Morozova S.V., Bidanova D.B. Possibilities of combined inhalation therapy of infectious and inflammatory diseases of the upper respiratory tract. RMJ. 2018;10(II);50–53 (in Russ.)].
19. Тулупов Д.А., Карпова Е.П. Возможности комбинированных назальных препаратов в лечении острой ринологической патологии у детей. Медицинский совет. 2021;(1):67–70. DOI: 10.21518/2079-701X-2021-1-67-70. [Tulupov D.A., Karpova E.P. Topical antibiotics for acute rhinosinusitis in children. Medical Council. 2021;(1):67–70 (in Russ.)]. DOI: 10.21518/2079-701X-2021-1-67-70.
20. Bahtouee M., Monavarsadegh G., Ahmadipour M. et al. Acetylcysteine in the treatment of subacute sinusitis: A double-blind placebo-controlled clinical trial. Ear Nose Throat J. 2017;96(1):E7–E11. DOI: 10.1177/014556131709600102. PMID: 28122105.
21. Savran F., Karabulut B., Yılmaz A.S. et al. Mucolytic and Antioxidant Effects of Intranasal Acetylcysteine Use on Acute Rhinosinusitis in Rats with an Acute Rhinosinusitis Model. ORL J Otorhinolaryngol Relat Spec. 2022;84(6):447–452. DOI: 10.1159/000524869.
22. Радциг А.Н. Выбор топического деконгестанта для симптоматической терапии назальной обструкции. Фарматека. 2021;1:115–118. DOI: 10.18565/pharmateca.2021.1.115-118. [Radtsig A.N. The choice of topical decongestants for symptomatic therapy of nasal obstruction. Farmateka. 2021;1:115–118 (in Russ.)]. DOI: 10.18565/pharmateca.2021.1.115-118.
23. Cogo A., Chieffo A., Farinatti M., Ciaccia A. Efficacy of topical tuaminoheptane combined with N-acetyl-cysteine in reducing nasal resistance. A double-blind rhinomanometric study versus xylometazoline and placebo. Arzneimittelforschung. 1996;46(4):385–388. PMID: 8740084.
24. Богомильский М.Р., Радциг Е.Ю., Пивнева Н.Д., Кеся О. Сравнение эффективности различных деконгестантов в лечении острого инфекционного ринита. Российский вестник перинатологии и педиатрии. 2021;66(6):129–133. DOI: 10.21508/1027-4065-2021-66-6-129-133. [Bogomilskiy M.R., Radtsig E.Yu., Pivneva N.D., Kesya O. Comparing effectiveness of various decongestants in the treatment of acute infectious rhinitis. Russian Bulletin of Perinatology and Pediatrics). 2021;66(6):129–133 (in Russ.)]. DOI: 10.21508/1027-4065-2021-66-6-129-133.
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