Clinical presentation of acute rhinosinusitis in children reflects - PDF document

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/5889815 Clinical presentation of acute rhinosinusitis in children reflects paranasal sinus development Article in Rhinology · October 2007 Source: PubMed CITATIONS READS 4 41 8 authors , including: Gian Luigi Marseglia Fabio Pagella Policlinico San Matteo Pavia Fondazione IRCCS Policlinico San Matteo Pavia Fondazione IRCCS 211 PUBLICATIONS 2,085 CITATIONS 113 PUBLICATIONS 2,063 CITATIONS SEE PROFILE SEE PROFILE Giorgio Ciprandi Casa di Cura Villa Montallegro 667 PUBLICATIONS 11,851 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Eosinophilic gastrointestinal disorders View project Atopic eczema treatment and prevention View project All content following this page was uploaded by Giorgio Ciprandi on 02 September 2015. The user has requested enhancement of the downloaded file.

R hi no l ogy , 4 5 , 202 - 20 4, 200 7 C li n i ca l presentat i on of acute r hi nos i nus i t i s i n c hild ren ref l ects paranasa l s i nus d e v e l opment* 1 , F a bi o Page ll a 2 , Da vid e Ca i mm i 1 , S ilvi a Ca i mm i 1 , G i an Lu i g i Marseg li a 1 , Al ess i a Marseg li a 1 , Cat h er i ne K l ersy 3 , G i org i o C i pran di 4 Ma dd a l ena Leone 1 D i part i mento di Sc i enze Pe di atr i c h e , F on d az i one IRCCS Po li c li n i co San Matteo , Un iv ers i tà di Pa vi a , Ita l y 2 C li n i ca ORL , F on d az i one IRCCS Po li c li n i co San Matteo , Un iv ers i tà di Pa vi a , Ita l y 3 Ser vi z i o di B i ometr i a e d E p id em i o l og i a C li n i ca , F on d az i one IRCCS Po li c li n i co San Matteo , Pa vi a , Ita l y 4 D i part i mento di Me di c i na Interna , A z i en d a Ospe d a li era Un iv ers i tar i a San Mart i no , Geno v a , Ita l y SUMM A RY Background: Acute rhinosinusitis (ARS) usually presents with respiratory symptoms that persist for more than 10 days without improving. The aim of the study was to establish whether age may have any influence on the clinical presentation during childhood. Methods: This prospective study evaluated 287 consecutive children (152 males and 135 females, aged between 2 and 15 years), in whom mild-moderate ARS was clinically suspected. Nasal endoscopy was performed in all of them to confirm the diagnosis. Results: Endoscopy confirmed clinical diagnosis of ARS in 256 patients (89.2%). The age has shown to have significant influence on the clinical presentation pattern. Conclusions: This study provides evidence that age significantly influences the clinical presentation in children with mild-moderate ARS. Key words: acute rhinosinusitis, clinical presentation, age, nasal endoscopy, nasal obstruction of d e v e l opment d ur i ng spec i f i e d age co h orts ( 2 , 9 ) . INTRODUCTION A cute r hi nos i nus i t i s (A RS ) represents a common di sor d er , T h us , t h e a i m of t hi s stu d y w as to esta bli s h wh et h er age may assoc i ate d wi t h cons i stent mor bidi ty an d l arge prescr i pt i on of h a v e any i nf l uence on t h e c li n i ca l presentat i on of A RS i n c hil- ant ibi ot i cs (1-1 0 ) . A RS h as a s i gn i f i cant i mpact on c li n i ca l prac - d ren. t i ce ; i t frequent l y occurs as a consequence of i nfect i ous r hi n i- t i s , whi c h i s genera ll y cause d b y vi ra l agents. It i s w e ll k no w n M A T E RI A LS A ND M E THODS t h at young c hild ren exper i ence 6 to 8 vi ra l upper resp i ratory Patients i nfect i ons per year , 5 -1 0% of whi c h may b e comp li cate d b y T hi s prospect iv e stu d y e v a l uate d 28 7 c hild ren (1 52 ma l es an d A RS ( 5 ) . 1 35 fema l es , age d b et w een 2 an d 1 5 years ), i n i t i a ll y seen b y a A RS i s c h aracter i ze d b y symptoms t h at may l ast se v era l d ays or genera l pae di atr i c i an an d t h en sent to our Pae di atr i c e v en up to 1 2 w ee k s. In a ddi t i on , t h e se v er i ty may b e c l ass i f i e d Department , wi t h suspecte d di agnos i s of m ild- mo d erate A RS. as m ild- mo d erate or se v ere ( 3 ,4) . T h e ma i n symptoms i nc l u d e A cute cases of A RS w ere not stu di e d b ut di rect l y referre d to puru l ent r hi norr h ea (b ot h anter i or an d poster i or ), nasa l t h e E mergency Room or to an E NT spec i a li st. o b struct i on , coug h, h ea d ac h e an d h a li tos i s (1, 3 -7,1 0 ) . Un l ess A RS i s a d equate l y di agnose d an d treate d, i t may l ea d to b ot h c h ron - Diagnosis i c r hi nos i nus i t i s an d se v ere comp li cat i ons ( potent i a ll y a l so li fe - D i agnost i c cr i ter i a w ere b ase d on t h e presence of t w o ma j or t h reaten i ng ), e v en t h oug h i t i s i n i t i a ll y m ild- mo d erate. T h us , i t symptoms or one ma j or an d at l east t w o m i nor ones accor di ng to v a lid ate d gu id e li nes (1, 3 ,4,1 0 ) . Ma j or symptoms i nc l u d e muco - i s i mportant for t h e pe di atr i c i an to prompt l y recogn i ze A RS. In t hi s regar d, t h e 1 0 -d ay mar k, t h at i s to say t h e presence of res - puru l ent anter i or r hi norr h ea , poster i or nasa l di sc h arge (i .e. t h e p i ratory symptoms for l onger t h an 1 0 d ays wi t h out any post - nasa l d r i p ), an d nasa l o b struct i on , wh ereas m i nor symp - toms i nc l u d e h ea d ac h e , coug h, an d h a li tos i s (1, 3 ,4,1 0 ) . Dry coug h i mpro v ement , i s cons id ere d a re li a bl e cr i ter i on to c li n i ca ll y di f - ferent i ate s i mp l e upper resp i ratory vi ra l i nfect i on from A RS (1 2 ) . w as d ef i ne d b y t h e presence of an attac k of non - pro d uct iv e T h e d e v e l opment pattern of paranasa l s i nuses h as to b e con - coug h, wh ereas w et coug h w as c h aracter i ze d b y t h e presence s id ere d as v ery i mportant too. In d ee d, i t wid e l y v ar i es accor d- of pro d uct iv e coug h assoc i ate d wi t h p hl egm. Muco id r hi nor - i ng to t h e su bj ect as w e ll as to hi s age , t h e et h mo id s i nuses r h ea w as c h aracter i ze d b y c l ear mucus di sc h arge , wh ereas b e i ng t h e f i rst to fu ll y d e v e l op , sequent i a ll y fo ll o w e d b y max il- puru l ent r hi norr h ea w as c h aracter i ze d b y ye ll o w- green mater i- l ary , sp h eno id, an d fronta l s i nuses. E ac h s i nus h as a rap id rate a l . T h e post - nasa l d r i p w as c h aracter i ze d i n sma ll er c hild ren b y *Rece iv e d for pu bli cat i on: May 11, 200 7; accepte d : June 1, 200 7