Çocuklarda Tekrarlayan Rinosinüzite Yaklaşım

Öz

Rinosinüzit çocukluk çağında görülen viral üst solunum yolu enfeksiyonlarının en sıkkomplikasyonu ve antimikrobial etken için yazılan reçetelerin de beşinci sıklıktakiendikasyonudur. Klinikte genellikle on günden uzun süren nazal akıntı veya öksürük veya her ikisi görülür. Akut rinosinüzit dört haftadan kısa, kronik rinosinüzit 12haftadan uzun sürer.Çocuklarda tekrarlayan akut ve kronik rinosinüzitin en sık nedenleri tekrarlayan viralüst solunum yolu enfeksiyonları, allerjik rinit, septum deviasyonu, adenoid hipertrofi,siliyer disfonksiyon sendromları, burunda yabancı cisim, gastroözofageal reflü ve kistikfibrozdur. Tanı klinik olarak konur. X-ışını ile çekilen grafilerin enfeksiyonu saptamadayararı gösterilememiştir. Bilgisayarlı tomografi ve manyetik rezonans görüntülemeleriancak komplikasyondan şüphelenildiğinde yarar sağlar.Akut/kronik rinosinüzitin antibiyotik ile tedavisi halen tartışma konusudur. Yüksek dozamoksisilin ağır akut ve kronik rinosinüzitte ilk tercih edilecek ilaçtır. Parenteralantibiyotik uygulamaları ağır kronik olgularda önerilir. Mukolitik, dekonjestan veantihistaminikler gibi ek tedaviler ek yarar sağlamadığı için rutin olarak önerilmez.Nazal steroidlerin kronik veya tekrarlayan rinosinüzitli çocukların tedavisinde yararıolabilir

Anahtar Kelimeler

• Çocuklar,rinosinüzit,tedavi

Management of Recurrent Rhinosinusitis in Children

Öz

Rhinosinusitis is the most common complication of viral upper respiratory tractinfections and the fifth most common indication for the prescription for antimicrobialagents in childhood period. In clinical evaluation a persistant nasal discharge or cough or both lasting more than ten days are generally seen. Acute rhinosinusitis lasts lessthan four weeks and chronic rhinosinusitis persists more than 12 weeks. The common causes of recurrent acute and chronic rhinosinusitis are recurrent viralupper respiratory tract infections, allergic rhinitis, septal deviation, adenoidalhypertrophy, ciliary dysfunction syndromes, foreign body in nazal cavity,gastroesophageal reflux disease and cystic fibrosis in children. The rhinosinusitisshould be diagnosed clinically. Generally plain X-ray films are not helpful indemonstration of the infection. Computed tomography CT scan and magneticresonans imaging have advantages in a suspicion of a complication of rhinosinusitis. The management of acute/chronic rhinosinusitis with antibiotics is still in debate. Highdose amoksisilin is the first choise of drug for both of the severe acute and chronicbacterial rhinosinusitis. Parenteral antibiotic regiments are taken in account in the caseof severe chronic cases. Additive therapies with mucolitics, decongestans andantihistamines give no additional benefit, therefore are not recommended routinely.Nazal steroids might have a role in treatment of children with chronic or recurrentrhinosinusitis

Anahtar Kelimeler

• Children,rhinosinusitis,treatment

Kaynakça

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