Çocuklarda Tekrarlayan Rinosinüzite Yaklaşım

Yıl 2012, Cilt: 10 Sayı: 2, 24 - 30, 01.09.2012

Pınar Uysal Özkan Karaman

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

• 1. Loebinger MR, Bilton D, Wilson R. Upper airway 2: Bronchiectasis, cystic fibrosis and sinusitis. Thorax 2009;64:1096-101.
• 2. Fokkens W, Lund V, Mullol J. European Position Paper on Rhinosinusitis and Nasal Polyps Group. EP3OS 2007: European position paper on rhinosinusitis and nasal polyps 2007. A summary for otorhinolaryngologists. Rhinology 2007;45:97-101.
• 3. Slavin RG. Nasal polyps and sinusitis. JAMA 1997;278:1849-54.
• 4. International Rhinosinusitis Advisory Board. Infectious rhinosinusitis in adults: classification, etiology, and management. Ear Nose Throat J 1997;76:5-22.
• 5. Brook I. Acute and chronic bacterial sinusitis. Infect Dis Clin North Am 2007;21:427-48.
• 6. Brook I. Chronic sinusitis in children. Pediatr Ann 2010;39:41-7.
• 7. Brook I. Treatment modalities for bacterial rhinosinusitis. Expert Opin Pharmocother 2010;11:755-69.
• 8. Sinus and Allergy Health Partnership. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg 2000;123:5-31.
• 9. Reid JR. Complications of pediatric paranasal sinusitis Pediatr Radiol 2004;34:933-42.
• 10. Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics 1991;87:129-33.
• 11. American Academy of Pediatrics. Subcommittee on Management of Sinusitis and Committee on Quality Improvement. Clinical practice guideline: management of sinusitis. Pediatrics 2001;108:798-808.
• 12. Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG et al. Clinical practice guideline:adult sinusitis. Otolaryngol Head Neck Surg 2007;137 (Suppl):1-31.
• 13. Clement PA, Bluestone CD, Gordts F, Lusk RP, Otten FW, Goossens H et al. Management of rhinosinusitis in children: consensus meeting, Brussels, Belgium, September 13, 1996. Arch Otolaryngol Head Neck Surg 1998;124:31-4.
• 14. Wald ER. Microbiology of acute and chronic sinusitis in children and adults. Am J Med Sci 1998;316:13-20.
• 15. Wald ER. Sinusitis. Pediatr Ann 1998;27:811-8.
• 16. Brook I. Current issues in the management of acute bacterial sinusitis in children. Int J Pediatr Otorhinolaryngol 2007;71:1653-61.
• 17. Loebinger MR, Bilton D, Wilson R. Upper airway 2: Bronchiectasis, cystic fibrosis and sinusitis. Thorax 2009;64:1096-101.
• 18. Wald ER. Chronic sinusitis in children. J Pediatr 1995;127:339-47.
• 19. Brook I, Thompson DH, Frazier EH. Microbiology and management of chronic maxillary sinusitis. Arch Otolaryngol Head Neck Surg 1994;120:1317-20.
• 20. Brook I, Frazier EH, Foote PA. Microbiology of the transition from acute to chronic maxillary sinusitis. J Med Microbiol 1996;45:372-5.
• 21. Brook I. Bacteriology of acute and chronic sphenoid sinusitis. Ann Otol Rhinol Laryngol 2002;111:1002-4.
• 22. Fokkens W, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M et al. EAACI Position Paper on rhinosinusitis and nasal polyps executive summary. Allergy 2005;60:583-601.
• 23. Gwaltney JM. Acute community-acquired sinusitis. Clin Infect Dis 1996;23:1209-23.
• 24. Ioannidis JP, Lau J. Technical report: evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children: a systematic overview. Pediatrics 2001;108(3):E57.
• 25. McAlister WH, Kronemer K. Imaging of sinusitis in children. Pediatr Infect Dis J 1999;18:1019-20.
• 26. Triulzi F, Zirpoli S. Imaging techniques in the diagnosis and management of rhinosinusitis in children Pediatr Allergy Immunol 2007;18(Suppl):46-9.
• 27. Herrmann BW, Forsen JW. Simultaneous intracranial and orbital complications of acute rhinosinusitis in children. Int J Pediatr Otorhinolaryngol 2004;68:619-25.
• 28. Germiller JA, Monin DL, Sparano AM, Tom LW. Intracranial complications of sinusitis in children and adolescents and their outcomes. Arch Otolaryngol Head Neck Surg 2006;132:969-76.
• 29. Sande MA, Gwaltney JM. Acute community-acquired bacterial sinusitis-continuing challenges and current management. Clin Infect Dis 2004;39(Suppl 3):151-8.
• 30. Ahovuo-Saloranta A, Rautakorpi UM, Borisenko OV, Liira H, Williams Jr JW, Mäkelä M. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev 2008;CD000243.
• 31. Brook I, Yocum P, Frazier EH. Bacteriology and beta-lactamase activity in acute and chronic maxillary sinusitis. Arch Otolaryngol Head Neck Surg 1996;122:418-22.
• 32. Brook I. Sinusitis-overcoming bacterial resistance. Int J Pediatr Otorhinolaryngol 2001;58:27-36.
• 33. Pichichero ME, Brixner DI. A review of recommended antibiotic therapies with impact on outcomes in acute otitis media and acute bacterial sinusitis. Am J Manag Care 2006;12(Suppl 10):292-302.
• 34. Sih TM, Bricks LF. Optimizing the management of the main acute infections in pediatric ORL: tonsillitis, sinusitis, otitis media. Braz J Otorhinolaryngol 2008;74:755-62.
• 35. Ahovuo-Saloranta A, Borisenko OV, Kovanen N, Varonen H, Rautakorpi UM, Williams JW Jr et al; Sinus And Allergy Health Partnership. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg 2004;130(Suppl 1):1-45.
• 36. Brooks I, Gooch WM 3rd, Jenkins SG, Pichichero ME, Reiner SA, Sher L et al. Medical management of acute bacterial sinusitis. Recommendations of a clinical advisory committee on pediatric and adult sinusitis. Ann Otol Rhinol Laryngol 2000;182:2-20.
• 37. Scadding GK, Durham SR, Mirakian R, Jones NS, Drake-Lee AB, Ryan D et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2008;38:260-75.
• 38. Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev 2009;CD005149.
• 39. Stephanie AJ, Rakhi T, Jie H. A systematic review of the use of intranasal steroids in the treatment of chronic rhinosinusitis Otolaryngology-Head and Neck Surgery 2008;139:340-7.
• 40. Barlan IB, Erkan E, Bakir M, Berrak S, Basaran MM. Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children. Ann Allergy Asthma Immunol 1997;78:598-601.
• 41. Druce HM. Adjuncts to medical management of sinusitis. Otolaryngol Head Neck Surg 1990;103:880-3.
• 42. Kassel JC, King D, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev 2010;CD006821.
• 43. Shaikh N, Wald ER, Pi M. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database Syst Rev 2010;CD007909.
• 44. Chan Y, Kuhn FA. An update on the classifications, diagnosis, and treatment of rhinosinusitis Current Opinion in Otolaryngology & Head and Neck Surgery 2009;17:204-8.
• 45. Parnes SM, Chuma AV. Acute effects of antileukotrienes on sinonasal polyposis and sinusitis. Ear Nose Throat J 2000;79:18- 20;24-5.
• 46. Edmondson NE, Parikh SR. Complications of Acute Bacterial Sinusitis in Children Pediatr Annals 2008;37:10-4.
• 47. Brook I. Microbiology of intracranial abscesses and their associated sinusitis. Arch Otolaryngol Head Neck Surg 2005;131:1017-9.