Acute rhinosinusitis in children is defined as sudden onset of two or more of the symptoms:
• nasal blockage/obstruction/congestion
• or discoloured nasal discharge
• or cough (daytime and night-time)
for < 12 weeks; with symptom free intervals if the problem is recurrent.
Assessment should also be made of allergic symptoms (i.e. sneezing, watery rhinorrhoea, nasal itching, and itchy watery eyes). ARS can occur once or more than once in a defined time period. This is usually expressed as episodes/year but there must be complete resolution of symptoms between episodes for it to constitute genuine recurrent ARS.
ARS – Clinical Course:
- Common cold/ acute viral rhinosinusits is defined as: duration of symptoms for less than 10 days.
- Acute post-viral rhinosinusitis is defined as: increase of symptoms after 5 days or persistent symptoms after 10 days with less than 12 weeks duration.
- Acute bacterial rhinosinusitis (ABRS) is suggested by the presence of at least 3 symptoms/signs of:
• Discoloured discharge (with unilateral predominance) and purulent secretion in the nasal cavity
• Severe local pain (with unilateral predominance)
• Fever (>38ºC)
• Elevated ESR/CRP
• ‘Double sickening’ (i.e. a deterioration after an initial milder phase of illness).
Please see Primary Care management for further detail.
Who to refer:
IMMEDIATE EMERGENCY REFERRAL to A&E or on call ENT is required if any of the following are present:
- periorbital oedema / erythema
- displaced globe
- double vision
- ophthalmoplegia
- reduced visual acuity
- severe unilateral or bilateral frontal headache
- frontal swelling
- signs of meningitis
- neurological signs.
Some children with severe bacterial rhinosinusitis may also need urgent assessment in A&E.
Where a diagnosis needs to be secured, please consider anterior rhinoscopy (using otoscope and large speculum or head light and nasal speculum).
CT AND X-RAYS are not recommended.
Saline irrigation and topical nasal steroids can be helpful for ongoing rhinosinusitis symptoms.
For severe cases, where acute bacterial rhinosinusits is being considered, consider antibiotics (or referral for acute admission for more severe illness).
Please see the RefHelp Chronic Rhinosinusitis page for management of longer term symptoms.
Nice Clinical Knowledge Summary (from age 3 months; covers acute and chronic sinusitis management): https://cks.nice.org.uk/sinusitis
The European Position Paper on Rhinosinusitis and Nasal Polyps – Epos Guidelines 2020:
www.rhinologyjournal.com/Documents/Supplements/supplement_29.pdf
