Chronic Rhinosinusitis – Paediatric

Chronic rhinosinusitis is a multifactorial condition, defined by symptoms lasting longer than 12 weeks.

It affects mostly older children, in the 10-to-15-year age group.

Diagnostic Criteria

Characteristic symptoms in addition to objective evidence of sinonasal inflammation on examination
Presence of nasal blockage (obstruction/congestion) or nasal discharge (anterior/posterior nasal drip)

AND

Facial pain/pressure and/or cough (day and night)
Lasting for longer than 12 weeks.

Predisposing factors include exposure to cigarette smoke, bacterial infection, allergy, physical obstruction, immune deficiency, cystic fibrosis and prolonged use of intranasal decongestants.

Patients with coexisting allergic rhinitis may also have symptoms such as sneezing, watery rhinorrhoea, nasal itching and itchy watery eyes.

Who to refer:

Periorbital cellulitis is a red flag for acute ethmoiditis and these children should be referred to the A&E Department immediately.

Non-emergency referral is indicated for:

Unilateral symptoms
Obstruction without other symptoms
The measures recommended under ‘Primary Care Management’ have failed, and symptoms have persisted for greater than 3 months

Note: If referring for nasal polyps, please provide photos as the vast majority of possible polyps are engorged turbinates (see RefHelp Nasal Polyps).

Primary Care Assessment & Management

Anterior rhinoscopy (using otoscope and large speculum or head light and nasal speculum):

Signs which support a diagnosis of chronic sinusitis such as nasal inflammation, mucosal oedema and mucopurulent discharge
Associated pathology such as nasal polyps.

Assess for predisposing factors