{"id":22487,"date":"2025-01-13T15:07:49","date_gmt":"2025-01-13T15:07:49","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=22487"},"modified":"2025-02-04T14:15:56","modified_gmt":"2025-02-04T14:15:56","slug":"chronic-rhinosinusitis-paediatric","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/nose-sinus-paediatric\/chronic-rhinosinusitis-paediatric\/","title":{"rendered":"Chronic Rhinosinusitis &#8211; Paediatric"},"content":{"rendered":"\n<p>Chronic rhinosinusitis is a multifactorial condition, defined by symptoms lasting longer than 12 weeks.<\/p>\n\n\n\n<p>It affects mostly older children, in the 10-to-15-year age group.<\/p>\n\n\n\n<p><strong>Diagnostic Criteria<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Characteristic symptoms <strong>in addition<\/strong> to objective evidence of sinonasal inflammation on examination<\/li>\n\n\n\n<li>Presence of nasal blockage (obstruction\/congestion) <strong>or <\/strong>nasal discharge (anterior\/posterior nasal drip)<\/li>\n<\/ul>\n\n\n\n<p><strong>AND<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Facial pain\/pressure and\/or cough (day <strong>and<\/strong> night)<\/li>\n\n\n\n<li>Lasting for longer than 12 weeks.<\/li>\n<\/ul>\n\n\n\n<p>Predisposing factors include exposure to cigarette smoke, bacterial infection, allergy, physical obstruction, immune deficiency, cystic fibrosis and prolonged use of intranasal decongestants.<\/p>\n\n\n\n<p>Patients with coexisting allergic rhinitis may also have symptoms such as sneezing, watery rhinorrhoea, nasal itching and itchy watery eyes.<\/p>\n\n\n\n<p><strong>C.M. &amp; G.T. 21-01-25<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<p><em>Periorbital cellulitis is a red flag for acute ethmoiditis and these children should be referred to the A&amp;E Department immediately.<\/em><\/p>\n\n\n\n<p>Non-emergency referral is indicated for:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unilateral symptoms<\/li>\n\n\n\n<li>Obstruction without other symptoms<\/li>\n\n\n\n<li>The measures recommended under \u2018Primary Care Management\u2019 have failed, and symptoms have persisted for greater than 3 months<\/li>\n<\/ul>\n\n\n\n<p><em>Note: If referring for nasal polyps, please provide photos as the vast majority of possible polyps are engorged turbinates (see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-ent\/nose-sinus-paediatric\/nasal-polyps-paediatric\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Nasal Polyps<\/a>).<\/em><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Primary Care Assessment &amp; Management<\/strong><\/p>\n\n\n\n<p><strong>Anterior rhinoscopy <\/strong>(using otoscope and large speculum or head light and nasal speculum)<strong>:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Signs which support a diagnosis of chronic sinusitis such as nasal inflammation, mucosal oedema and <strong>mucopurulent<\/strong> discharge<\/li>\n\n\n\n<li>Associated pathology such as nasal polyps.<\/li>\n<\/ul>\n\n\n\n<p><strong>Assess for predisposing factors<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Allergic rhinitis<\/li>\n\n\n\n<li>Asthma<\/li>\n\n\n\n<li>Immunosuppresion<\/li>\n\n\n\n<li>Exposure to cigarette smoke (active\/passive) <\/li>\n<\/ul>\n\n\n\n<p><strong>Management<\/strong><\/p>\n\n\n\n<p><em>CT scans and plain X-rays should NOT be performed.<\/em><\/p>\n\n\n\n<p>Address predisposing factors including allergen avoidance<\/p>\n\n\n\n<p><strong><em>Regular nasal douching with saline solutions<\/em><\/strong><\/p>\n\n\n\n<p>Intranasal steroids for a minimum of 3 months<\/p>\n\n\n\n<p>Oral antihistamine if suspect allergy<\/p>\n\n\n\n<p>Treat eye symptoms if present (Sodium chromoglygate)<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Nice Clinical Knowledge Summary (from age 3 months; covers acute and chronic sinusitis management): <a href=\"https:\/\/cks.nice.org.uk\/sinusitis\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/cks.nice.org.uk\/sinusitis<\/a><\/p>\n\n\n\n<p>The European Position Paper on Rhinosinusitis and Nasal Polyps &#8211;&nbsp; <a href=\"https:\/\/www.rhinologyjournal.com\/Documents\/Supplements\/supplement_29.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Epos<\/a> Guidelines 2020:<\/p>\n\n\n\n<p><a href=\"http:\/\/www.rhinologyjournal.com\/Documents\/Supplements\/supplement_29.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">www.rhinologyjournal.com\/Documents\/Supplements\/supplement_29.pdf<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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 AND 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<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":22473,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1211,183],"class_list":["post-22487","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-chronic-rhinosinusitis-paediatric","category-rhinosinusitischronicpaeds"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entpaediatric\/https-apps-nhslothian-scot-refhelp-nose-sinus-paediatric\/https-apps-nhslothian-scot-refhelp-chronic-rhinosinusitis-paediatric\/\" rel=\"tag\">Chronic Rhinosinusitis-Paediatric<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/entpaediatric\/rhinosinusitischronicpaeds\/\" rel=\"tag\">Rhinosinusitis - Chronic (Paeds)<\/a>","rttpg_excerpt":"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 AND 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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22487","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=22487"}],"version-history":[{"count":3,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22487\/revisions"}],"predecessor-version":[{"id":22603,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22487\/revisions\/22603"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22473"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=22487"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=22487"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}