Diagnosis and Treatment of Pediatric Chronic Sinusitis
Collar, Janet Lynn
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Although chronic sinusitis triggers billions of dollars of healthcare expenditures each year, surprisingly little is known about its epidemiology, pathophysiology, and management. The immune theories of chronic sinusitis serve as a theorectical framework and conceptual model for this paper. To accomplish this, the initial sections of this paper are devoted to a general discussion of basic immunology to lay a strong foundation for understanding the complex immune aspects of the disease. The pathophysiology and management of pediatric chronic sinusitis is presented in this manuscript. Factors thought to contribute to pediatric chronic sinusitis, including inflammation, microbial invasion, allergic rhinitis, non-infectious-non-allergic rhinitis, anatomic obstruction, cystic fibrosis, immunodeficiency, frequent upper respiratory infections, asthma, and gastroesophageal reflux are examined. Drug treatment options including: antibiotics, nasal steroids, decongestants, mucolytics, antihistamines, and nasal irrigation will be evaluated for their efficacy and value. Also, the risks and benefits of surgical intervention are discussed. The use of Computed Tomography (CT) scans in the diagnostic treatment will be discussed. Antibiotic treatment based on recent sinus nasal aspirate culture and sensitivity studies will be reviewed and evaluated for their efficacy.