Chronic rhinosinusitis and adenoiditis in children

Rinosinuitis je simptomatska upala sluznice nosne šupljine i paranazalnih sinusa. Rinosinuitis se, ovisno o trajanju simptoma, dijeli na akutni u trajanju do četiri tjedna te subakutni u trajanju od četiri do dvanaest tjedana. Kronični rinosinuitis definiran je najmanje dvama simptomima koji traju duže od dvanaest tjedana. Podaci o trajanju simptoma dobivaju se ili od pacijenta osobno ili heteroanamnestički. Klinička slika kod djeteta varira ovisno o dobi, a obuhvaća: nazalnu opstrukciju, mukopurulentnu rinoreju, postnazalni drip i posljedični kašalj, što bitno narušava higijenu spavanja i, uz uvećane adenoide, dovodi do opstrukcije disanja u snu. Nadalje, javlja se osjećaj punoće, pritiska ili boli lica u projekciji sinusa te glavobolja. Etiologija i patogeneza kroničnog rinosinuitisa je vezana uz velik broj čimbenika, a često se povezuje s hipertrofijom adenoidnih vegetacija prekrivenih gustim biofilmom bakterija. Dijagnoza kroničnog rinosinuitisa kod djeteta postavlja se kliničkim pregledom, rinoskopijom i endoskopijom. Kompjutorizirana tomografija sinusa, stupnjevana prema Lund – Mackayevom sustavu bodovanja, korisna je u dijagnostici, procjeni komplikacija te predoperacijskoj dijagnostici. Čimbenici koji predodređuju razvoj bolesti mogu biti lokalni i sustavni. Lokalni obuhvaćaju devijaciju nazalnog septuma, nazalne polipe ili hipertrofiju adenoidnih vegetacija u epifarinksu. U daljnjoj dijagnostičkoj obradi potrebno je isključiti sustavne bolesti: alergijski rinitis, astmu, cističnu fibrozu ili mukocilijarnu disfunkciju. Liječenje pedijatrijske populacije može biti medikamentozno i kirurško. Smanjenje upale sluznice i poboljšanje mukocilijarnog protoka postiže se ispiranjem izotoničnom ili hipertoničnom fiziološkom otopinom, nazalnim dekongestivima, antibioticima i intranazalnim ili peroralnim kortikosteroidima. Kirurškim pristupom razmatra se adenoidektomija s ili bez ispiranja sinusa, endoskopski te funkcionalni endoskopski kirurški pristup sinusima. Adenoidektomija u kombinaciji s ispiranjem sinusa dovodi do poboljšanja simptoma i unapređenja kvalitete života pacijenta.Rhinosinusitis is a symptomatic inflammation of the nasal mucosa and the paranasal sinuses. Rhinosinusitis is classified according to duration into acute, up to 4 weeks, subacute between 4 and 12 weeks duration, respectively, and chronic rhinosinusitis, which is defined with at least two symptoms, lasting longer than 12 weeks. History taking is obtained either from the patient themselves and/or from the patient's caregivers. Depending on the age, the patients most frequently exhibit nasal obstruction, mucopurulent secretion, postnasal drip, as well as consequent cough, which significantly disturbs sleep, and, with increased adenoids, leads to obstruction of breathing during sleep. In addition to the aforementioned symptoms, there is also a feeling of fullness, pressure or pain in the face of projection of the sinuses and headache. Furthermore, it is characterized by multifactorial pathogenetic factors. Hypertrophy of adenoids, covered with dense bacterial biofilm, causes either mechanical posterior nasal obstruction or compromises ventilation and mucociliary transport. Diagnostic procedures include rhinoscopy and endoscopy, as the process of a visual examination of the nasal cavity and nasopharynx. Computed tomography of paranasal sinuses, graded according to Lund – Mackay scoring system is specific and sensitive enough to confirm the diagnosis and evaluate complications, as well as to complement perioperative diagnostic procedures. Furthermore, predisposition for such condition combines both local and systematic causes. Nasal septum deviation, nasal polyps as well as hypertrophy of adenoids in nasopharynx insinuate local, whereas further diagnostic procedures exclude systemic causes, such as allergic rhinitis, asthma, cystic fibrosis or mucociliary dysfunction. Treatment options for chronic rhinosinusitis include medications and surgical procedures. Isotonic or hypertonic saline solution, nasal decongestants, antibiotics and topical intranasal or oral corticosteroids in the majority of patients improve the quality of life. Surgical procedures can include adenoidectomy, with or without sinus wash, endoscopic sinus surgery or functional endoscopic sinus surgery. Adenoidectomy combined with sinus lavage reduces symptoms and improves the quality of life of the patients