Lusk Rodney
ENT Institute, Boys Town National Research Hospital, Omaha, NE 68131, USA.
Curr Opin Otolaryngol Head Neck Surg. 2006 Dec;14(6):393-6. doi: 10.1097/MOO.0b013e32801000ed.
Pediatric acute and chronic rhinosinusitis are common pediatric ailments averaging six to eight occurrences a year with 0.5-5% of these progressing to acute sinusitis. A yet undefined number of children progress to chronic sinusitis. Significant resources are spent treating children for sinus infections that would otherwise clear on their own. Practice guidelines for chronic sinusitis are needed.
Good prospective studies are lacking because of the shear numbers of patients that must be enrolled to obtain a homogeneous population for study. This lack of good prospective studies prevents the development of pediatric practice guidelines for medical and surgical management of chronic rhinosinusitis. Most recent studies focus primarily on pathophysiology and medical management. An area of significant knowledge deficit is the role of gastroesophageal reflux disease in chronic sinusitis. There have been no recent significant changes in the medical or surgical management of chronic rhinosinusitis other than the rationale of performing an adenoidectomy prior to endoscopic sinus surgery for eradication of biofilms.
Current therapy for pediatric chronic rhinosinusitis continues to be prolonged courses of antibiotics and if the symptoms persist, staged surgical intervention with initial adenoidectomy followed by partial or anterior ethmoidectomy.
儿童急慢性鼻窦炎是常见的儿科疾病，平均每年发作6至8次，其中0.5% - 5%会发展为急性鼻窦炎。发展为慢性鼻窦炎的儿童数量尚不明确。大量资源被用于治疗儿童鼻窦感染，而这些感染原本可能会自行痊愈。因此需要慢性鼻窦炎的治疗指南。
由于必须纳入大量患者才能获得同质化的研究群体，所以缺乏良好的前瞻性研究。这种缺乏良好前瞻性研究的情况阻碍了儿童慢性鼻窦炎药物和手术治疗实践指南的制定。最近的研究主要集中在病理生理学和药物治疗方面。一个存在重大知识空白的领域是胃食管反流病在慢性鼻窦炎中的作用。除了在内镜鼻窦手术前进行腺样体切除术以清除生物膜的理论依据外，慢性鼻窦炎的药物或手术治疗最近没有重大变化。
目前儿童慢性鼻窦炎的治疗仍然是长期使用抗生素，如果症状持续，则进行分阶段手术干预，首先进行腺样体切除术，然后进行部分或前筛窦切除术。
