Department of Ophtalmology and Otolaryngology, Otolaryngology Clinic, University of Bari, Bari, Italy.
Pediatr Allergy Immunol. 2012 Aug;23 Suppl 22:5-16. doi: 10.1111/j.1399-3038.2012.01323.x.
The pathogenesis of rhinosinusitis (RS) is related to inflammation, caused by infections in the acute form of the disease but also by other agents in the chronic forms. Cytology allows to evaluate the defensive components, such as hair cells and muciparous cells, while the presence in the nasal mucosa of eosinophils, mast cells, bacteria and/or fungal hyphae, or spores indicates the nasal pathology. The anatomic and physiologic characteristics of the otorhinosinusal system account for the frequent concomitant involvement of the different components. The pivotal pathophysiologic sites are the ostiomeatal complex, the spheno-ethmoidal recess, and the Eustachian tube. The latter is the link with acute otitis media (AOM), which is the most common disease in infants and children and has major medical, social, and economic effects. Moreover, because of the strict relationship between upper and lower airways, nasal sinus disease may contribute to asthma and sinusitis may be considered as an independent factor associated with frequent severe asthma exacerbations. Concerning the role of allergy, the available data do not permit to attribute a central role to atopy in sinusitis and thus allergy testing should not be a routine procedure, while an allergologic evaluation may be indicated in children with OM, especially when they have concomitant rhinitis.
鼻窦炎的发病机制与炎症有关，急性形式的疾病由感染引起，但慢性形式也由其他因素引起。细胞学检查可以评估防御成分，如毛细胞和粘液细胞，而在鼻黏膜中存在嗜酸性粒细胞、肥大细胞、细菌和/或真菌菌丝或孢子则表明存在鼻病理。耳鼻咽喉系统的解剖和生理特征解释了不同成分经常同时受累的原因。关键的病理生理部位是口咽鼓管复合体、蝶筛隐窝和咽鼓管。后者与急性中耳炎（AOM）有关，AOM 是婴儿和儿童中最常见的疾病，具有重大的医疗、社会和经济影响。此外，由于上呼吸道和下呼吸道之间的密切关系，鼻-鼻窦疾病可能导致哮喘，而鼻窦炎可被视为与频繁严重哮喘加重相关的独立因素。关于过敏的作用，现有数据不允许将特应性在鼻窦炎中起主要作用，因此过敏测试不应作为常规程序，而在伴有 OM 的儿童中，特别是当他们同时伴有鼻炎时，过敏评估可能是必要的。
