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© Borgis - New Medicine 2/2005, s. 20-23
Lechosław P. Chmielik, Anna Kaczmarczyk, Mieczysław Chmielik
Diagnostic and therapeutic difficulties in children with chronic rhinosinusitis
Clinic of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head: Prof. Mieczysław Chmielik MD, PhD
Summary
Chronic rhinosinusitis in children generates various clinical problems in laryngological practice. In our paper, we present two clinical cases and discuss diagnostic and therapeutic courses/proceedings for children with chronic rhinosinusitis.
INTRODUCTION
Chronic rhinosinusitis is a combined condition, influenced by many factors. Symptoms of chronic or prolonged rhinosinusitis include mucopurulent secretion in nasal cavities, cough, particularly after falling asleep or shortly before awakening. Older children may complain of headaches or tenderness in sinus regions. Febrile or sub-febrile conditions may be observed. Chronic or prolonged rhinosinusitis is diagnosed in children when the abovementioned symptoms persist for at least 12 weeks. Retardation in physical development or disturbances of mental concentration may be associated to the symptoms. The most frequent causes for chronic rhinosinusitis in children are anomalies in the development of the lateral wall of the nose causing stenosis of the ostio-meatal complex and deformation of the nasal septum. The treatment of chronic conditions requires surgical elimination of the causes by endoscopic sinus surgery.
AIM OF THE STUDY
Analysis of the non-typical symptoms in children with chronic rhinosinusitis, based on 2 cases.
MATERIAL AND METHOD
Case report – 1
A 7-year-old boy (W.N., no 10272/2005) was admitted to the Department of Pediatric Laryngology, transferred form other hospital because of a tumor found in the left nasal cavity. Medical history evidenced disturbances of nasal patency, purulent secretion in nasal cavities and snoring, observed for the last 6 months. According to the mother´s words, a pale-yellow discharge fluid appeared after effort. In June 2005, a pathological mass was evidenced in the left nasal. Computed topography revealed a mass which obstructed the left nasal cavity, with opacity present in the left maxillary sinus.
No communication of the tumour with the central nervous system was demonstrated. A cerebro - meningeal hernia was suspected, therefore the patient underwent exploratory surgery. Nasopharyngoscopy was performed in July 2005. A pale-grey polyp-shaped tumour with vascular netting on the surface, obstructing the left nasal cavity and nasopharynx was evidenced. The adenoid was also shown. The tumour was punctured and 2 ml of transparent, yellow fluid was obtained. The biochemical properties of the fluid were as follows: cytosis – 21/mL, glucose level – 85 mg%, chlorides – 107 mmol/l, polymorphonuclear cells – 28%, lymphocytes – 72%, and a small count of erythrocytes.
After surgery, a second computed topography was performed showing a reduction of the mass filling the left maxillary sinus, with continuity into the nasal cavity through a damaged section of the lateral nasal wall. The child was transferred to our Department for further therapy. At admission, the boy was in good general condition, without evident symptoms of acute infection of the upper respiratory tract. No abnormalities were evidenced on paediatric examinations, beside a haemangioma of the left shoulder and left upper limb. On laryngological examination: decreased patency of the nose, grey glossy mass in left nasal cavity. The previous CT images were presented to radiologists. Communication of the polyp with central nervous system was not visible, and cerebro-meningeal hernia was excluded. The boy was qualified for endoscopic sinus surgery. The procedure was performed in August 2005. During surgery, the mass from the left nasal cavity was removed. Amber fluid was aspirated from the sinus and remnants of the walls of the cysts and polypiform mucus, especially from the region of the natural ostium of the sinus, were found and removed. The uncinate process and the second part of the choanal polyp were removed. No complications were observed in the postoperative period (Fig. 1).
Fig. 1. Computed tomography shows a mass obstructing the left nasal cavity and opacity in the left maxillary sinus.

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Piśmiennictwo
1. Chmielik M. Otolaryngologia Dziecięca. Warszawa PZWL 2000. 2.Saito H, Honda N, Yamada T, Mori S, Fujieda S, Saito T. Intractable pediatric chronic sinusitis with antrochoanal polyp. Int J Pediatr Otorhinolaryngol. 2000 Aug 31;54(2-3):111-6. 3.Lopatin A, Bykova V, Piskunov G. Choanal polyps: one entity, one surgical approach? Rhinology. 1997 Jun;35(2):79-83. 4.Morgan DW, Evans JN. Developmental nasal anomalies. J Laryngol Otol. 1990 May;104(5):394-403. 5. Katori H, Tsukuda M. Lobular capillary hemangioma of the nasal cavity in child. Auris Nasus Larynx. 2005 Jun;32(2):185-8. Epub 2005 Mar 23. 6.Krzeski A, Janczewski G. Choroby nosa i zatok przynosowych. Warszawa. Sanmedia Wydawnictwo Medyczne 1997. 7.Ligęziński A. i wsp., Postępy w diagnostyce i leczeniu chorób nosa i zatok przynosowych. Medycyna Parktyczna, Kraków 1998. 8.Kirtsreesakul V, Naclerio RM, Role of allergy in rhinosinusitis. Curr Opin Allergy Clin Immunol. 2004 Feb;4(1):17-23. 9.Sanclement JA, Webster P, Thomas J, Ramadan HH, Bacterial biofilms in surgical specimens of patients with chronic rhinosinusitis. Laryngoscope. 2005 Apr;115(4):578-82.
Adres do korespondencji:
laryngologia@litewska.edu.pl

New Medicine 2/2005
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