© Borgis - New Medicine 2/2005, s. 24-25
Lechosław P. Chmielik, Agata Kuniszyk, Mieczysław Chmielik
Diseases in chronic rhinosinusitis in children – initial report
Clinic of Paediatric Otorhinolaryngology Medical University of Warsaw, Poland
Head: Prof. Mieczysław Chmielik MD, PhD
Chronic rhinosinusitis in children is one of the most common conditions of this age. However, there is a wide range of other diseases with similar symptoms differing in aetiopathogenesis and treatment methods, such as prolonged rhinosinusitis or recurring acute rhinosinusitis. The present paper presents a collection and incidence analysis of symptoms characteristic for chronic rhinosinusitis. Headache and its location have been particularly important in the present study. Based on the analysis of 103 medical histories of children hospitalized and surgically treated for chronic rhinosinusitis, it has been established that the most common disorders were headaches and catarrh. The prevalent location of lesions was maxillary sinuses. The most common lesion was swelling.
Advances in diagnostic methods allow more and more accurate diagnostics of various diseases. Disorders undiagnosed until recently or classified in wider disease scopes may now be diagnosed with more accuracy (owing to computed tomography among others), thus more effectively managed. Progress in medicine also provides more advanced methods for the management of rhinitis and sinusitis. According to the classical definition, the term ´rhinosinusitis´ is applicable to inflammation of the mucous membranes of the nose and sinuses, connected with one or more of the following symptoms:
1. Nasal obstruction
2. Nasal discharge
3. Sneezing and pruritus
In the inflammatory stage of rhinosinusitis, as in any inflammatory state, pain may occur, especially in cases with inflammatory involvement paranasal sinuses. Such cases generate headaches, a common, interdisciplinary problem that should also be managed as a neurological and ophthalmologic disorder.
When analyzing available literature, authors found only a few reports regarding diseases that accompany rhinosinusitis in adults, and did not find any reports on rhinosinusitis in children. (2, 3).
In the course of rhinosinusitis, pain may have a radiating nature due to innervation by the trigeminal nerve. According to Kennedy, in the course of acute rhinosinusitis, symptoms are as follows:
– in case of ethmoid sinuses inflammation: pressure pain in eye corners, headaches around eye orbits, temporal pain
– in acute maxillary sinuses inflammation: cheek pain on one side, toothaches, orbital pain, temporal temples
– in frontal sinuses inflammation: acute headaches
– in sphenoid sinuses inflammation: posterior headaches in the occipital area, anterior temporal area, orbital area and jaw.
According to Levin (4), pain is experienced in the following areas:
– in case of frontal sinuses: pain in the frontal, temporal and occipital areas
– in case of maxillary sinuses: teeth, temporal area and cheeks
– in case of ethmoid sinuses: top of head, base of nose, upper neck
– in case of sphenoid sinuses: top of skull, temporal, occipital, mastoid areas, arms
In chronic rhinosinusitis, pain symptoms can either lessen or not occur at all.
AIM OF THE STUDY
The objective of the present study was to analyze the subjective and objective symptoms in children with chronic rhinosinusitis.
MATERIAL AND METHOD
The study consisted in an analysis of 103 medical histories of children hospitalized and surgically treated for chronic rhinosinusitis at the Clinic of Paediatric Otorhinolaryngology of the Medical University in Warsaw.
In the analysis, the following elements were taken into account:
1. Medical history, in particular:
– Incidence of headaches – location and duration
– Incidence of nose discharge – characteristics and duration
2. Patient examination:
– Nasal septum deviation
– Adenoid hypertrophy
3. Analysis of CT scans
– Pre-existing inflammatory lesions in sinuses
– Coexistence of concha bullosa
– Coexistence of inflammatory lesions
One hundred and three medical histories of children surgically treated for chronic rhinosinusitis were analysed. The average age was 10.8. There were 62 cases with pain disorders in area of the head (60.19% of children).
Localisation of headaches
Pain in the frontal area – 1
Pain in the temporal area – 2
Pain in the occipital area – 3
Pain without exact localisation – 4
Other locations – 5
Nose discharge was observed in 92 children (89.32%). Forty two children had a chronic nose discharge and in thirty cases it was a seasonal, autumn – winter nose discharge. In 27 cases, catarrh duration exceeded one year, in 4 cases it lasted one – three months, while in 7 cases, it lasted up to one month. Nose discharge had a purulent character in 76 children and rhinitis had such character in 16 children.
Types of nose discharge
Nasal polyps were detected in 3 patients, and conchal polyps were found in 3 patients. Nasal septum deviation was found in 26 patients and adenoid hypertrophy in 23. CT scans revealed Haller cells in 16 cases, swelling lesions in 65. In 79 cases, the lesions concerned maxillary sinuses, frontal ethmoid in 46 cases, posterior ethmoid in 33, frontal sinuses in 17, and sphenoid sinuses in 29. Hypoplasia was detected in 10 children.
Fig. 1. Computed tomography with inflammatory lesions in paranasal sinusitis.
1. The most common disorders in the examined group of children were headaches and catarrh
2. The most common location of lesions in computed tomography were those in maxillary sinuses
3. The majority of lesions found in computed tomography are of an oedematous character.
1. Chmielik M.: Otorynolaryngologia dziecięca (red.) PZWL 2001; 67-68. 2.Paediatric Otolaryngology. Bluestone Ch., Stool S., Alper C., et all. Saunders 2003, 933-939. 3.Antonelli A., Bisetti A., Ferrara A., et all: Fisiologia e fistiopatologia del tratto respiratorio integrato. E.S. Valeas 1995. 4.Krzeski A., Janczewski G.: Choroby nosa i zatok przynosowych. Sanmedia 1998, 209-226.