Inflammatory disorders of the upper respiratory tract are very frequent in people. Present living conditions, especially staying most of the time indoors, in heated or air-conditioned rooms, makes for additional loading on the respiratory tract. This loading concerns mainly the nose and paranasal sinuses, the places where the atmospheric air changes to respiratory air. A properly functioning respiratory system can perform sufficiently the above-mentioned functions. Nevertheless, leaving small children in a permanently infected environment, in poor climate conditions, may cause exhaustion of adaptive and defensive properties of the upper respiratory tract and lead to symptoms of inflammation. Allergic disorders may play a significant but difficult to assess role.

Sinusitis at the development age is an inflammatory process of the mucosa of the upper respiratory tract caused by infection or allergy, with disturbances of the drainage and ventilation of the nasal cavities and paranasal sinuses. Most cases of sinusitis in children are found together with rhinitis. So this disorder is named rhinosinusitis (according to Danielewicz).

Inflammation of the upper respiratory tract in children, especially in young children, has a different course from analogous disorders in adults, because of the different anatomical structure of the nose and paranasal sinuses, different immunological properties of the mucous membrane of this region and different defensive possibilities of the reticuloendothelial system. So, the classifications of sinusitis proposed by Lanz, Kennedy, Lunda and Benningera are not possible to completely use for patients at the development age.

The classification of inflammatory disorders of the nose should be based on Zeiger´s classification from 1998, in Orgel´s modification from 1991. The Mygind classification from 1993 and Meltzer from 1994, which take into account inflammatory non-inflammatory and structural rhinitis, may be used also.

So we proposed our own classification based on investigations over a few tens of years, as a special interest in this problem in our Paediatric Department of Medical University.

The proposed classification appears as below.

1. Acute rhinosinusitis.

2. Prolonged rhinosinusitis (in the literature described sometimes as subacute).

3. Chronic rhinosinusitis.

The clinical implications of this system are adjusted to the physiopathology of the child. The therapeutic consequences arising from this classification have a high clinical effectiveness. The classifications of the disorders of the nose and paranasal sinuses in adults do not exclude the presented system, but may more precisely assess the course of disease in a particular patient.

Acute rhinosinusitis is recognized on the history (loss of appetite, fever, irritation or sleepiness, sometimes vomiting). On examination congestion of the nasal turbinates and mucous or mucopurulent discharge from the nasal cavities are found. This mucopurulent secretion may be seen on the posterior wall of the pharynx. The secretion may not present when a massive oedema completely blocks the natural ostia of the sinuses. Acute sinusitis is more frequently seen in the ethmoid sinuses in younger children than in older children. In the case of total blockage of the pus in ethmoid sinuses purulent orbital complications may be seen as blepharo-oedema. Intracranial complications with numerous, various symptoms may develop too.

The treatment of acute rhinosinusitis may include administrations of antibiotics effective against bacteria most commonly known as a cause of sinusitis or according to the antibiogram of the sample of the secretion taken from the sinus cavities, from its ostia or from the nose. The poor diagnostic value of a culture from the nose should be emphasised.

Prolonged rhinosinusitis is a disorder typical for children in the pre-school and early school age. It arises from specific humoral and cellular mechanisms of the immunological responses of the upper respiratory tract. One of the more frequent forms of this disorder is inobronchial syndrome, and its symptoms include a mucopurulent discharge from both nasal cavities lasting for a few months in autumn and winter and episodes of cough in the evening and early morning or after exercise. Sinobronchial syndrome develops when the patency of the natural ostia of the sinuses is preserved. Treatment of sinobronchial syndrome in children involves antibiotycotherapy for 3 weeks; antibiotics should act on pathogens causing this disorder. Additionally, immunomodifying drugs and climatotherapy may be efficient.

Chronic rhinosinusitis – it is a long-lasting inflammatory process caused by bacteria, viruses, fungi or by allergen factors in children with structural impairment of the patency of the nasal cavities and ostia of the paranasal sinuses, by disturbances of the mucociliary transport or immunological defect.

The complaint lasts throughout the year; generally a seasonal course is not seen. Treatment is surgical and the obstruction is removed and dilation of the natural ostia of the sinuses is performed. Defect of the mucociliary transport or immunologic system disorders are treated by high-trained capitalistic paediatric wards.

The schema of the diagnostic and therapeutic management of rhinosinusitis in children is based on the accessible world literature and our own investigations. This scheme is still being updated.

The scheme is shown below.