Pediatric Chronic Rhinosinusitis: Treatment Options to Consider

Pediatric chronic rhinosinusitis (CRS) is a prevalent condition marked by sinus and nasal mucosal inflammation.¹ Diagnosis of pediatric CRS requires the presence of sinus symptoms for ≥3 months despite standard medical treatment with antibiotics, steroids, and nasal rinses and sprays. A recent consensus statement asserted that “at least two of the following should be present to diagnose CRS: nasal obstruction, purulent rhinorrhea, cough, facial pressure or pain, purulent drainage, endoscopic or CT scan findings consistent with the diagnosis, mucosal edema, or nasal polyposis.”

Not only does CRS cause significant morbidity and a decrease in quality of life, it is also a major healthcare resource and financial burden.¹ Due to the complexity of the etiology and pathophysiology of the disease, multiple diagnoses must be considered prior to determining an appropriate treatment plan, thus increasing costs. Because of this, it is important for providers to be able to accurately and efficiently evaluate, diagnose, and treat pediatric CRS. 

The first step in the management of pediatric CRS includes conducting a thorough medical evaluation of the patient and determining the subtype of a patient’s disease.¹ Because determining an appropriate treatment plan for a patient depends on the subtype of the disease, it is imperative for providers to know and understand the underlying mechanisms of CRS as well as the components included in a medical evaluation of a patient. Table 1 lists the mechanisms of CRS and Table 2 summarizes the recommended components that should be included in a medical evaluation.  

For pediatric patients diagnosed with CRS, initial management of the disease includes both medical therapy as well as counseling on techniques of proper “sinus hygiene”.¹ Goals of treatment for pediatric CRS include a decrease in inflammation, an improvement in drainage, and elimination of pathogens. Medical therapies include antibiotics, nasal irrigation, topical and/or oral steroids, allergen immunotherapy, as well as combinations of these therapies. Table 3 provides a summary of the various medical treatment options for pediatric CRS. Surgical management of pediatric CRS is an alternative treatment route that can be utilized for patients as well. Early consideration of surgical adenoidectomy has shown to improve outcomes in pediatric patients with CRS. Additionally, endoscopic sinus surgery can also be conducted in some pediatric CRS cases.

There are also several potential therapeutic options that are currently under investigation for the treatment of CRS.¹ There is an increased focus on developing new potential therapies for allergic CRS. Medications currently being investigated include omalizumab, mepolizumab, reslizumab, and dupilumab. It is important to note that, although these monoclonal antibodies are being tested in adults with CRS, no trials including pediatric patients exist at this time.

Pediatric CRS is a common condition that causes significant morbidity and is a burden on healthcare resources and finances. Diagnosing pediatric CRS includes conducting a full evaluation of the patient as well as determining the subtype of their disease. Mainstays of therapy include antibiotics, nasal saline irrigation, intranasal and topical steroids, adenoidectomy, and endoscopic sinus surgery.

Reference

Heath J, Hartzell L, Putt C, Kennedy JL. Chronic Rhinosinusitis in Children: Pathophysiology, Evaluation, and Medical Management. Curr Allergy Asthm R. 2018; 18(7):37.