Acute infectious rhinosinusitis is an acute infection of the mucosal areas of the nasal cavity and sinuses caused by pathogenic microorganisms such as viruses and bacteria, with symptoms lasting but not more than 12 weeks or pus with high fever (temperature ≥39°C) lasting at least 3 d, provided that fever caused by other factors (especially lower respiratory tract infection) is excluded.
The main symptoms are: nasal congestion, mucous (pus) nasal discharge, facial pain or headache, and in severe cases, fever. The younger the patient is, the more pronounced the systemic symptoms are.
Signs: congestion and swelling of the turbinate mucosa, mucous (pus) secretions in the nasal cavity and nasal passages, mucous (pus) secretions in the posterior pharyngeal wall, and pressure pain in the sinus area of the face.
Auxiliary examinations 1. Nasal endoscopy Nasal endoscopy is an important tool for diagnosis and is suitable for children of any age.
2. Sinus CT scan CT scan shows sinus orifice nasal tract complex or sinus mucosal lesions. CT scan of the sinuses is not recommended routinely, especially in children of young age (<6 years). The gold standard for the diagnosis of acute bacterial rhinosinusitis is a sinus puncture fluid concentration of ≥10,000 units/mL, however, this microbiological sample extraction requires sinus puncture, which lacks clinical operability and is not listed as a routine screening tool for rhinosinusitis in children. Treatment principles Acute infectious rhinosinusitis in children is mainly treated with conservative medication and comprehensive treatment, according to its relative importance, in the following order. 1. Antimicrobial drugs Acute primary or secondary infectious rhinosinusitis due to bacteria, fungi and atypical microorganisms have indications for the use of antimicrobial drugs. The common bacterial pathogens of rhinosinusitis include Streptococcus pneumoniae, Haemophilus influenzae and Catamorax. The recommended choice is oral amoxicillin-clavulanic acid 7:1 preparation at a dose (based on amoxicillin) of 30-45 mg/kg twice daily for at least 10-14 d. Or choose macrolide antibiotics, such as azithromycin at a dose of 10 mg/kg once daily for 3-5 d, with the total dose not exceeding 1500 mg. The second or third generation cephalosporins can be used for those who are resistant to first-line drugs. 2.Glucocorticoids Nasal glucocorticoids have anti-inflammatory and anti-edema effects, especially for the more serious symptoms of acute rhinosinusitis can relieve symptoms, the application of nasal glucocorticoids to the morning spray is good, the course of treatment for 2 to 4 weeks. 3.Nasal rinsing The use of saline or hypertonic saline or physiological seawater to rinse the nasal cavity can effectively relieve the acute edema of the nasal mucosa, stimulate the activity of nasal mucosal cilia, increase the rate of nasal secretion clearance, and can relieve clinical symptoms and improve the quality of life of children. 4, antihistamines and leukotriene receptor antagonists A significant proportion of children with acute infectious rhinosinusitis have clear allergic factors, especially those with allergic rhinitis, can be used systemically or locally in the nasal cavity 2nd generation antihistamines, nasal antihistamines are preferable, but also oral leukotriene receptor antagonists, the course of treatment is generally not less than 2 weeks. For patients with asthma, oral leukotriene receptor antagonists are preferred.