Children’s sinus mucosal inflammation clinical features: 1, children’s chronic sinusitis CT features and clinical correlation: clinical has been noted, children’s nasal – sinus mucosa response to inflammation degree than adults obvious, children’s sinusitis once occurred, although the course of the disease is not long, but the CT often shows for the whole sinus opacity phenomenon. Children’s nasal cavity, sinus mouth nasal tract complex, sinus openings are relatively narrow, the mucosal response to inflammation is more pronounced than in adults, which may be the reason why children’s CT is mostly “total sinusitis”. It has been suggested that sinus CT opacities do not indicate the presence of sinusitis. A prospective survey showed that only 31% of children with sinus opacity have a recent history of upper respiratory tract infection, and 18% of these children have no symptoms, the diagnosis of chronic sinusitis in children should not be based on the CT scan alone to determine, but according to the symptoms, signs and symptoms of a comprehensive analysis. Therefore, sinus CT opacity cannot be the basis for surgical indications. 2, infection and allergic reaction caused by mucosal edema is the main cause of sinusitis: children’s sinusitis predisposing factors include six aspects, namely, systemic diseases (mainly upper respiratory tract infection and allergic reaction), secretion nature change, cilia dysfunction, drug rhinitis, pathogenic microbial toxicity, anatomical structure abnormality. Of these, mucosal edema due to infection and metaplasia is the main cause. Mucosal edema can lead to rapid obstruction of narrow sinus orifices and drainage channels, local tissue hypoxia, and weakened ciliary activity, which provides a basic environment for pathogenic bacteria to colonize and promotes the vicious cycle of mucosal inflammation. Therefore, anti-inflammatory, anti-edema has become the key link in the treatment of children’s sinusitis. 3, children’s chronic sinusitis clinical regression characteristics: some data show that 40% of children’s acute sinusitis can be healed without treatment, most of the chronic sinusitis on the appropriate drugs and conservative treatment is more sensitive. And children’s chronic sinusitis in adulthood may have a natural tendency to heal, which in some untreated children’s chronic sinusitis, adult CT images show normal basis. Clinical guidelines for the diagnosis and treatment of chronic sinusitis in children: 1. Diagnosis of chronic sinusitis in children: persistent purulent nasal discharge, chronic nasal obstruction, increased posterior nostril secretion, coughing, breath with foul odor, headache, habitual changes as the main symptoms, can be accompanied by otitis media, adenoiditis, asthma and bronchitis. There are reports that asymptomatic people close to 50%.Weinberg according to clinical symptoms, CT scan and onset of chronic sinusitis in children are divided into chronic sinusitis and recurrent acute sinusitis two kinds of chronic sinusitis refers to continuous drug treatment for 3 months the symptoms and signs still exist, recurrent acute sinusitis refers to the drug treatment is effective for 3-4 weeks, but there are 3-4 acute episodes of authors per year. 2, children’s chronic sinusitis step-by-step treatment: according to the above theoretical findings, the treatment program of children’s chronic sinusitis should be divided into three steps: systemic drug therapy – to lift the obstruction factors and hidden places of pathogenic bacteria – functional endoscopic minimally invasive rhinosinusitis surgery. ① Stage 1: Systemic drug therapy. Including antibiotics and local steroids, the dosage and duration should be sufficient; broad-spectrum antibiotics should be applied continuously for 1 month and local steroids for at least 2 months. Topical steroids are effective in shortening the course of the disease and prolonging the time to reoccurrence. Low concentrations of nasal mucosal vasoconstrictors can be used appropriately and intermittently for severe nasal obstruction. Diagnosis of metrorrhagia can be made by skin tests and intradermal food provocation tests, and antimetrorrhagic therapy (systemic antihistamines and hormones) can be given. Additional treatments such as nasal sinus lavage and pharmacologic nebulized inhalation may also be indicated.David believes that nasal lavage with buffered hypertonic saline is effective in relieving nasal mucosal edema. Antigastroesophageal reflux and immunoglobulin should also be considered in the treatment plan. ② Stage 2: Release of nasal obstruction and pathogenic bacterial hiding places. Adjunctive surgical approaches (this approach is also known as pre-surgical intervention prior to nasal endoscopic surgery) can only be considered when systemic medications fail. Many reports have suggested that adenoidectomy in conjunction with medication is effective in the treatment of chronic sinusitis in children (especially those under 10 years of age) and may obviate the need for FESS surgery. Removal of single polyps in the middle nasal tract that do not affect nasal ventilation is not recommended and can be treated with topical steroids. ③ Stage III: Transnasal endoscopic functional nasal and sinus minimally invasive surgery. Indications for surgery: inadequate medication and pre-treatment, clear nasal polyps obstructing nasal ventilation or multiple polyps, severe anatomical abnormalities of the nasal cavity and sinuses, concomitant asthma, and the presence of highly drug-resistant bacteria.