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Pediatric Versus Adult Chronic Rhinosinusitis

  • Rhinosinusitis (J Mullol, Section Editor)
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Abstract

Purpose of Review

Pediatric and adult chronic rhinosinusitis (CRS) have some similarities but a number of differences. This article reviews the similarities and differences between pediatric and adult CRS.

Recent Findings

Rhinosinusitis is an inflammatory disease of the nose and the paranasal sinuses. In adults, inflammation in CRS without polyps (CRSsNP) mainly manifests with T-helper 1 lymphocytes while in CRS with polyps (CRSwNP) manifests with T-helper 2 lymphocytes and eosinophilic inflammation. In children, CRS inflammation manifests with neutrophils, macrophages, and lymphocytes. The associations between the ostiomeatal complex occlusion and CRS are revealed in adults but are not so evident in children. Although the relationship between the CRS and allergic rhinitis is still controversial, recent findings have shown an association between allergen sensitization and a specific group of adults with rhinosinusitis. Intranasal corticosteroids and saline constitute the first-line of medical treatment for both pediatric and adult rhinosinusitis. Low-dose macrolides are used for immunomodulatory activities and beneficial effects to adult patients with CRSsNP were demonstrated by recent meta-analyses. For surgical treatment, adenoidectomy is a key strategy to eradicate mature biofilms in pediatric CRS and effective in treating children with CRS regardless of the adenoid size. Although endoscopic sinus surgery has been proven to improve quality of life outcomes in adult CRS, it should be only considered in the pediatric CRS after failure of adenoidectomy.

Summary

Pediatric and adult CRS are different in many aspects, including immunopathogenesis and management. Investigations should be considered in specific cases. After failure of medical treatments, endoscopic sinus surgery is recommended for adults, while adenoidectomy is primarily considered for children.

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Authors and Affiliations

  1. Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Kornkiat Snidvongs

  2. Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Kornkiat Snidvongs

  3. Laemchabang Hospital, Chonburi, Thailand

    Melissa Sangubol

  4. Center of Excellence for Allergy, Asthma and Pulmonary Diseases, Thammasat University Hospital, Bangkok, Thailand

    Orapan Poachanukoon

  5. Department of Pediatrics, Faculty of Medicine, Thammasat University, Bangkok, Thailand

    Orapan Poachanukoon

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  1. Kornkiat Snidvongs
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Correspondence to Kornkiat Snidvongs.

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Dr. Snidvongs has served on speakers’ bureau for Merck Sharp Dolme, GSK, and Menarini. The other authors declare no conflicts of interest relevant to this manuscript.

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Snidvongs, K., Sangubol, M. & Poachanukoon, O. Pediatric Versus Adult Chronic Rhinosinusitis. Curr Allergy Asthma Rep 20, 29 (2020). https://doi.org/10.1007/s11882-020-00924-6

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