Chronic rhinosinusitis in young children differs from adults: a histopathology study

Objective

A histopathologic study of children with chronic rhinosinusitis (CRS) was undertaken to compare the sinus mucosa in pediatric and adult CRS.

Study design

CRS has been defined as persistent or recurrent sinusitis symptoms for ≥12 weeks despite conventional medical therapy, with abnormal computed tomography of the maxillary sinuses. Maxillary mucosal biopsies were obtained from pediatric CRS subjects for inflammatory cell and morphologic studies. Archival sinus mucosal tissues from adults with CRS were used as histologic controls. Sinus lavages were performed on children with and without CRS for microbiologic studies.

Results

Sinus mucosal biopsies were obtained from 19 children with CRS (median age, 3.0 years; range 1.4-8.2 years). Pediatric CRS biopsies, as compared with adult CRS controls, had a higher density of submucosal lymphocytes (median 469 versus 294 cells/mm² per 5 high-power fields HPF]; P = .02), lower density of submucosal eosinophils (medians 13 versus 82 cells/mm² per 5 HPF; P = .01), thinner and more intact epithelium (P = .01 and .07, respectively), thinner basement membranes (P = .002), and fewer submucosal mucous glands (P = .004).

Conclusion

The sinus mucosa of young children with CRS has less eosinophilic inflammation, basement membrane thickening, and mucus gland hyperplasia characteristic of adult CRS.