Chronische Rhinosinusitis im Kindesalter

Chronic rhinosinusitis (CRS) in childhood is a heterogeneous disease with a high incidence and is defined as nasal obstruction or/and secretions persisting over a minimum of 12 weeks, possibly associated with pain and pressure, impaired sense of smell and coughing. Epidemiological data on CRS in childhood are insufficient and there is a lack of controlled trials assessing the effects of medication and surgical therapy. As a specific problem in children with CRS adenoid vegetation causes or aggravates the symptoms in infants and allergies play an important role in triggering the disease in school age children. Additionally, CRS is a hallmark in many patients with immune defects and almost all patients with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD). The symptoms impair the quality of life to a much greater extent than currently assumed and the impairment of nasal respiration with failure of the air conditioning function leads to inspiration of dry, cold and unfiltered air into the lower airways, which increases bronchial hyperreactivity. For pediatricians it is important to regularly use an otoscope for nasal inspection and to consistently apply conservative therapeutic options. These include nasal lavages in the presence of secretions and crusts (from the age of 1 year) and long-term use of topical steroids for nasal obstruction, adenoids and nasal polyps. As additional therapy in atopic children allergens should be avoided and antihistamines and specific immunotherapy can be helpful. In CF, PCD and immunodeficiency additional assessment of pathogen colonization from nasal lavages is essential together with an adapted antibiotic treatment. Close cooperation with otorhinolaryngologists is important, above all for specific problems and surgery if consistently administered conservative therapy is unsuccessful.