Çocuklarda tekrarlayan rinosinüzite yaklaşım

Rinosinüzit çocukluk çağında görülen viral üst solunum yolu enfeksiyonlarının en sık komplikasyonu ve antimikrobial etken için yazılan reçetelerin de beşinci sıklıktaki endikasyonudur. Klinikte genellikle on günden uzun süren nazal akıntı veya öksürük (veya her ikisi) görülür. Akut rinosinüzit dört haftadan kısa, kronik rinosinüzit 12 haftadan uzun sürer. Çocuklarda tekrarlayan akut ve kronik rinosinüzitin en sık nedenleri tekrarlayan viral üst solunum yolu enfeksiyonları, allerjik rinit, septum deviasyonu, adenoid hipertrofi, siliyer disfonksiyon sendromları, burunda yabancı cisim, gastroözofageal reflü ve kistik fibrozdur. Tanı klinik olarak konur. X-ışını ile çekilen grafilerin enfeksiyonu saptamada yararı gösterilememiştir. Bilgisayarlı tomografi ve manyetik rezonans görüntülemeleri ancak komplikasyondan şüphelenildiğinde yarar sağlar. Akut/kronik rinosinüzitin antibiyotik ile tedavisi halen tartışma konusudur. Yüksek doz amoksisilin ağır akut ve kronik rinosinüzitte ilk tercih edilecek ilaçtır. Parenteral antibiyotik uygulamaları ağır kronik olgularda önerilir. Mukolitik, dekonjestan ve antihistaminikler gibi ek tedaviler ek yarar sağlamadığı için rutin olarak önerilmez. Nazal steroidlerin kronik veya tekrarlayan rinosinüzitli çocukların tedavisinde yararı olabilir. (Güncel Pediatri 2012; 10: 24-30)

Management of recurrent rhinosinusitis in children

Rhinosinusitis is the most common complication of viral upper respiratory tract infections and the fifth most common indication for the prescription for antimicrobial agents in childhood period. In clinical evaluation a persistant nasal discharge or cough (or both) lasting more than ten days are generally seen. Acute rhinosinusitis lasts less than four weeks and chronic rhinosinusitis persists more than 12 weeks. The common causes of recurrent acute and chronic rhinosinusitis are recurrent viral upper respiratory tract infections, allergic rhinitis, septal deviation, adenoidal hypertrophy, ciliary dysfunction syndromes, foreign body in nazal cavity, gastroesophageal reflux disease and cystic fibrosis in children. The rhinosinusitis should be diagnosed clinically. Generally plain X-ray films are not helpful in demonstration of the infection. Computed tomography (CT) scan and magnetic resonans imaging have advantages in a suspicion of a complication of rhinosinusitis. The management of acute/chronic rhinosinusitis with antibiotics is still in debate. High dose amoksisilin is the first choise of drug for both of the severe acute and chronic bacterial rhinosinusitis. Parenteral antibiotic regiments are taken in account in the case of severe chronic cases. Additive therapies with mucolitics, decongestans and antihistamines give no additional benefit, therefore are not recommended routinely. Nazal steroids might have a role in treatment of children with chronic or recurrent rhinosinusitis. (Journal of Current Pediatrics 2012; 10: 24-30)

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