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Current Allergy and Asthma Reports
Published in: Current Allergy and Asthma Reports 8/2020

01-08-2020 | Sinus Surgery | Rhinosinusitis (J Mullol, Section Editor)

Pediatric Versus Adult Chronic Rhinosinusitis

Authors: Kornkiat Snidvongs, Melissa Sangubol, Orapan Poachanukoon

Published in: Current Allergy and Asthma Reports | Issue 8/2020

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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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Metadata
Title
Pediatric Versus Adult Chronic Rhinosinusitis
Authors
Kornkiat Snidvongs
Melissa Sangubol
Orapan Poachanukoon
Publication date
01-08-2020
Publisher
Springer US
Published in
Current Allergy and Asthma Reports / Issue 8/2020
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-020-00924-6

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