Clinical Consensus Statement: Pediatric Chronic Rhinosinusitis
Scott E. Brietzke, MD, MPH; Jennifer J. Shin, MD, SM; Sukgi Choi, MD; Jivianne T. Lee, MD; Sanjay R. Parikh, MD; Maria Pena, MD; Jeremy D. Prager, MD; Hassan Ramadan, MD; Maria Veling, MD; Maureen Corrigan; Richard M. Rosenfeld, MD, MPH This month, the AAO-HNSF publishes its latest clinical consensus statement on Pediatric Chronic Rhinosinusitis in Otolaryngology–Head and Neck Surgery. Pediatric chronic rhinosinusitis (PCRS) is a commonly encountered condition in otolaryngological practice. Five percent to 13 percent of childhood viral upper respiratory tract infections may progress to acute rhinosinusitis,1-4 with a proportion of these progressing to a chronic condition. PCRS may also co-exist and/or be exacerbated by other widespread conditions such as allergic rhinitis and adenoid disease,5-9 and some suggest the incidence of PCRS may be rising.10 In addition, PCRS has a meaningful influence on quality of life,11 with its related adverse effects potentially exceeding that of chronic respiratory and arthritic disease.12 PRCS also has the potential to exacerbate asthma,13, 14 a condition which negatively affects 2 percent to 20 percent of children.15-17 In spite of its prevalence and influence on affected families, many aspects of PCRS remain ill defined. Nonetheless, PCRS occurs with sufficient frequency that otolaryngologists regularly encounter it in their practice, creating opportunities for optimizing practice patterns. While experience regarding the epidemiology, diagnosis, and management of PCRS is burgeoning, the associated evidence regarding optimal medical and surgical management has clear limits. The AAO-HNSF Guidelines Task Force therefore, selected this topic for clinical consensus statement (CCS) development. The expert panel convened with the objectives of addressing opportunities to promote appropriate care, reduce inappropriate variations in care, and educate and empower clinicians and patients toward the optimal management of PCRS. The final document describes the result of this process, and focuses on diagnosis, medical therapy, and surgical interventions. This consensus statement was developed using a modified Delphi method, a systematic approach to achieving consensus among a panel of topic experts. Initially designed by the RAND Corporation to better utilize group information in the 1950s, this methodology has been modified to accommodate advances in technology and is used widely to address evidence gaps in medicine and improve patient care without face-to-face interaction.18,19 Thirty-eight clinical statements were developed for assessment with the Delphi survey method. After two iterations of the Delphi survey, 22 statements (58 percent) met the standardized definition for consensus. Twelve clinical statements (31 percent) did not meet the criteria for consensus. Four clinical statements (11 percent) were omitted due to redundancy. The clinical statements were organized into four specific subject areas: Definition and diagnosis of PCRS Medical treatment of PCRS Adenoiditis/adenoidectomy Endoscopic sinus surgery/turbinoplasty. For the full listing of clinical statements, see the full text of the consensus statement at http://oto.sagepub.com/. References Clinical practice guideline: management of sinusitis. Pediatrics. 2001;108:798-808. Aitken M, Taylor JA. Prevalence of clinical sinusitis in young children followed up by primary care pediatricians. Arch Pediatr Adolesc Med. 1998;152(3):244-248. Ueda D, Yoto Y. The ten-day mark as a practical diagnostic approach for acute paranasal sinusitis in children. Pediatr Infect Dis J. 1996;15(7):576-579. Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics. 1991;87(2):129-133. Smart BA. The impact of allergic and nonallergic rhinitis on pediatric sinusitis. Cur Allergy Asthma Rep. 2006;6(3):221-227. Marseglia GL, Pagella F, Klersy C, et al. The 10-day mark is a good way to diagnose not only acute rhinosinusitis but also adenoiditis, as confirmed by endoscopy. Int J Pediatr Otorhinolaryngol. 2007;71(4):581-583. Tosca MA, Riccio AM, Marseglia GL, et al. Nasal endoscopy in asthmatic children: assessment of rhinosinusitis and adenoiditis incidence, correlations with cytology and microbiology. Clin Exp Allergy. 2001;31(4):609-615. Lee D, Rosenfeld RM. Adenoid bacteriology and sinonasal symptoms in children. Otolaryngol Head Neck Surg. 1997;116(3):301-307. Nguyen KL, Corbett ML, Garcia DP, et al. Chronic sinusitis among pediatric patients with chronic respiratory complaints. J Allergy Clin Immunol. 1993;92(6):824-830. Kim HJ, Jung Cho M, Lee J-W, et al. The relationship between anatomic variations of paranasal sinuses and chronic sinusitis in children. Acta Otolaryngol. 2006;126(10):1067-1072. Kay DJ, Rosenfeld RM. Quality of life for children with persistent sinonasal symptoms. Otolaryngol Head Neck Surg. 2003;128(1):17-26. Cunningham JM, Chiu EJ, Landgraf JM, et al. The health impact of chronic recurrent rhinosinusitis in children. Arch Otolaryngol Head Neck Surg. 2000;126(11):1363-1368. Smart BA, Slavin RG. Rhinosinusitis and pediatric asthma. Immunol Allergy Clin North Am. 2005;25(1):67-82. Rachelefsky GS, Katz RM, Siegel SC. Chronic sinus disease with associated reactive airway disease in children. Pediatrics. 1984;73(4):526-529. Larsson M, Hagerhed-Engman L, Sigsgaard T, et al. Incidence rates of asthma, rhinitis and eczema symptoms and influential factors in young children in Sweden. Acta Paediatr. 2008;97(9):1210-1215. Ronmark E, Perzanowski M, Platts-Mills T, et al. Incidence rates and risk factors for asthma among school children: a 2-year follow-up report from the obstructive lung disease in Northern Sweden (OLIN) studies. RespirMed. 2002;96:1006-1013. Ayres JG, Pansari S, Weller PH, et al. A high incidence of asthma and respiratory symptoms in 4-11 year old children. RespirMed. 1992;86(5):403-407. Vonk Noordegraaf A, Huirne JA, Brolmann HA, van Mechelen W, Anema JR. Multidisciplinary convalescence recommendations after gynaecological surgery: a modified Delphi method among experts. BJOG. Dec 2011;118(13):1557-1567. Dalkey NC. The Delphi Method: An Experimental Study of Group Opinion. Santa Monica: RAND Corporation;1969. RM-5888-PR.
Scott E. Brietzke, MD, MPH; Jennifer J. Shin, MD, SM; Sukgi Choi, MD; Jivianne T. Lee, MD; Sanjay R. Parikh, MD; Maria Pena, MD; Jeremy D. Prager, MD; Hassan Ramadan, MD; Maria Veling, MD; Maureen Corrigan; Richard M. Rosenfeld, MD, MPH
This month, the AAO-HNSF publishes its latest clinical consensus statement on Pediatric Chronic Rhinosinusitis in Otolaryngology–Head and Neck Surgery. Pediatric chronic rhinosinusitis (PCRS) is a commonly encountered condition in otolaryngological practice. Five percent to 13 percent of childhood viral upper respiratory tract infections may progress to acute rhinosinusitis,1-4 with a proportion of these progressing to a chronic condition. PCRS may also co-exist and/or be exacerbated by other widespread conditions such as allergic rhinitis and adenoid disease,5-9 and some suggest the incidence of PCRS may be rising.10 In addition, PCRS has a meaningful influence on quality of life,11 with its related adverse effects potentially exceeding that of chronic respiratory and arthritic disease.12 PRCS also has the potential to exacerbate asthma,13, 14 a condition which negatively affects 2 percent to 20 percent of children.15-17
In spite of its prevalence and influence on affected families, many aspects of PCRS remain ill defined. Nonetheless, PCRS occurs with sufficient frequency that otolaryngologists regularly encounter it in their practice, creating opportunities for optimizing practice patterns. While experience regarding the epidemiology, diagnosis, and management of PCRS is burgeoning, the associated evidence regarding optimal medical and surgical management has clear limits.
The AAO-HNSF Guidelines Task Force therefore, selected this topic for clinical consensus statement (CCS) development. The expert panel convened with the objectives of addressing opportunities to promote appropriate care, reduce inappropriate variations in care, and educate and empower clinicians and patients toward the optimal management of PCRS. The final document describes the result of this process, and focuses on diagnosis, medical therapy, and surgical interventions.
This consensus statement was developed using a modified Delphi method, a systematic approach to achieving consensus among a panel of topic experts. Initially designed by the RAND Corporation to better utilize group information in the 1950s, this methodology has been modified to accommodate advances in technology and is used widely to address evidence gaps in medicine and improve patient care without face-to-face interaction.18,19
Thirty-eight clinical statements were developed for assessment with the Delphi survey method. After two iterations of the Delphi survey, 22 statements (58 percent) met the standardized definition for consensus. Twelve clinical statements (31 percent) did not meet the criteria for consensus. Four clinical statements (11 percent) were omitted due to redundancy. The clinical statements were organized into four specific subject areas:
- Definition and diagnosis of PCRS
- Medical treatment of PCRS
- Adenoiditis/adenoidectomy
- Endoscopic sinus surgery/turbinoplasty.
For the full listing of clinical statements, see the full text of the consensus statement at http://oto.sagepub.com/.
References
- Clinical practice guideline: management of sinusitis. Pediatrics. 2001;108:798-808.
- Aitken M, Taylor JA. Prevalence of clinical sinusitis in young children followed up by primary care pediatricians. Arch Pediatr Adolesc Med. 1998;152(3):244-248.
- Ueda D, Yoto Y. The ten-day mark as a practical diagnostic approach for acute paranasal sinusitis in children. Pediatr Infect Dis J. 1996;15(7):576-579.
- Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics. 1991;87(2):129-133.
- Smart BA. The impact of allergic and nonallergic rhinitis on pediatric sinusitis. Cur Allergy Asthma Rep. 2006;6(3):221-227.
- Marseglia GL, Pagella F, Klersy C, et al. The 10-day mark is a good way to diagnose not only acute rhinosinusitis but also adenoiditis, as confirmed by endoscopy. Int J Pediatr Otorhinolaryngol. 2007;71(4):581-583.
- Tosca MA, Riccio AM, Marseglia GL, et al. Nasal endoscopy in asthmatic children: assessment of rhinosinusitis and adenoiditis incidence, correlations with cytology and microbiology. Clin Exp Allergy. 2001;31(4):609-615.
- Lee D, Rosenfeld RM. Adenoid bacteriology and sinonasal symptoms in children. Otolaryngol Head Neck Surg. 1997;116(3):301-307.
- Nguyen KL, Corbett ML, Garcia DP, et al. Chronic sinusitis among pediatric patients with chronic respiratory complaints. J Allergy Clin Immunol. 1993;92(6):824-830.
- Kim HJ, Jung Cho M, Lee J-W, et al. The relationship between anatomic variations of paranasal sinuses and chronic sinusitis in children. Acta Otolaryngol. 2006;126(10):1067-1072.
- Kay DJ, Rosenfeld RM. Quality of life for children with persistent sinonasal symptoms. Otolaryngol Head Neck Surg. 2003;128(1):17-26.
- Cunningham JM, Chiu EJ, Landgraf JM, et al. The health impact of chronic recurrent rhinosinusitis in children. Arch Otolaryngol Head Neck Surg. 2000;126(11):1363-1368.
- Smart BA, Slavin RG. Rhinosinusitis and pediatric asthma. Immunol Allergy Clin North Am. 2005;25(1):67-82.
- Rachelefsky GS, Katz RM, Siegel SC. Chronic sinus disease with associated reactive airway disease in children. Pediatrics. 1984;73(4):526-529.
- Larsson M, Hagerhed-Engman L, Sigsgaard T, et al. Incidence rates of asthma, rhinitis and eczema symptoms and influential factors in young children in Sweden. Acta Paediatr. 2008;97(9):1210-1215.
- Ronmark E, Perzanowski M, Platts-Mills T, et al. Incidence rates and risk factors for asthma among school children: a 2-year follow-up report from the obstructive lung disease in Northern Sweden (OLIN) studies. RespirMed. 2002;96:1006-1013.
- Ayres JG, Pansari S, Weller PH, et al. A high incidence of asthma and respiratory symptoms in 4-11 year old children. RespirMed. 1992;86(5):403-407.
- Vonk Noordegraaf A, Huirne JA, Brolmann HA, van Mechelen W, Anema JR. Multidisciplinary convalescence recommendations after gynaecological surgery: a modified Delphi method among experts. BJOG. Dec 2011;118(13):1557-1567.
- Dalkey NC. The Delphi Method: An Experimental Study of Group Opinion. Santa Monica: RAND Corporation;1969. RM-5888-PR.