Background The body of knowledge regarding rhinosinusitis(RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods Evidence-based reviews with recommendations(EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR)was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS)with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AECRS), and pediatric RS. Conclusion As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too often the foundation upon which these recommendations are based is comprised of lower level evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/alr.21695

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis.

ObjectiveTo develop a clinical consensus statement on the optimal diagnosis and management of pediatric chronic rhinosinusitis (PCRS).MethodsA representative 9-member panel of otolaryngologists wit...

https://journals.sagepub.com/doi/pdf/10.1177/0194599814549302

Clinical Consensus Statement: Pediatric Chronic Rhinosinusitis

Antrochoanal polyps are benign lesions originating from the mucosa of the maxillary sinus. Nasal obstruction and rhinorrhea are their main symptoms. Their endoscopical and radiological appearance makes them relatively easy to diagnose. These polyps are usually presented unilaterally, although bilateral presentation is also possible. We described two cases of atypically giant antrochoanal polyps: in a 15-year-old child and in a 38-year-old man. In both cases, the diagnosis was done by nasal endoscopy and computed tomography (CT) of the paranasal sinuses and supported by histopathological analysis. In the first patient, the excised polyp had the histological characteristic of an angiomatous antrochoanal polyp. Because of their unusual dimension, the combined transoral and endonasal endoscopic approach was performed for complete polyp excision. We discussed the clinical, histopathological and immunohistochemical characteristics of choanal polyps in comparison to inflammatory nasal polyps, and the applicable surgical techniques for treatment of these polyps.

/pdf/clinical-case-report-of-a-large-antrochoanal-polyp-44x39lhntr.pdf

Clinical case report of a large antrochoanal polyp.

Pediatric chronic sinusitis is currently designated as pediatric chronic rhinosinusitis. In most pediatric cases, sinusitis is considered as infectious. In the adult literature, a wider repertoire of chronic rhinosinusitis conditions is recognized. In this review, the adult forms of chronic rhinosinusitis are used as a framework for identifying and defining the potential spectrum of pediatric chronic rhinosinusitis that exists beyond the most recognized condition, pediatric infectious chronic rhinosinusitis.

Do Adult Forms of Chronic Rhinosinusitis Exist in Children and Adolescents

Choanal polyps (CPs) are benign, solitary, soft-tissue lesions extending towards the junction between the nasal cavity and the nasopharynx through the choana. The aim of this retrospective study was to evaluate clinical and histological characteristics of CPs in children comparing to adult patients. Characteristics of CPs treated in our hospital (demography, main complaints, side, localization, surgical approach, histological characteristics, accompanying paranasal sinus diseases, association with allergic rhinitis, postoperative follow-up period, and recurrence rates) were retrospectively reviewed. Seventy-eight patients with CPs were included, 22 (28%) patients in children and 56 (72%) patients in adults. We found no differences in the prevalence of main nasal complaints (nasal obstruction, rhinorrhea, snoring, and epistaxis) between the child and adult. In 27% children and in 7% adults, we found the oropharyngeal extension of CPs (p < 0.01). In 18% children and in 5.3% adults, we found the histological characteristics of an angiomatous CP (p < 0.05). The association with allergic rhinitis was more frequent in children (32%) than in adults (18%) (p < 0.05). In 32% pediatric patients and in 14% adult patients, we found the association with ipsilateral chronic maxillary rhinosinusitis without nasal polyps (CRSsNP) (p < 0.05). After the surgical treatment, we found the recurrence in 3 (14%) pediatric and in 5 (8%) adult patients, without the significant difference. Our results suggest some specificities of CPs in children comparing to adults. Oropharyngeal extension, association with allergic rhinitis and ipsilateral CRS, and the presence of angiomatous histological type of CPs are more frequent in the pediatric population.

Choanal polyps in children and adults: 10-year experience from a tertiary care hospital.

Objective Chronic sinusitis with nasal polyps is an uncommon pathology in the pediatric population and may be associated with systemic disease. In this study we aimed to characterize children who underwent nasal surgery at our medical center due to nasal polyps and review the current literature related to pediatric nasal polyps. Study design We retrospectively reviewed all medical records of patients younger than 18 years who had sinus surgery from 2000 to 2010. We collected demographic and clinical data including age, sex, laterality, revision operations, and comorbidities including asthma, allergy, and cystic fibrosis (CF). Results Thirty-one patients age 8.8 to 18 years (mean 13.7) were treated surgically in our hospital. Thirteen had antrochoanal polyp, 16 had chronic sinusitis with nasal polyps, and 2 had mucocele. Among patients treated for nasal polyps, there were 6 boys and 10 girls, mean age was 14.2 years, and 14 (87.5%) had bilateral disease. Mean Lund McKay score was 15.8. Five (31.2%) had asthma, 15 (93.7%) had sleep breathing disorder, and none had known allergy. Three patients (18.7%) had more than one surgery, including one patient with CF. Nine healthy children were tested for CF; one was positive. Conclusions Nasal polyps in children are more common in teenagers, are usually bilateral, and are commonly associated with bronchial asthma. There was no association with allergy. Meticulous anamnesis and a high index of suspicion are recommended to manage other comorbidities.

Nasal polyps in the pediatric population.

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Nasal polyps in the pediatric population.