Paranasal Sinus Findings in Children During Respiratory Infection Evaluated With Magnetic Resonance Imaging

Kristo, Aila; Uhari, Matti; Luotonen, Jukka; Koivunen, Petri; Ilkko, E.; Tapiainen, Terhi; Alho, Olli‐Pekka

doi:10.1542/peds.111.5.e586

Cited by 62 publications

(32 citation statements)

References 11 publications

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“…Several studies have reported the presence of incidental abnormalities of the sinuses on CT scan in asymptomatic children 1398,1399 and the occurrence of abnormal CT or MRI sinus findings in a large proportion of children with viral URIs. [1400][1401][1402] This reinforces the notion that, like in adults, every URI is essentially an episode of RS with common involvement of the paranasal sinuses by the viral process. As a result, the AAP's clinical practice guidelines 1376 state that imaging does not have a role in distinguishing acute viral from acute bacterial RS and does not have a role in uncomplicated ARS.…”

Section: Xia3 Pediatric Ars: Diagnosissupporting

confidence: 77%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

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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 (AE-CRS), 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 o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Xia3 Pediatric Ars: Diagnosissupporting

confidence: 77%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

View full text Add to dashboard Cite

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“…Kristo et al 7 estudaram crianças com infecções das vias aéreas superiores (IVAS) por RM e encontraram opacidades em 88% dos casos. Gwaltney et al 11 revelaram altos índices de anormalidades na TC de adultos com resfriado comum (até 87% dos maxilares).…”

Section: Discussionunclassified

“…O espessamento mucoso, os níveis líquidos e a opacificação total dos SPNs são alterações da RS 6 , mas também são encontradas em pacientes com resfriados, gripes, rinite e asma alérgica em proporções que variam de 33 a 88% [7][8][9][10][11] . Mesmo sem qualquer doença respiratória, esses achados frequentemente constituem achado incidental de exame [12][13][14][15][16][17][18] .…”

Section: Introductionunclassified

Clinical progression of incidental tomographic findings in paranasal sinuses of asymptomatic individuals: cohort study

Araújo-Neto¹,

Baracat²

2011

J Pediatr (Rio J)

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Objective: To determine whether the presence of opacification in the paranasal sinuses of children and adolescents without rhinosinusitis implies an increased risk of later development of upper respiratory tract symptoms. Methods:This was a prospective study of a cohort of patients aged 0 to 18 years who underwent computerized tomography (CT) scans for indications unrelated to rhinosinusitis. Sinus opacification was evaluated using an opacification/development ratio score. The patients' clinical progression was followed up using a questionnaire for 1 month after the scans.Results: Fifty-six percent (56%) of the 106 patients enrolled in the study had opacity, the majority due to mucosal thickening. Intense opacification was defined as "suspected" (score ≥ 15) and patients in this subset had a greater risk of developing symptoms during followup (odds ratio = 2.74; 95%CI 1.10-6.83) compared to those with no findings or discrete findings. Conclusions ResumoObjetivo: Verificar se, em crianças e adolescentes sem rinossinusite, a presença de opacificações dos seios paranasais implica em maior risco de desenvolvimento posterior de sintomas do trato respiratório superior.Métodos: Estudo prospectivo de coorte, com pacientes entre 0 e 18 anos, submetidos à tomografia computadorizada do crânio por indicações não relacionadas à rinossinusite. As opacificações sinusais foram aferidas pelo escore razão opacificação/desenvolvimento. A evolução clínica dos pacientes foi então avaliada por questionários durante o mês que se seguia ao exame.Resultados: Dos 106 pacientes incluídos, as opacidades acometeram 56%, a maioria de espessamento mucoso. Opacidades intensas, ditas suspeitas (escore ≥ 15), impuseram maior risco de desenvolvimento de sintomas no seguimento (odds ratio = 2,74; IC95%:1,10-6,83), em comparação aos exames normais ou às opacidades discretas. Conclusão:Opacidades tomográficas sinusais incidentais em crianças e adolescentes oferecem risco de desenvolvimento futuro de quadro clínico respiratório quando intensas. J Pediatr (Rio J) IntroduçãoA inflamação sintomática do revestimento mucoso dos seios paranasais (SPNs), conhecida por rinossinusite (RS), é altamente prevalente e pode ser classificada em aguda, recorrente e crônica 1 . A RS aguda (RSA) é uma das cinco indicações mais frequentes para a prescrição de antibióticos 2 e, por isso, é desejável que não seja confundida com outras enfermidades a fim de evitar o uso desnecessário desses medicamentos.O diagnóstico da RS é prioritariamente clínico 1 . A radiografia simples apresenta baixa acurácia, sendo, atual-

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“…34,35 In addition, several small observational studies have assessed the use of MRI to diagnose acute sinusitis. [36][37][38] In the first, MRI was performed on a group of children 4 to 7 years of age presenting to a primary care center with any sign of respiratory infection. 36 Forty-one (68%) of 60 children had a major abnormality on imaging.…”

Section: Imagingmentioning

confidence: 99%

“…[36][37][38] In the first, MRI was performed on a group of children 4 to 7 years of age presenting to a primary care center with any sign of respiratory infection. 36 Forty-one (68%) of 60 children had a major abnormality on imaging. …”

Section: Imagingmentioning

confidence: 99%

Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Review

Smith¹

2013

Pediatrics

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In 2001, the American Academy of Pediatrics published clinical practice guidelines for the management of acute bacterial sinusitis (ABS) in children. The technical report accompanying those guidelines included 21 studies that assessed the diagnosis and management of ABS in children. This update to that report incorporates studies of pediatric ABS that have been performed since 2001. Overall, 17 randomized controlled trials of the treatment of sinusitis in children were identified and analyzed. Four randomized, double-blind, placebo-controlled trials of antimicrobial therapy have been published. The results of these studies varied, likely due to differences in inclusion and exclusion criteria. Because of this heterogeneity, formal meta-analyses were not performed. However, qualitative analysis of these studies suggests that children with greater severity of illness at presentation are more likely to benefit from antimicrobial therapy. An additional 5 trials compared different antimicrobial therapies but did not include placebo groups. Six trials assessed a variety of ancillary treatments for ABS in children, and 3 focused on subacute sinusitis. Although the number of pediatric trials has increased since 2001, there are still limited data to guide the diagnosis and management of ABS in children. Diagnostic and treatment guidelines focusing on severity of illness at the time of presentation have the potential to identify those children most likely to benefit from antimicrobial therapy and at the same time minimize unnecessary use of antibiotics.

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Paranasal Sinus Findings in Children During Respiratory Infection Evaluated With Magnetic Resonance Imaging

Cited by 62 publications

References 11 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Clinical progression of incidental tomographic findings in paranasal sinuses of asymptomatic individuals: cohort study

Evidence for the Diagnosis and Treatment of Acute Uncomplicated Sinusitis in Children: A Systematic Review

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