Could seasonal allergy be a risk factor for acute rhinosinusitis in children?

OBJECTIVE: To evaluate the incidence of acute rhinosinusitis in children with grass pollen induced rhinitis during the period of grass pollinosis. METHODS: Children with nasal symptoms from grass pollen induced rhinitis but without rhinosinusitis symptoms were selected. Their parents were asked to complete a diary during pollen exposure to report nasal symptoms and drugs used daily. When rhinosinusitis was suspected, the confirmatory diagnosis of acute rhinosinusitis was made by fibro-endoscopy. Children without inhalant allergy served as controls. RESULTS: Seventeen out of 242 children (7.0 per cent) had a diagnosis of acute rhinosinusitis, confirmed by fibro-endoscopy, during grass pollination, compared to 3 out of 65 (4.6 per cent) in the control group (p = 0.49). Among allergic children, those with acute rhinosinusitis had symptoms for a greater number of days and/or a higher symptoms score than children without acute rhinosinusitis. CONCLUSION: Children with grass pollen induced rhinitis during exposure to pollen have an incidence of endoscopically confirmed acute rhinosinusitis comparable to non-allergic children. This suggests that grass pollen induced rhinitis is a negligible risk factor for acute rhinosinusitis.

Treatment of rhinosinusitis: the role of surgery.

The treatment of rhinosinusitis in children is mostly medical. Surgery is indicated in few but important exceptions: orbital or intracranial complications of acute rhinosinusitis not responding to medical therapy, chronic rhinosinusitis (CRS) with persisting sinonasal infection and purulent discharge, cystic fibrosis, ciliary diskinesia, dacryocystitis due to sinusitis and resistant to medical treatment, fungal rhinosinusitis. According to recent data, 50 percent of ENT specialist perform an adenoidectomy to manage CRS before endoscopic sinus surgery (ESS). ESS techniques introduced in mid 90s, has significantly modified the treatment of complications of acute rhinosinusitis and of selected cases of chronic recurrent infections. ESS consists of minimally invasive surgical procedure as middle meatal antrostomy and anterior ethmoidectomy. Evidence suggests that adenoidectomy and ESS are the most frequent surgical procedure performed in RS management.

Reappraising the role of radiography in the diagnosis of chronic rhinosinusitis.

OBJECTIVE: To revaluate the role of radiography in the diagnosis of chronic rhinosinutis, versus the currently suggested standards of computed tomography (CT) or nasal endoscopy. MATERIALS AND METHODS: In total, 269 children consecutively admitted to our Unit for symptoms suggestive of chronic rhinosinusitis were included in this study; of these 222 were confirmed by fiberoptic nasopharyngeal endoscopy to have chronic rhinosinusitis, while 47 were not. Analysis of sensitivity and specificity of plain radiography by Waters' projection was carried. RESULTS: Radiography had a sensitivity of 84.2% (95% confidence interval 78.8 to 88.8), and a specificity of 76.6% (95% confidence interval 62.0 to 87.7) against the standard of nasal endoscopy. CONCLUSIONS: In routine practice, the clinical diagnosis of chronic rhinosinusitis may be obtained in many cases by Waters' projection radiography, limiting more expensive CT scanning or endoscopic techniques, which remain the reference diagnostic tools, to a smaller number of patients.

Clivus osteomyelitis secondary to Enterococcus faecium infection in a 6-year-old girl.

A 6-year-old girl was diagnosed to suffer from clivus osteomyelitis secondary to Enterococcus faecium infection. On the basis of the magnetic resonance image, the abscess was drained via the posterior wall of the pharyngeal tract immediately. Subsequent antibiotic therapy allowed rapid improvement and long-term healing of the osteomyelitic process without any side effect. Osteomyelitis or abscess of the clivus is very rare in adult patients and extremely rare in children. Some etiopathogenetic hypotheses are discussed in this case.

Some effects of the stimulus repetition rate on N1 and N2 in transtympanic and surface recordings.

The early auditory evoked electrical activity has been recorded in man at the promontory (transtympanic approach) and on the scalp vertex-mastoid derivation), in response to clicks delivered at different rates. Latency and amplitude of the first two peaks (N1 and N2), as a function of the repetition rate, have been measured and compared. The differences between the latencies of transtympanic and surface N1 are very small, at any rate, with a maximum value of 0.08 msec. In the transtympanic recording, the latency difference between N2 and N1 is constant throughout the whole range of rate values, from 3 to 100 clicks per second. In the surface responses, on the contrary, the latency difference between N2 and N1 tends to increase as the rate is increased. The amplitude of the transtympanic N2 is consistently reduced at click rates above 20-50 per second (more markedly than the amplitude of N1), while the amplitude of the surface N2 is much more insensitive to the rate increase. Some implications of these results are discussed with respect to the origin of N2 in the two recording conditions.