儿童鼻窦炎的诊治——困难、挑战与对策

doi:10.6040/j.issn.1673-3770.1.2019.055

摘要/Abstract

摘要： 儿童鼻窦炎作为耳鼻咽喉科和儿科常见疾病,近十几年来发病率逐渐上升,但中国有关于儿童鼻窦炎的流行病学调查缺失。儿童鼻窦炎因为常伴有急性病毒性上呼吸道感染、腺样体肥大、变应性鼻炎等,其症状重叠,诊断容易混淆。鼻内镜检查是重要的诊断手段之一,鼻窦CT扫描往往与病情不相符,且对儿童来说放射量偏大,在儿童中需要慎用。在治疗方面与成人不同,但较少有高质量的循证医学证据可循,局部糖皮质激素、鼻腔喷雾逐渐成为治疗儿童鼻窦炎的一线治疗方法,但抗生素的副作用近年来争议较大。就以上儿童鼻窦炎的诊断和治疗方面的难点和面临挑战急需达到临床共识,寻找对策。

关键词: 儿童鼻窦炎, 诊治, 治疗

Abstract: Sinusitis in children is a common disease in pediatric otorhinolaryngology. The incidence of sinusitis has gradually increased over the last 10 years. However, there is a lack of epidemiological research that focusses on pediatric sinusitis in China. Pediatric sinusitis is often accompanied by an acute viral upper respiratory tract infection, adenoid hypertrophy, and allergic rhinitis. As symptoms overlap it can be challenging to diagnose pediatric sinusitis. Nasal endoscopy is an important diagnostic method that can be used. A computed tomography(CT)scan of the sinus can often be inconsistent. Additionally, as the radiation dose is high, it should be carefully used in children. Treatment of pediatric sinusitis is different from sinusitis in adults. Also, there is less high-quality evidence available. An intranasal steroid and nasal spray are the first-line treatment used for children with sinusitis. The role of antibiotics has become increasingly controversial over the last few years. The difficulties and challenges in diagnosing and treating pediatric sinusitis need to be addressed so that clinical consensus can be reached and countermeasures can be used.

Key words: Pediatric sinusitis, Diagnosis, Treatment

中图分类号:

R765.4

李勇. 儿童鼻窦炎的诊治——困难、挑战与对策[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 1-7.

LI Yong. The difficulties, challenges, and strategy for diagnosing and treating pediatric sinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(6): 1-7.

参考文献

[1] Aitken M, Taylor JA. Prevalence of clinical sinusitis in young children followed up by primary care pediatricians[J]. Arch PediatrAdolesc Med, 1998, 152(3): 244-248. doi:10. 1001/archpedi. 152.3.244.
[2] Wald ER, Bordley WC, Darrow DH, et al. Clinical practice guideline: management of sinusitis[J]. Pediatrics, 2001, 108(3): 798-808. doi: 10.1542/peds. 108.3. 798.
[3] Gilani S, Shin JJ. The Burden and visit prevalence of pediatric chronic rhinosinusitis[J]. Otolaryngology Head Neck Surgery, 2017, 157(6): 1048-1052. doi:10.1177/0194599817721177.
[4] Strachan DP. Hay fever, hygiene, and household size[J]. BMJ, 1989, 299(6710): 1259-1260. doi:10. 1136/bmj. 299. 6710. 1259.
[5] Zuliani G, Carron M, Gurrola J, et al. Identification of adenoid biofilms in chronic rhinosinusitis[J]. Int J Pediatr Otorhinolaryngol, 2006, 70(9): 1613-1617. doi:10. 1016/j. ijporl. 2006.05.002.
[6] Soler ZM, Rosenbloom JS, Skarada D, et al. Prospective, multicenter evaluation of balloon sinus dilation for treatment of pediatric chronic rhinosinusitis[J]. Int Forum Allergy Rhinol, 2017, 7(3): 221-229. doi: 10. 1002/alr. 21889.
[7] 中华医学会儿科学分会呼吸学组慢性咳嗽协作组, 《中华儿科杂志》编辑委员会. 中国儿童慢性咳嗽诊断与治疗指南(2013年修订)[J]. 中华儿科杂志, 2014, 52(3): 184-188.
[8] 谷庆隆, 陆颖霞, 庞冲, 等. 儿童难治性咳嗽128例病因分析[J]. 中华耳鼻咽喉头颈外科杂志, 2010, 45(1): 28-31. doi:10. 3760/cma. j. issn.1673-0860. 2010. 01. 008. GU QingIong, LU Yingxia, PANG Chong, et al. Analysis of intractable cough in 128 children[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2010, 45(1): 28-31. doi: 10. 3760/cma. j. issn. 1673-0860. 2010.01.008.
[9] 谷庆隆, 高帆, 陈育智, 等. 儿童腺样体肥大和腺样体炎所致上气道咳嗽综合征的临床特点探讨[J]. 中国中西医结合耳鼻咽喉科杂志, 2011, 19(5): 343-346, 348. doi: CNKI: SUN: XYJH. 0. 2011-05-017. GU Qinglong, GAO Fan, CHEN Yuzhi, et al. Analysis of upper airway cough syndrome caused by adenoidal hypertrophy and adenoiditis in children[J]. Chin J Otorhinolaryngol Integr Med, 2011, 19(5): 343-346, 348. doi:CNKI:SUN:XYJH.0. 2011-05-017.
[10] Rosenfeld RM. Pilot study of outcomes in pediatric rhinosinusitis[J]. Arch Otolaryngol Head Neck Surg, 1995, 121(7): 729-736. doi:10.1001/archotol. 1995. 01890070015005.
[11] Chan KH, Abzug MJ, Coffinet L, et al. Chronic rhinosinusitis in young children differs from adults: a histopathology study[J]. J Pediatr, 2004, 144(2): 206-212. doi: 10. 1016/j. jpeds. 2003.11.009.
[12] Steinke JW, Borish L. The role of allergy in chronic rhinosinusitis[J]. Immunol Allergy Clin North Am, 2004, 24(1): 45-57. doi:10.1016/S0889-8561(03)00108-5.
[13] Gilead B, Tatiana K, Miki P, et al. Pediatric chronic rhinosinusitis histopathology: differences and similarities with the adult form[J]. Otolaryngology Head Neck Surgery, 2011, 144(1): 85-90. doi: 10.1177/0194599810390443.
[14] 李华斌, 赖玉婷. 慢性鼻-鼻窦炎的发病机制及诊疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 4-9. LI Huabin, LAI Yuting. Pathogenesis, diagnosis, and treatment of chronic rhinosinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(3): 4-9.
[15] Kennedy JL, Borish L. Chronic sinusitis pathophysiology: the role of allergy[J]. Am J Rhinol Allergy, 2013, 27(5): 367-371. doi:10.2500/ajra. 2013.27. 3906.
[16] Kalliomäki M, Kirjavainen P, Eerola E, et al. Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing[J]. J Allergy ClinImmunol, 2001, 107(1): 129-134. doi:10.1067/mai. 2001.111237.
[17] Lue KH, Sun HL, Lu KH, et al. A trial of adding Lactobacillusjohnsonii EM1 to levocetirizine for treatment of perennial allergic rhinitis in children aged 7-12 years[J]. Int J PediatrOtorhinolaryngol, 2012, 76(7): 994-1001. doi:10.1016/j.ijporl. 2012.03.018.
[18] Mjösberg J, Rao AN. Lung inflammation originating in the gut[J]. Science, 2018, 359(6371): 36-37. doi: 10.1126/science. aar4301.
[19] 李勇, 李静. 益生菌在儿童变应性鼻炎中的应用[J]. 中国中西医结合耳鼻咽喉科杂志, 2018, 26(3): 177-181. doi:10.16542/j.cnki.issn. 1007-4856. 2018.03.007
[20] Fokkens WJ, Lund VJ, Mullol J, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists[J]. Rhinology, 2012, 50(1): 1-12. doi:10.4193/Rhino50E2.
[21] 中华耳鼻咽喉头颈外科杂志编辑委员会. 儿童鼻-鼻窦炎诊断和治疗建议(2012年,昆明)[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(3): 177-179. Chinese Journal of Otorhinolaryngology, Head and Neck Surgery Editorial Board. Recommendations for Diagnosis and Treatment of Rhinosinusitis in Children(2012, kunming)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2013, 48(3): 177-179.
[22] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018)[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(2): 81-100. Chinese Journal of Otorhinolaryngology Head and Neck Surgery Editorial Board Rhinology Group, Otorhinolaryngology Head and Neck Surgery Branch of Chinese Medical Association Rhinology Group. Chinese guidelines for diagnosis and treatment of chronic rhinosinusitis(2018)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2019, 54(2): 81-100.
[23] 沈翎, 林宗通, 林兴, 等. 儿童阻塞性睡眠呼吸暂停低通气综合征危险因素的病例对照研究[J]. 山东大学耳鼻喉眼学报, 2018, 32(2): 25-29. doi: 10.6040/j.issn.1673-3770.0. 2018.086. SHEN Ling, LIN Zongtong, LIN Xing, et al. Risk factors associated with obstructive sleep apnea-hypopnea syndrome in children: a retrospective case-control study[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(2): 25-29. doi: 10.6040/j.issn. 1673-3770.0. 2018.086.
[24] Brietzke SE, Shin JJ, Choi S, et al. Clinical consensus statement: pediatric chronic rhinosinusitis[J]. Otolaryngology Head Neck Surgery, 2014, 151(4): 542-553. doi: 10.1177/0194599814549302.
[25] Dierckx D, Saldarriaga Vargas C, Rogge F, et al. Dosimetric analysis of the use of CBCT in diagnostic radiology: sinus and middle ear[J]. Radiat Prot Dosimetry, 2015, 163(1): 125-132. doi:10.1093/rpd/ncu117.
[26] Capelli M, Gatti P. Radiological study of maxillary sinus using CBCT: relationship between mucosal thickening and common anatomic variants in chronic rhinosinusitis[J]. J Clin Diagn Res, 2016, 10(11): MC07-MC10. doi:10.7860/JCDR/2016/22365. 8931.
[27] Woodworth BA, Chennupati SK, Chiu AG. CBCT-based image guidance for sinus and skull basesurgery[M]. Maxillofacial Cone Beam Computed Tomography. Cham: Springer International Publishing, 2018: 1057-1070. doi: 10.1007/978-3-319-62061-9_27.
[28] Shoseyov D, Bibi H, Shai P, et al. Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis[J]. J Allergy ClinImmunol, 1998, 101(5): 602-605. doi:10.1016/S0091-6749(98)70166-6.
[29] Wang YH, Ku MS, Sun HL, et al. Efficacy of nasal irrigation in the treatment of acute sinusitis in atopic children[J]. J Microbiol Imnunol Infect, 2014, 47(1): 63-69. doi: 10.1016/j. jmii. 2012.08.018.
[30] Neff L, Adil EA. What is the role of the adenoid in pediatric chronic rhinosinusitis?[J]. Laryngoscope, 2015, 125(6): 1282-1283. doi:10.1002/lary. 25090.
[31] Ramadan HH, Terrell AM. Balloon catheter sinuplasty and adenoidectomy in children with chronic rhinosinusitis[J]. Ann Otol Rhinol Laryngol, 2010, 119(9): 578-582. doi: 10.1177/000348941011900902.

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