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Rhinitis and sinusitis are frequently referred to as two separate and distinct disease processes. However, since the mucosa of the nasal cavity and sinuses are contiguous, rhinitis and sinusitis often coexist, making a distinction on clinical presentation difficult. Therefore, rhinosinusitis may serve as a more appropriate term1 to define a “group of disorders characterized by inflammation of the mucosa of the nose and paranasal sinuses.”2


The inflammation resulting in rhinosinusitis can be multifactorial including viral infections, bacterial infections, and allergic processes. This varied etiology of rhinosinusitis in children makes the management of the condition challenging for pediatricians. Defining the etiology of rhinosinusitis is paramount to guiding therapeutic interventions. Definitions based on the patient's history and clinical presentation have been created to categorize rhinosinusitis as acute, subacute, recurrent, chronic, and acute superimposed on chronic (Table 30–1).2,3 Practitioners are encouraged to utilize these definitions to guide their therapeutic decisions.

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Table 30–1. Classification of Rhinosinusitis

Estimates of the incidence and prevalence of rhinosinusitis are varied. This is likely attributable to the inclusion of different subcategories of rhinosinuisitis in various estimates of disease burden. In adults suffering an acute viral upper respiratory infection there is often concominant evidence of paranasal sinus inflammation, a finding that supports the diagnosis of viral rhinosinusitis.4,5 Based on this, there are over 1 billion episodes of all-cause rhinosinusitis each year in the United States.4 More important to the practitioner is the rate at which a viral process progresses to acute bacterial rhinosinusitis. Approximately 0.5–2% of patients with viral upper respiratory infections progress to bacterial rhinosinusitis. This translates into 5–20 million cases of acute bacterial rhinosinusitis each year.4


Attempts to quantify the burden of acute bacterial rhinosinusitis in children have also been performed. Progression from viral upper respiratory infection to bacterial disease is thought to be more frequent in pediatric cases at a rate of 5–10%.6 The rate of progression to a bacterial infection may be as high as 13% in children attending daycare.7 In one prospective study, ...

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