We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Skip to main content

Medical Treatment of Pediatric Rhinosinusitis: Focus on Intranasal and Systemic Corticosteroids

  • Chapter
  • First Online:
Pediatric Rhinosinusitis

Abstract

Rhinosinusitis is a commonly encountered problem in both pediatric and otorhinolaryngologic practices with a recent increase in the diagnosis of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) in both adult and pediatric patients. This is likely a consequence of an improved understanding of the etiology, pathophysiology, and microbiology of the disease. This chapter overviews the medical treatment of the disease with special focus on the evidence supporting corticosteroid therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gilani S, Shin JJ. The burden and visit prevalence of pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2017;157(6):1048–52.

    Article  PubMed  Google Scholar 

  2. Westman M, Stjärne P, Bergström A, Kull I, Toskala E, Cardell LO, Wickman M, Holmström M. Chronic rhinosinusitis is rare but bothersome in adolescents from a Swedish population-based cohort. J Allergy Clin Immunol. 2015;136(2):512–4.

    Article  PubMed  Google Scholar 

  3. Van der Veken P, Clement PA, Buisseret T, Desprechins B, Kaufman L, Derde MP. CAT-scan study of the prevalence of sinus disorders and anatomical variations in 196 children. Acta Otorhinolaryngol Belg. 1989;43(1):51–8.

    PubMed  Google Scholar 

  4. Nguyen KL, Corbett ML, Garcia DP, Eberly SM, Massey EN, Le HT, et al. Chronic sinusitis among pediatric patients with chronic respiratory complaints. J Allergy Clin Immunol. 1993;92(6):824–30.

    Article  CAS  PubMed  Google Scholar 

  5. Wang YH, Yang CP, Ku MS, Sun HL, Lue KH. Efficacy of nasal irrigation in the treatment of acute sinusitis in children. Int J Pediatr Otorhinolaryngol. 2009;73(12):1696–701.

    Article  PubMed  Google Scholar 

  6. Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane database of systematic reviews (Online). 2007(3):CD006394.

    Google Scholar 

  7. Wei JL, Sykes KJ, Johnson P, He J, Mayo MS. Safety and efficacy of once daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis. Laryngoscope. 2011;121(9):1989–2000.

    PubMed  Google Scholar 

  8. Jeffe JS, Bhushan B, Schroeder JW Jr. Nasal saline irrigation in children: a study of compliance and tolerance. Int J Pediatr Otorhinolaryngol. 2012;76(3):409–13.

    Article  PubMed  Google Scholar 

  9. Brietzke SE, Shin JJ, Choi S, Lee JT, Parikh SR, Pena M, et al. Clinical consensus statement: pediatric chronic rhinosinusitis. Otolaryngol Head and Neck Surg. 2014;151(4):542–53.

    Article  Google Scholar 

  10. Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 year. Pediatrics. 2013;132(1):e262–80.

    Article  PubMed  Google Scholar 

  11. Falagas ME, Giannopoulou KP, Vardakas KZ, Dimopoulos G, Kara-georgopoulos DE. Comparison of antibiotics with placebo for treatment of acute sinusitis: a meta-analysis of randomised controlled trials. Lancet Infect Dis. 2008;8(9):543–52.

    Article  PubMed  Google Scholar 

  12. Kristo A, Uhari M, Luotonen J, Ilkko E, Koivunen P, Alho OP. Cefu-roxime axetil versus placebo for children with acute respiratory infection and imaging evidence of sinusitis: a randomized, controlled trial. Acta Paediatr. 2005;94(9):1208–13.

    Article  PubMed  Google Scholar 

  13. Garbutt JM, Goldstein M, Gellman E, Shannon W, Littenberg B. A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis. Pediatrics. 2001;107(4):619–25.

    Article  CAS  PubMed  Google Scholar 

  14. Casey JR, Adlowitz DG, Pichichero ME. New patterns in the otopathogens causing acute otitis mediasix to eight years after introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2010;29(4):304–9.

    PubMed  PubMed Central  Google Scholar 

  15. Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis. Otolaryngol Head Neck Surg. 2007;136(3):340–7.

    Article  PubMed  Google Scholar 

  16. Grady R. Safety profile of quinolone antibiotics in the pediatric population. Pediatr Infect Dis J. 2003;22(12):1128–32.

    Article  PubMed  Google Scholar 

  17. Harrison CJ, Woods C, Stout G, Martin B, Selvarangan R. Susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae, including serotype 19A, and Moraxella catarrhalis paediatric isolates from 2005 to 2007 to commonly used antibiotics. J Antimicrob Chemother. 2009;63(3):511–9.

    Article  CAS  PubMed  Google Scholar 

  18. Tristram S, Jacobs MR, Appelbaum PC. Antimicrobial resistance in Haemophilus influenzae. Clin Microbiol Rev. 2007;20(2):368–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Otten FW, Grote JJ. Treatment of chronic maxillary sinusitis in children. Int J Pediatr Otorhinolaryngol. 1988;15(3):269–78.

    Article  CAS  PubMed  Google Scholar 

  20. Otten HW, Antvelink JB, Ruyter de Wildt H, Rietema SJ, Siemelink RJ, Hordijk GJ. Is antibiotic treatment of chronic sinusitis effective in children? Clin Otolaryngol Allied Sci. 1994;19(3):215–7.

    Article  CAS  PubMed  Google Scholar 

  21. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:1–298.

    Google Scholar 

  22. Don DM, Yellon RF, Casselbrant ML, Bluestone CD. Efficacy of a stepwise protocol that includes intravenous antibiotic therapy for the management of chronic sinusitis in children and adolescents. Arch Otolaryngol Head Neck Surg. 2001;127(9):1093–8.

    Article  CAS  PubMed  Google Scholar 

  23. Meltzer EO, Charous BL, Busse WW, Zinreich SJ, Lorber RR, Danzig MR, The Nasonex Sinusitis Group. Added relief in the treatment of acute recurrent sinusitis with adjunctive mometasone furoate nasal spray. J Allergy Clin Immunol. 2000;106(4):630–7.

    Article  CAS  PubMed  Google Scholar 

  24. Dolor RJ, Witsell DL, Hellkamp AS, Williams JW Jr, Califf RM, Simel DL, Ceftin and Flonase for Sinusitis (CAFFS) Investigators. Comparison of cefuroxime with or without intranasal fluticasone for the treatment of rhinosinusitis. The CAFFS Trial: a randomized controlled trial. JAMA. 2001;286(24):3097–105.

    Article  CAS  PubMed  Google Scholar 

  25. Barlan IB, Erkan E, Bakir M, Berrak S, Başaran MM. Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children. Ann Allergy Asthma Immunol. 1997;78(6):598–601.

    Article  CAS  PubMed  Google Scholar 

  26. Wan KS, Wu WF, Chen TC, Wu CS, Hung CW, Chang YS. Comparison of amoxicillin + clavulanate with or without intranasal fluticasone for the treatment of uncomplicated acute rhinosinusitis in children. Minerva Pediatr. 2015;67(6):489–94.

    CAS  PubMed  Google Scholar 

  27. Nayak AS, Settipane GA, Pedinoff A, Charous BL, Meltzer EO, Busse WW, et al. Effective dose range of mometasone furoate nasal spray in the treatment of acute rhinosinusitis. Ann Allergy Asthma Immunol. 2002;89(3):271–8.

    Article  CAS  PubMed  Google Scholar 

  28. Meltzer EO, Bachert C, Staudinger H. Treating acute rhinosinusitis: comparing efficacy and safety of mometasone furoate nasal spray, amoxicillin, and placebo. J Allergy Clin Immunol. 2005;116(6):1289–95.

    Article  CAS  PubMed  Google Scholar 

  29. Bucher HC, Tschudi P, Young J, Periat P, Welge-Luussen A, Zust H, et al. Effect of amoxicillin-clavulanate in clinically diagnosed acute rhinosinusitis: a placebo-controlled, double-blind, randomized trial in general practice. Arch Intern Med. 2003;163:1793–8.

    Article  CAS  PubMed  Google Scholar 

  30. Tugrul S, Dogan R, Baki ES, Meric A, Ozturan O. The use of large volume low pressure nasal saline with fluticasone propionate for the treatment of pediatric acute rhinosinusitis. Int J Pediatr Otorhinolaryngol. 2014;78:1393–9.

    Article  PubMed  Google Scholar 

  31. Beswick DM, Messner AH, Hwang PH. Pediatric chronic rhinosinusitis management in rhinologists and pediatric otolaryngologists. Ann Otol Rhinol Laryngol. 2017;126(9):634–9.

    Article  PubMed  Google Scholar 

  32. Beswick DM, Ramadan H, Baroody FM, Hwang PH. Practice patterns in pediatric chronic rhinosinusitis: a survey of the American Rhinologic Society. Am J Rhinol Allergy. 2016;30(6):418–23.

    Article  PubMed  Google Scholar 

  33. Chong LY, Head K, Hopkins C, Philpott C, Schilder AGM, Burton MJ. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4:CD011996.

    PubMed  Google Scholar 

  34. Chur V, Small CB, Stryszak P, Teper A. Safety of mometasone furoate nasal spray in the treatment of nasal polyps in children. Pediatr Allergy Immunol. 2013;24:33–8.

    Article  PubMed  Google Scholar 

  35. Maspero JF, Rosenblut A, Finn A Jr, Lim J, Wu W, Philpot E. Safety and efficacy of fluticasone furoate in pediatric patients with perennial allergic rhinitis. Otolaryngol Head Neck Surg. 2008;138:30–7.

    Article  PubMed  Google Scholar 

  36. Meltzer EO, Tripathy I, Maspero JF, Wu W, Philpot E. Safety and tolerability of fluticasone furoate nasal spray once daily in paediatric patients aged 6-11 years with allergic rhinitis: subanalysis of three randomized, double-blind, placebo-controlled, multicentre studies. Clin Drug Investig. 2009;29:79–86.

    Article  CAS  PubMed  Google Scholar 

  37. Rosenblut A, Bardin PG, Muller B, Faris MA, Wu W, Caldwell MF, Fokkens WJ. Long-term safety of fluticasone furoate nasal spray in adults and adolescents with perennial allergic rhinitis. Allergy. 2007;62:1071–7.

    Article  CAS  PubMed  Google Scholar 

  38. Ratner PH, Meltzer EO, Teper A. Mometasone furoate nasal spray is safe and effective for 1-year treatment of children with perennial allergic rhinitis. Int J Pediatr Otorhinolaryngol. 2009;73:651–7.

    Article  PubMed  Google Scholar 

  39. Lanier B, Kai G, Marple B, et al. Pathophysiology and progression of nasal septal perforation. Ann Allergy Innumol. 2007;99:473–80.

    Article  Google Scholar 

  40. Verkerk MM, Bhatia D, Rimmer J, Earls P, Sacks R, Harvey RJ. Intranasal steroids and the myth of mucosal atrophy: a systematic review of original histological assessments. Am J Rhinol Allergy. 2015;29:3–18.

    Article  PubMed  Google Scholar 

  41. Van AA, Bronsky EA, Dockhorn RJ, Grossman J, Lumry W, Meltzer EO, et al. Once daily fluticasone propionate is as effective for perennial allergic rhinitis as twice daily beclomethasone diproprionate. J Allergy Clin Immunol. 1993;91:1146–54.

    Article  Google Scholar 

  42. Brannan MD, Herron JM, Reidenberg P, Affrime MB. Lack of hypothalamic-pituitary- adrenal axis suppression with once-daily or twice-daily beclomethasone dipropionate aqueous nasal spray administered to patients with allergic rhinitis. Clin Ther. 1995;17:637–47.

    Article  CAS  PubMed  Google Scholar 

  43. Vargas R, Dockhorn RJ, Findlay SR, Korenblat PE, Field EA, Kral KM. Effect of fluticasone propionate aqueous nasal spray versus oral prednisone on the hypothalamic-pituitary-adrenal axis. J Allergy Clin Immunol. 1998;102:191–7.

    Article  CAS  PubMed  Google Scholar 

  44. Howland WC 3rd, Dockhorn R, Gillman S, Gross GN, Hille D, Simpson B, et al. A comparison of effects of triamcinolone acetonide aqueous nasal spray, oral prednisone, and placebo on adrenocortical function in male patients with allergic rhinitis. J Allergy Clin Immunol. 1996;98:32–8.

    Article  CAS  PubMed  Google Scholar 

  45. Nayak AS, Ellis MH, Gross GN, Mendelson LM, Schenkel EJ, Lanier BQ, et al. The effects of triamcinolone acetonide aqueous nasal spray on adrenocortical function in children with allergic rhinitis. J Allergy Clin Immunol. 1998;101:157–62.

    Article  CAS  PubMed  Google Scholar 

  46. Galant SP, Melamed IR, Nayak AS, Blake KV, Prillaman BA, Reed KD, et al. Lack of effect of fluticasone propionate aqueous nasal spray on the hypothalamic- pituitary-adrenal axis in 2- and 3-year-old patients. Pediatrics. 2003;112:96–100.

    Article  PubMed  Google Scholar 

  47. Kim K, Weiswasser M, Nave R, Ratner P, Nayak A, Herron J, et al. Safety of once-daily ciclesonide nasal spray in children 2 to 5 years of age with perennial allergic rhinitis. Pediatric Asthma Allergy Immunol. 2007;20:229–42.

    Article  Google Scholar 

  48. Chervinsky P, Kunjibettu S, Miller DL, Prenner BM, Raphael G, Hall N, Shah T. Long-term safety and efficacy of intranasal ciclesonide in adult and adolescent patients with perennial allergic rhinitis. Ann Allergy Asthma Immunol. 2007;99:69–76.

    Article  CAS  PubMed  Google Scholar 

  49. Patel D, Ratner P, Clements D, Wu W, Faris M, Philpot E. Lack of effect on adult and adolescent hypothalamic-pituitary-adrenal axis function with use of fluticasone furoate nasal spray. Ann Allergy Asthma Immunol. 2008;100:490–6.

    Article  PubMed  Google Scholar 

  50. Weinstein S, Qaqundah P, Georges G, Nayak A. Efficacy and safety of triamcinolone acetonide aqueous nasal spray in children aged 2 to 5 years with perennial allergic rhinitis: a randomized, double-blind, placebo-controlled study with an open-label extension. Ann Allergy Asthma Immunol. 2009;102:339–47.

    Article  CAS  PubMed  Google Scholar 

  51. Tripathy I, Levy A, Ratner P, Clements D, Wu W, Philpot E. HPA axis safety of fluticasone furoate nasal spray once daily in children with perennial allergic rhinitis. Pediatr Allergy Immunol. 2009;20:287–94.

    Article  PubMed  Google Scholar 

  52. Hampel FC Jr, Nayak NA, Segall N, Small CJ, Li J, Tantry SK. No hypothalamic-pituitary-adrenal function effect with beclomethasone dipropionate nasal aerosol, based on 24-hour serum cortisol in pediatric allergic rhinitis. Ann Allergy Asthma Immunol. 2015;115(2):137–42.

    Article  CAS  PubMed  Google Scholar 

  53. Liu A, Manche EE. Bilateral posterior subcapsular cataracts associated with long-term intranasal steroid use. J Cataract Refract Surg. 2011;37:1555–8.

    Article  PubMed  Google Scholar 

  54. Ahmadi N, Snidvongs K, Kalish L, Sacks R, Tumuluri K, Wilcsek G, Harvey R. Intranasal corticosteroids do not affect intraocular pressure or lens opacity: a systematic review of controlled trials. Rhinology. 2015;53(4):290–302.

    Article  CAS  PubMed  Google Scholar 

  55. Mener DJ, Shargorodsky J, Varadhan R, Lin SY. Topical intranasal corticosteroids and growth velocity in children: a meta-analysis. Int Forum Allergy Rhinol. 2015;5:95–103.

    Article  PubMed  Google Scholar 

  56. Ozturk F, Bakirtas A, Ileri F, Turktas I. Efficacy and tolerability of systemic methylprednisolone in children and adolescents with chronic rhinosinusitis: a double-blind, placebo-controlled randomized trial. J Allergy Clin Immunol. 2011;128(2):348–52.

    Article  CAS  PubMed  Google Scholar 

  57. Tosca MA, Cosentino C, Pallestrini E, Riccio AM, Milanese M, Canonica GW, Ciprandi G. Medical treatment reverses cytokine pattern in allergic and nonallergic chronic rhinosinusitis in asthmatic children. Pediatr Allergy Immunol. 2003;14:238–41.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Fuad M. Baroody .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Baroody, F.M. (2020). Medical Treatment of Pediatric Rhinosinusitis: Focus on Intranasal and Systemic Corticosteroids. In: Ramadan, H., Baroody, F. (eds) Pediatric Rhinosinusitis. Springer, Cham. https://doi.org/10.1007/978-3-030-22891-0_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-22891-0_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-22890-3

  • Online ISBN: 978-3-030-22891-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics