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Invited Article
Clinical Consensus Statement: Pediatric
Chronic Rhinosinusitis
Otolaryngology–
Head and Neck Surgery
2014, Vol. 151(4) 542–553
American Academy of
Otolaryngology—Head and Neck
Surgery Foundation 2014
Reprints and permission:
sagepub.com/journalsPermissions.navDOI: 10.1177/0194599814549302
http://otojournal.orgScott E. Brietzke, MD, MPH
1
, Jennifer J. Shin, MD
2
, Sukgi Choi, MD
3
,
Jivianne T. Lee, MD
4
, Sanjay R. Parikh, MD
5
, Maria Pena, MD
6
,
Jeremy D. Prager, MD
7
, Hassan Ramadan, MD
8
, Maria Veling, MD
9
,
Maureen Corrigan
10
, and Richard M. Rosenfeld, MD, MPH
11
Sponsorships or competing interests that may be relevant to content are
disclosed at the end of this article.
Abstract
Objective.
To develop a clinical consensus statement on the
optimal diagnosis and management of pediatric chronic rhi-
nosinusitis (PCRS).
Methods.
A representative 9-member panel of otolaryngolo-
gists with no relevant conflicts of interest was assembled to
consider opportunities to optimize the diagnosis and man-
agement of PCRS. A working definition of PCRS and
the scope of pertinent otolaryngologic practice were
first established. Patients of ages 6 months to 18 years
without craniofacial syndromes or immunodeficiency were
defined as the targeted population of interest. A modified
Delphi method was then used to distill expert opinion into
clinical statements that met a standardized definition of
consensus.
Results.
After 2 iterative Delphi method surveys, 22 state-
ments met the standardized definition of consensus while
12 statements did not. Four statements were omitted due
to redundancy. The clinical statements were grouped into 4
categories for presentation and discussion: (1) definition and
diagnosis of PCRS, (2) medical treatment of PCRS, (3) ade-
noiditis/adenoidectomy, and (4) endoscopic sinus surgery
(ESS)/turbinoplasty.
Conclusion.
Expert panel consensus may provide helpful infor-
mation for the otolaryngologist in the diagnosis and manage-
ment of PCRS in uncomplicated pediatric patients.
Keywords
pediatric otolaryngology, rhinosinusitis, chronic rhinosinusi-
tis, evidence-based medicine, review, Delphi method
Received May 7, 2014; revised July 30, 2014; accepted August 8, 2014.
Introduction
Pediatric chronic rhinosinusitis (PCRS) is a commonly
encountered condition in otolaryngological practice. Five
percent to 13% of childhood viral upper respiratory tract
infections may progress to acute rhinosinusitis,
1-4
with a
proportion of these progressing to a chronic condition.
PCRS may also coexist and/or be exacerbated by other
widespread conditions such as allergic rhinitis and adenoid
disease,
5-9
and some suggest the incidence of PCRS may be
rising.
10
In addition, PCRS has a meaningful impact on
quality of life,
11
with its related adverse effects potentially
exceeding that of chronic respiratory and arthritic disease.
12
PRCS also has the potential to exacerbate asthma,
13,14
a
condition that negatively affects 2% to 20% of children.
15-17
In spite of its prevalence and impact on affected families,
many aspects of PCRS remain ill-defined. At the most basic
level, even the diagnostic definition of PCRS has not been
concretely elucidated among our specialty societies, creating
challenges in discussing clinical presentations or establish-
ing human study protocols. Similarly, while performing
nasal endoscopy and obtaining site-specific cultures may be
routine in the cooperative adult population, their role in the
evaluation of children has not been clearly established.
Likewise, the concept of maximal medical therapy has yet to
be specifically delineated, although there is a broad spectrum
1
Walter Reed National Military Medical Center, Bethesda, Maryland, USA
2
Harvard Medical School, Boston, Massachusetts, USA
3
University of Pittsburgh/Children’s Hospital of Pittsburgh of UMPC,
Pittsburgh, Pennsylvania, USA
4
David Geffen School of Medicine at University of California Los Angeles,
Los Angeles, California, USA
5
University of Washington/Seattle Children’s Hospital, Seattle, Washington,
USA
6
Children’s National Medical Center, Washington, DC, USA
7
University of Colorado/Children’s Hospital Colorado, Aurora, Colorado,
USA
8
West Virginia University, Morgantown, West Virginia, USA
9
University of Texas–Southwestern Medical Center/Children’s Medical
Center-Dallas, Dallas, Texas, USA
10
American Academy of Otolaryngology—Head and Neck Surgery
Foundation, Alexandria, Virginia, USA
11
SUNY Downstate Medical Center, Brooklyn, New York, USA
Corresponding Author:
Scott E. Brietzke, MD, MPH, Walter Reed Department of Otolaryngology,
8901 Wisconsin Ave., Bethesda, MD 20889.
Email:
SEBrietzke@msn.comReprinted by permission of Otolaryngol Head Neck Surg. 2014; 151(4):542-553.
20