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Chronic nasal dysfunction in children: Allergic rhinitis? Infectious? What to do if neither?

Abstract

PURPOSE OF REVIEW

To review challenges in the diagnosis, work-up, and management of healthy children who present to the otolaryngologist with nasal dysfunction. Common symptoms include chronic nasal congestion, with or without rhinorrhea, with or without previous empirically treated 'allergic rhinitis' and/or 'sinus' infection. Symptoms are often unresolved despite chronic use of intranasal steroid, antihistamine, and/or leukotriene receptor antagonists.

RECENT FINDINGS

There are no published studies addressing nasal symptoms in children who test negative for allergies yet report persistent nasal obstruction, congestion, and/or rhinorrhea. Recent publications continue to address efficacy of medical and/or surgical treatment for allergic rhinitis or acute/chronic rhinosinusitis. Best practice for children who 'fail' medical therapy but have impaired quality of life because of nasal dysfunction remains unknown.

SUMMARY

Chronic nasal symptoms are common in childhood despite daily treatment using intranasal steroid, antihistamines, and/or leukotriene receptor antagonist therapies. Diet and dietary habit history should be included during evaluation and differential diagnosis as excessive dairy and sugar may contribute to chronic symptoms. Children who fail medical therapy for persistent nasal symptoms, allergic or not, should be referred and considered for outfracture of inferior turbinates and inferior turbinoplasty. Turbinate reduction procedures have demonstrated significant improvement in all domains of SinoNasal Quality of Life as measured by 'SN-5' survey.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    University of Central Florida College of Medicine, Nemours Children's Hospital, Orlando, Florida, USA.

    Source

    MeSH

    Child
    Chronic Disease
    Constipation
    Diet
    Dyspepsia
    Humans
    Medical History Taking
    Physical Examination
    Practice Guidelines as Topic
    Rhinitis
    Rhinitis, Allergic
    Sinusitis
    Therapeutic Irrigation

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    26488532

    Citation

    Wei, Julie L.. "Chronic Nasal Dysfunction in Children: Allergic Rhinitis? Infectious? what to Do if Neither?" Current Opinion in Otolaryngology & Head and Neck Surgery, vol. 23, no. 6, 2015, pp. 491-8.
    Wei JL. Chronic nasal dysfunction in children: Allergic rhinitis? Infectious? What to do if neither? Curr Opin Otolaryngol Head Neck Surg. 2015;23(6):491-8.
    Wei, J. L. (2015). Chronic nasal dysfunction in children: Allergic rhinitis? Infectious? What to do if neither? Current Opinion in Otolaryngology & Head and Neck Surgery, 23(6), pp. 491-8. doi:10.1097/MOO.0000000000000207.
    Wei JL. Chronic Nasal Dysfunction in Children: Allergic Rhinitis? Infectious? what to Do if Neither. Curr Opin Otolaryngol Head Neck Surg. 2015;23(6):491-8. PubMed PMID: 26488532.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Chronic nasal dysfunction in children: Allergic rhinitis? Infectious? What to do if neither? A1 - Wei,Julie L, PY - 2015/10/22/entrez PY - 2015/10/22/pubmed PY - 2016/8/23/medline SP - 491 EP - 8 JF - Current opinion in otolaryngology & head and neck surgery JO - Curr Opin Otolaryngol Head Neck Surg VL - 23 IS - 6 N2 - PURPOSE OF REVIEW: To review challenges in the diagnosis, work-up, and management of healthy children who present to the otolaryngologist with nasal dysfunction. Common symptoms include chronic nasal congestion, with or without rhinorrhea, with or without previous empirically treated 'allergic rhinitis' and/or 'sinus' infection. Symptoms are often unresolved despite chronic use of intranasal steroid, antihistamine, and/or leukotriene receptor antagonists. RECENT FINDINGS: There are no published studies addressing nasal symptoms in children who test negative for allergies yet report persistent nasal obstruction, congestion, and/or rhinorrhea. Recent publications continue to address efficacy of medical and/or surgical treatment for allergic rhinitis or acute/chronic rhinosinusitis. Best practice for children who 'fail' medical therapy but have impaired quality of life because of nasal dysfunction remains unknown. SUMMARY: Chronic nasal symptoms are common in childhood despite daily treatment using intranasal steroid, antihistamines, and/or leukotriene receptor antagonist therapies. Diet and dietary habit history should be included during evaluation and differential diagnosis as excessive dairy and sugar may contribute to chronic symptoms. Children who fail medical therapy for persistent nasal symptoms, allergic or not, should be referred and considered for outfracture of inferior turbinates and inferior turbinoplasty. Turbinate reduction procedures have demonstrated significant improvement in all domains of SinoNasal Quality of Life as measured by 'SN-5' survey. SN - 1531-6998 UR - https://www.unboundmedicine.com/medline/citation/26488532/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=26488532 DB - PRIME DP - Unbound Medicine ER -