Rhinosinusitis is the inflammation of the mucous membranes of nose and paranasal sinus(es). 5–13% of upper respiratory tract infections in children complicate into acute rhinosinusitis. Though not life threatening, it profoundly affects child’s school performance and sleep pattern. If untreated, it could progress to chronic rhinosinusitis (CRS). The pathogens involved in perpetuation of CRS consist of multidrug-resistant mixed microflora. CRS is challenging to manage and could further extend to cause eye or intracranial complications. In children, CRS diagnosis is often either missed or incomprehensive. Due to this, morbidity and strain on healthcare budget are tremendous. Flexible fiberoptic endoscopy has revolutionized management of CRS. Its utility in children is being increasingly recognized. Optimal management entails specific appropriate antimicrobials as well as treatment of underlying causes. The aim is to normalize sinus anatomy and physiology and regain normal mucociliary function and clearance. 1. Introduction Rhinosinusitis is a widely prevalent disease affecting more than 14% of adults and children [1–4]. It has high propensity to become chronic. Though the acute form of rhinosinusitis is unimicrobial, multiple microorganisms characterize the chronic form [5–7]. The latter microbes usually demonstrate antimicrobial resistance and pose a therapeutic challenge for the practising physician [8]. Fungi often coinhabit such chronically infected sinuses and are extremely difficult to eradicate [9]. They add on to the morbidities and complications [10, 11]. Maximum medical therapy often fails and surgical interventions become mandatory [12, 13]. This wells up healthcare costs. Hence early detection and prompt and appropriate treatment of rhinosinusitis could possibly avert CRS and its individual and societal burden [14, 15]. 2. Definition The combined term “Rhinosinusitis” was coined by 1997 Task Force of Rhinology and Paranasal Sinus Committee because sinusitis is invariably accompanied by rhinitis [16]. Acute rhinosinusitis implies sudden onset of two or more of the following symptoms: nasal discharge, stuffiness or congestion, facial pain/pressure, or anosmia/hyposmia [17, 18]. There may be associated fever, malaise, irritability, headache, toothache, or cough. When symptoms are present for 4–12 weeks, it is subacute rhinosinusitis. When they persist for more than 12 weeks, it is termed as “chronic rhinosinusitis” [19]. The latter results usually due to untreated/improperly treated/refractory acute rhinosinusitis. Recurrent rhinosinusitis is 4
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