ABSTRACT
There is increasing evidence that acute and chronic rhinosinusitis (CRS) in children and adults is of different etiology and therefore warrants different treatment strategies. It is becoming more apparent that adult CRS has a relatively greater inflammatory component whereas childhood CRS has a relatively greater infectious component (1). This is secondary to immaturity of the pediatric immune system, the increased incidence of viral upper respiratory tract infections, and the smaller ostia to the sinuses in children. Concentrations of eosinophils in adult mucosa are greater than those noted in children (2) with a correspondingly higher incidence of atopic adults (86%) than children (43%). There is also a greater degree of collagen deposition and expansion of submucosal mucous glands in the adult sinus indicating more tissue remodeling and potentially greater irreversible scarring (2,3). The workup and treatment options for acute and CRS in children are therefore different than in adults. Certain systemic diseases are also more likely to occur in children. Immune deficiencies, cystic fibrosis, and ciliary dyskinesia are good examples. It must be realized that the disease processes between adults and children may be entirely different.
