The condition of the paranasal sinuses in children and adolescents with extended sinonasal symptoms according to computed tomography

Introduction. Chronic rhinosinusitis (CRS) with and without nasal polyps is a syndrome associated with the persistent inflammation and remodeling of the sinonasal mucosa (SM) leading to prolonged sinonasal symptoms (SNS). Its prevalence in children and adolescents has not yet been established. The diagnostic algorithm includes the use of CT to visualize the sinonasal structures.

Purpose of the study: to use the CT method to assess the condition of the paranasal sinuses in children with prolonged SNS.

Material and methods. The CT scans of the paranasal sinuses were evaluated in 105 patients with the median age of 14,0 [11,0; 16,0] years, 59,0% (62/105) males, who had prolonged (more than 3 months) SNS that had not resolved with standard therapy. Hounsfield units (HU), reflecting the tissue X ray absorption coefficient, were used in describing and analyzing CT scans.

Results. Severe changes in SM of the paranasal sinuses were detected in 72 (66,7%) patients. In 40 (38,1%) patients, the changes were regarded as cystic, in 16,2% (17/105) as cystic polypoid, and polypoid changes were revealed in 14,3% (15/105) of the children. The absorption coefficient was 22,4±6,4 HU in patients with cystic SM changes, 36,4±8,3 HU in cystic polypoid changes, and 59,1±9,2 HU in polypoid changes (p<0, 0001).

Conclusions. Thus, 68,6% of pediatric and adolescent patients with prolonged SNS had CT signs of cystic, cystic polypoid, and polypoid SM changes. These changes, in our opinion, should be considered in terms of the onset of CRS with or without polyps in children and adolescents.
Key words: chronic rhinosinusitis, remodeling, computed tomography