CLINICAL SIGNIFICANCE OF POSTNASAL DRIP SYNDROME IN CHILDREN WITH CHRONIC RHINOSINUSITIS AND MODERN THERAPEUTIC APPROACHES (LITERATURE REVIEW)

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 131 CLINICAL SIGNIFICANCE OF POSTNASAL DRIP SYNDROME IN CHILDREN WITH CHRONIC RHINOSINUSITIS AND MODERN THERAPEUTIC APPROACHES (LITERATURE REVIEW) A.Kh. Rajabov1, A.Kh. Rustamov2 Tashkent State Medical University1,2 https://doi.org/10.5281/zenodo.17799967 Abstract. This literature review analyzes current evidence on the etiology, pathogenesis, and clinical characteristics of chronic rhinosinusitis in children. The importance of endoscopic assessment and imaging modalities is highlighted. Conservative and surgical treatment approaches are compared. Preventive strategies and factors that reduce recurrence rates are discussed. The review emphasizes the clinical relevance of pediatric CRS and the need for optimized diagnostic and therapeutic tactics. Keywords: chronic rhinosinusitis, postnasal syndrome, children, treatment. Introduction. Chronic rhinosinusitis (CRS) in children is considered one of the most clinically significant pathologies not only among ENT diseases but also in pediatric outpatient practice. According to the World Health Organization and several international otorhinolaryngology societies, the incidence of chronic forms of rhinosinusitis in children continues to show an upward trend each year. This tendency is associated with the multifactorial pathogenesis of the disease and the anatomical-physiological characteristics of the pediatric population [7, 11]. Clinical-epidemiological studies conducted in different regions indicate that the prevalence of CRS in children ranges between 5–15%. Recent statistical data from Europe and the United States show that the prevalence of chronic rhinosinusitis among children aged 6–12 years is 8–12%. Observations from Central Asian countries, including Uzbekistan, report a prevalence rate of approximately 10–18% [3]. Furthermore, the frequency of CRS is significantly higher among children with adenoid vegetations and those with recurrent upper respiratory tract infections. Some sources indicate that CRS may reach up to 20–25% in these groups. In addition, the incidence of chronic rhinosinusitis is notably higher in large cities, industrial regions, or areas with significant air pollution [9]. Chronic rhinosinusitis is most commonly observed in children aged 3–7 years. During this period, specific otorhinolaryngological anatomical factors—such as the incomplete development of the paranasal sinuses and the narrowness of the osteomeatal complex—along with the immaturity of the immune system, contribute to prolonged infection and its progression to a chronic state. Etiopathogenesis. Chronic rhinosinusitis (CRS) in children is one of the most common upper respiratory tract conditions and represents a multifactorial (polyetiological) disease. Determining its etiology and pathogenesis plays a decisive role in clinical diagnosis, therapeutic strategy, and prevention of recurrences. The anatomical and physiological characteristics of the pediatric organism—such as the incomplete development of the paranasal sinuses, the narrowness of the osteomeatal area, and the functionally maturing immune system—predispose children to chronic infection [2, 4]. Chronic rhinosinusitis in children develops due to the combined influence SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 132 of microbiological, allergic, viral, and anatomical factors. The etiological agents most commonly involved include Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and anaerobic bacteria such as Peptostreptococcus and Bacteroides species [5]. Acute viral respiratory infections (AVRIs) are considered the most prevalent trigger of CRS in children. Viral agents impair mucociliary clearance in the nasal mucosa and create a favorable environment for bacterial colonization. Frequent AVRIs (6–10 episodes per year) contribute significantly to the chronicization of sinusitis. Adenoid hypertrophy plays a key role in CRS etiology in children: enlarged adenoid tissue alters Eustachian tube pressure, restricts nasal ventilation, and obstructs sinus drainage, thereby promoting the development of a chronic disease course. In addition, functional immune insufficiency—such as IgA deficiency and impaired phagocytosis—is an important contributor to CRS development in children. The pathogenesis of chronic rhinosinusitis is a systemic, multistage process involving several pathophysiological mechanisms. The primary pathogenetic and initial stage in CRS development is the disruption of mucociliary transport. Viral and allergic influences lead to dysfunction of the nasal mucosal epithelium and ciliated cells, increased mucin secretion, and impaired clearance, which together result in restricted evacuation of exudate from the sinuses. Obstruction of the osteomeatal complex (OMC) — the principal drainage pathway for the frontal, ethmoid, and maxillary sinuses — leads to allergic edema, hypersecretion, and accumulation of pathological secretions [12]. Reduced ventilation in the sinuses causes tissue hypoxia. Hypoxia-inducible factor (HIF1α) further amplifies inflammation by increasing mucin and interleukin secretion. Prolonged inflammation may result in mucosal hyperplasia and the development of polypoid changes [1]. Thus, the etiology and pathogenesis of chronic rhinosinusitis in children are based on multiple interacting factors, including infection, allergy, anatomical peculiarities, immune status, and environmental influences. A thorough understanding of the main pathogenetic links is essential for selecting modern, individualized treatment strategies, optimizing antibiotic and antiinflammatory therapy, and determining indications for necessary surgical correction. Diagnosis. Chronic rhinosinusitis (CRS) in children is a multifactorial pathological condition, and its accurate diagnosis is crucial for determining an appropriate treatment strategy. Modern diagnostic approaches rely not only on clinical symptoms but also on endoscopic and instrumental methods, functional assessment tests, laboratory indicators, and imaging studies. Today, CRS diagnosis is performed using an integrated, comprehensive approach [6]. Among the most reliable and up-to-date diagnostic methods for pediatric CRS are the evaluation of the osteomeatal complex, determination of the degree of adenoid vegetation, assessment of nasal discharge, and identification of structural changes within the nasal cavity. Endoscopic examination allows precise identification of anatomical abnormalities (such as septal deviation or concha bullosa), and an objective evaluation can be performed using the Lund–Kennedy scoring system [8]. In addition, complete blood count, bacteriological cultures from nasal swabs, identification of pathogenic flora, and determination of antibiotic sensitivity (AB-gram) are essential. Because allergy plays a significant pathogenetic role in CRS, allergological tests—such as skin-prick testing and specific IgE measurement—are of great importance. Computed tomography (CT) of the paranasal sinuses is considered the “gold standard” of modern diagnostics, enabling detection of sinus opacification, osteomeatal complex obstruction, mucosal thickening, polyps, and various anatomical variants. The most widely used scoring system is the Lund–Mackay scale (0–24 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 133 points). Magnetic resonance imaging (MRI) is recommended only in specific cases, such as suspected orbital or intracranial complications. Functional tests include rhinomanometry, which evaluates nasal airway patency in children, and active anterior rhinopneumotachometry to measure the efficiency and dynamics of nasal breathing. Olfactometry is used to assess the degree of hyposmia or anosmia. Additional laboratory investigations—such as immunological and biomarker analyses—may also be performed as part of the diagnostic process. Clinical Course. Chronic rhinosinusitis (CRS) in children has a clinical presentation that differs significantly from that of adults. These differences are primarily associated with anatomical and physiological characteristics, an immature immune system, and increased susceptibility to infectious agents. The key clinical features are outlined below. In many cases, CRS in children presents with subfebrile temperature, prolonged fatigue, irritability, and sleep disturbances [3, 10]. Typical clinical manifestations of pediatric CRS include persistent nasal obstruction lasting ≥12 weeks, mucous or purulent nasal discharge (especially postnasal drip), recurrent or constant cough—often worsening at night—headache (in older children localized in the frontal or facial regions), reduced sense of smell, fatigue, impaired breathing, and decreased concentration. The persistence of these symptoms for ≥12 weeks is considered a primary diagnostic criterion for CRS [9]. Children may also experience frequent respiratory infections (6–8 times per year or more). Nasal obstruction and impaired nasal airflow are major symptoms. Chronic difficulty in nasal breathing leads to mouth breathing, resulting in dryness of the oral mucosa, development of tonsillitis and pharyngitis, and improper development of the craniofacial complex (“adenoid facies”). Fever and systemic intoxication are usually mild in CRS; high fever is uncommon. However, persistent low-grade fever (37.2–37.5°C), increased evening fatigue, and morning headaches may be present. Adenoid vegetations are commonly associated with CRS in children. Enlarged adenoids cause symptoms such as snoring, nocturnal apnea episodes, decreased attention, and reduced cognitive performance. Disease duration and relapse-remission pattern. CRS is characterized by symptoms lasting longer than 12 weeks. Exacerbations typically occur after acute viral respiratory infections and may last 7–14 days. During remission, symptoms decrease but generally do not disappear completely. Complications. Although uncommon, several complications may occur in children with CRS, including orbital cellulitis, periostitis, meningitis, epidural abscess (very rare), bronchial obstruction syndrome, bronchitis, and worsening of allergic diseases [14]. Treatment. Management of chronic rhinosinusitis (CRS) in children must be comprehensive, stepwise, and based on pathogenetic principles. Modern therapeutic approaches rely on international clinical guidelines such as EPOS 2020, AAO–HNS, and ICAR recommendations. The main goals of treatment include reducing inflammation in the paranasal sinuses, restoring drainage of the osteomeatal complex, eliminating infectious agents, and preventing recurrences [3]. Conservative (medical) treatment methods include intranasal corticosteroids (INCS), nasal saline irrigation (irrigation therapy), antibiotic therapy, and other supportive measures. In children, antibiotics are prescribed in cases where purulent exudate is identified on endoscopy or CT scan, when pathogenic bacterial flora is detected, during acute recurrences unresponsive to initial therapy, and in other specific indications. The Lund–Kennedy and Lund–Mackay scoring systems are important for evaluating treatment effectiveness [1]. Mucolytic and secretolytic agents such as acetylcysteine and carbocysteine help liquefy mucus and improve drainage. Antihistamines (when an allergic component is present) — including SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 134 cetirizine, loratadine, and fexofenadine — show high effectiveness in atopic children when combined with INCS. Immunomodulators may be used in children with frequent respiratory infections to enhance immune response and reduce the frequency of recurrences. Among physiotherapeutic methods, UV therapy (when indicated), inhalation therapy via nebulizers, magnetotherapy, and laser therapy are currently used as effective adjunctive treatments [4]. Surgical interventions are indicated when conservative therapy for more than 3 months is ineffective or when persistent anatomical obstructions are present. Functional endoscopic sinus surgery (FESS) is currently the preferred approach in pediatric patients. FESS is performed in cases of anatomical defects obstructing sinus drainage, polypoid formations, mucosal hyperplasia, or refractory CRS unresponsive to medical treatment. The purpose of surgery is to open the osteomeatal complex, restore sinus ventilation, minimally resect pathological tissue, and, when necessary, perform septoplasty or conchotomy [13]. Prevention. Preventive measures are essential to reduce CRS recurrences in children. These include several groups of strategies. Infectious prevention: reducing the incidence of acute respiratory viral infections (ARVI), preventing the spread of infections in kindergarten settings, maintaining hand hygiene, and keeping indoor humidity at 45–60%. Allergy control: minimizing exposure to dust mites, limiting contact with animal dander, using air filters, and applying allergenspecific immunotherapy (ASIT), which is highly effective in allergic CRS. Conclusions. Modern diagnostic approaches for chronic rhinosinusitis (CRS) in children are complex and include the combined evaluation of clinical symptoms, endoscopy, CT imaging, laboratory analyses, and functional tests. Endoscopy and CT serve as the “gold standard,” while laboratory and immunological methods help clarify the underlying pathogenic mechanisms. Contemporary diagnostic strategies make it possible to identify CRS phenotypes and endotypes in children, forming the basis for selecting individualized treatment tactics. The clinical course of CRS in children is often characterized by less pronounced symptoms, with general signs (fatigue, low-grade fever, cough) being more dominant. Anatomical features, adenoid vegetations, and the immaturity of the immune system contribute to the persistent and recurrent nature of the disease. The treatment of chronic rhinosinusitis in children requires a comprehensive and long-term approach. Modern therapy is based on intranasal corticosteroids, saline irrigation, antibacterial, and anti-inflammatory agents. In cases of adenoid hypertrophy, adenoidectomy is effective, while FESS shows high efficacy when anatomical obstructions are present. Preventive measures significantly reduce recurrences and improve the quality of life of affected children. REFERENCES 1. Алибаева К.М. 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