Rhinosinusitis is one of the most common upper respiratory tract disorders in children, significantly affecting quality of life and potentially leading to complications if misdiagnosed or untreated. Catarrhal and purulent rhinosinusitis represent distinct pathological processes, necessitating accurate differential diagnosis for appropriate management. Endoscopic examination has emerged as a critical tool for visualizing the nasal and sinus mucosa, facilitating precise evaluation of inflammatory changes. This study investigates the role of endoscopic examinations in differentiating catarrhal from purulent rhinosinusitis in pediatric patients. A cohort of 80 children aged 3–12 years with clinical signs of rhinosinusitis underwent diagnostic nasal endoscopy, alongside standard imaging and laboratory assessments. Endoscopic findings were analyzed for mucosal edema, discharge characteristics, and sinus ostia involvement. Results demonstrate that endoscopy significantly enhances diagnostic accuracy, allowing early identification of purulent changes and guiding targeted therapy. Integration of endoscopic evaluation into routine clinical practice can improve treatment outcomes, reduce complications, and optimize antibiotic use in pediatric rhinosinusitis.
Keywords: rhinosinusitis, children, endoscopy, catarrhal, purulent, differential diagnosis
Rhinosinusitis is a prevalent condition in pediatric populations, contributing to discomfort, recurrent infections, and decreased quality of life. Clinically, rhinosinusitis is classified into catarrhal and purulent forms, based on the nature of mucosal inflammation and secretions. Catarrhal rhinosinusitis is typically mild, characterized by mucosal edema and serous nasal discharge, whereas purulent rhinosinusitis involves bacterial infection, thick yellow or green discharge, and systemic symptoms such as fever. Early and accurate differentiation is crucial for selecting appropriate management strategies, avoiding unnecessary antibiotic therapy, and preventing chronicity or complications such as orbital or intracranial infections. Endoscopic examination provides direct visualization of the nasal cavity and sinus ostia, enabling clinicians to assess mucosal status, detect purulent secretions, and identify anatomical variations that may predispose to sinus infection. This study explores the utility of endoscopy in comparative diagnosis of catarrhal and purulent rhinosinusitis in children, emphasizing its role in improving diagnostic precision and clinical outcomes.
The primary objective of this study is to evaluate the diagnostic value of endoscopic examinations in the comparative assessment of catarrhal and purulent rhinosinusitis in pediatric patients. This research aims to determine how endoscopy can enhance the accuracy of differential diagnosis by providing direct visualization of the nasal mucosa, sinus ostia, and the nature of nasal secretions. A particular focus is placed on identifying specific endoscopic features that distinguish catarrhal rhinosinusitis, characterized by mild mucosal edema and serous secretions, from purulent rhinosinusitis, which involves bacterial infection, thick purulent discharge, and more pronounced mucosal inflammation.
Additionally, the study seeks to correlate endoscopic findings with clinical symptoms, laboratory markers of infection, and imaging results to assess the reliability and predictive value of endoscopy in real-world clinical settings. Another objective is to examine the impact of incorporating endoscopic examination into routine pediatric ENT practice on treatment decision-making, including the reduction of unnecessary antibiotic use in children with non-purulent rhinosinusitis.
By systematically analyzing the role of endoscopy, the study aims to provide evidence-based guidance for clinicians to improve early and accurate diagnosis, facilitate timely and appropriate interventions, and minimize the risk of complications. Ultimately, the objective is to establish endoscopic examination as a key tool in the comparative diagnosis of pediatric rhinosinusitis, supporting personalized management strategies, optimizing therapeutic outcomes, and enhancing the overall quality of care for children with upper respiratory tract infections.
MATERIALS AND METHODS
A prospective observational study was conducted in the Pediatric ENT Department of a tertiary care hospital. The study included 80 children aged 3–12 years presenting with signs of acute rhinosinusitis. Exclusion criteria were chronic sinus disease, immunodeficiency, and prior nasal surgery. All participants underwent a detailed clinical examination, laboratory investigations including complete blood count and C-reactive protein, and imaging studies (X-ray or CT scan where indicated). Diagnostic nasal endoscopy was performed using a flexible 2.7 mm pediatric endoscope to assess mucosal edema, color and consistency of nasal secretions, and involvement of sinus ostia. Endoscopic findings were categorized as indicative of catarrhal or purulent rhinosinusitis. Statistical analysis included sensitivity, specificity, and predictive values of endoscopic diagnosis compared to combined clinical and laboratory criteria.
Among the 80 children, 45 (56%) were diagnosed with catarrhal rhinosinusitis and 35 (44%) with purulent rhinosinusitis based on endoscopic evaluation. Endoscopy detected purulent secretions in 94% of cases where laboratory markers indicated bacterial infection, demonstrating high correlation with CRP elevation and leukocytosis. Mucosal edema and serous secretions were consistent with catarrhal rhinosinusitis. Sensitivity and specificity of endoscopic examination for purulent rhinosinusitis were 92% and 88%, respectively. Endoscopy facilitated targeted therapy, reducing unnecessary antibiotic prescriptions in children with catarrhal rhinosinusitis.
Endoscopic examination proves to be a valuable tool for the differential diagnosis of pediatric rhinosinusitis. Direct visualization allows clinicians to distinguish between catarrhal and purulent forms accurately, ensuring appropriate treatment. This is particularly important in reducing antibiotic overuse, preventing progression to chronic sinusitis, and avoiding potential complications. The study highlights the high sensitivity and specificity of endoscopy compared to conventional clinical assessment alone. Incorporating endoscopic evaluation into routine pediatric ENT practice improves diagnostic confidence and enables individualized management plans.
Endoscopic examination plays a critical role in the comparative diagnosis of catarrhal and purulent rhinosinusitis in children. Its use enhances diagnostic accuracy, informs treatment decisions, and minimizes unnecessary antibiotic use. Early and precise differentiation between rhinosinusitis types contributes to improved clinical outcomes and reduces the risk of complications. Routine integration of nasal endoscopy in pediatric ENT practice is recommended to optimize patient care.
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