A student has post this as a discussion post, please reply with 1 reference. Upper respiratory disorders: The common cold, rhinosinusitis Upper respiratory disorders are very common in children. Here in my clinical, more than 50% of the children that come in for a sick visit are here for respiratory symptoms. Some symptoms are as simple as my child coughed a few times so the school sent him/her home and they cannot return without a note. Other symptoms are a little more severe and the child has rhinosinusitis that is not clearing up. According to De Corso et al. (2020) allergic rhinitis (AR) in children has a significant impact on global quality of life, including school performance, sleep disorders, and emotional health. acute rhinosinusitis (ARS) in children is defined as a sudden onset of two or more of the following symptoms: nasal blockage/ obstruction/congestion, discolored nasal discharge, and cough (both day and night) for less than 12 weeks (De Corso et al., 2020). Rhinosinusitis is usually a result of an infection in one or more of the paranasal sinuses usually associated with the common cold that typically resolves on its own between 7-10 days, but antibiotics speed up recovery (Wald, 2021). Pathophysiology The paranasal sinuses are usually sterile. On occasion, they can become contaminated with bacteria that colonize the nasal mucosa and nasopharynx because the membranes that line the nose are continuous with the membranes that line the sinus cavities (Wald, 2021). The contaminating bacteria are typically removed by mucociliary clearance but when this is altered, the sinuses may be inoculated with large numbers of microorganisms, allowing infection to develop (Wald, 2021). Epidemiology Acute bacterial rhinosinusitis (ABRS) is a common problem in children. It is estimated that approximately 6 to 9 percent of viral upper respiratory infections in children are complicated by the development of secondary ABRS (Wald, 2020). ABRS is most common in children aged 4-7 years old but can occur at any age (Wald, 2021). There are 2 main factors that contribute to the lower instance of ABRS in younger children. The first is that the viral antecedent infection predisposes to acute otitis media (AOM) and treatment of AOM with antibiotics prevents the viral infection from evolving to ABRS. The 2nd factor is that the sinus ostia are larger (relative to the body of the sinus) than in older children making obstruction less likely (Ortiz et al., 2019). Physical Exam Findings Physical exam findings for the common cold and rhinosinusitis include cough, fever, mild redness, and swelling of the nasal turbinates with mucopurulent anterior nasal discharge along with a purulent material in the posterior pharynx caused by the drainage in the posterior ethmoids (Ortiz et al., 2019). Differential Diagnosis According to Wald (2021) The main consideration in the differential diagnosis of acute bacterial rhinosinusitis is the distinction between viral upper respiratory infection and secondary bacterial infection of the paranasal sinuses which is usually differentiated by the persistence and the severity of the illness. Some differential diagnoses include: Allergic rhinitis with or without reactive airways disease. Children with allergic rhinitis may have "allergic facies" (eg, infraorbital edema, accented lines or folds below the lower eyelids, a transverse nasal crease, and cobblestoning of the posterior pharynx (Wald, 2021). ?Nasal foreign body (usually suspected on basis of foul odor and serosanguineous nasal drainage; may be apparent by direct observation) (Wald, 2021). ?Infected adenoids (associated symptoms and signs include mouth breathing, halitosis, snoring, and downward displacement of the soft palate [adenoids are usually not seen during oropharyngeal examination]) (Wald, 2021). ?Gastroesophageal or laryngopharyngeal reflux disease may be associated with persistent nasal discharge, wheezing, and cough (Wald, 2021). ?Pertussis, particularly in the catarrhal stage. In pertussis, nasal symptoms usually resolve after one to two weeks, after which the severity of the cough increases. The cough is typically paroxysmal and sometimes followed by an inspiratory whoop. Paroxysmal cough distinguishes pertussis from sinusitis (Wald, 2021). Management Plan Diagnostic testing is usually not necessary for the common cold (Wald, 2021). For children with ABRS and 10 days of symptoms that are neither severe nor worsening, and no indication to immediately start antimicrobial therapy, providers should do a three-day period of observation (Wald, 2021). Additional factors that should be considered when deciding whether to start an antibiotic include the severity of symptoms, quality of life, past history of ABRS, cost and ease of administration of antibiotics, and concerns about adverse effects of antibiotics or development of complications (Wald, 2021). ABRS requires prompt initiation of antibiotics when the child has severe or worsening symptoms, received antibiotic therapy in the past month, concurrent bacterial infection (eg, pneumonia, suppurative cervical adenitis, group A streptococcal pharyngitis, acute otitis media), and underlying conditions, including asthma, cystic fibrosis, immunodeficiency, previous sinus surgery, or anatomic abnormalities of the upper respiratory tract (Wald, 2021). Follow-up would be routine as needed. The common cold will resolve on its own typically. For the rhinosinusitis, the patient will follow up 1 week after the antibiotic therapy is complete or if symptoms worsen. The patient will receive education on the common cold or rhinosinusitis whichever is appropriate. Some indications for a referral would include a need for sinus aspiration, Isolation of resistant or rare pathogens from sinus aspirate (if performed), child with immunodeficiency and recurrent rhinosinusitis, particularly if it exacerbates underlying pulmonary conditions (Wald, 2021).