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An integrative approach to rhinosinusitis in children.

The common cold is a mild, self-limiting acute illness that can be caused by more than 200 different viruses capable of infecting the upper respiratory tract. Of these pathogens, the rhinovirus accounts for more than 50% of all colds.1 The average child experiences 5–8 upper respiratory tract infections per year, depending on the age, exposure, use of preventative measures, and other variables.2 Infants and pre–school-aged children are particularly susceptible to common colds because of their immature immune systems and resultant lack in resistance to many of the pathogenic viruses. Although upper respiratory tract infections manifest in different ways, acute rhinosinusitis, an inflammation of the nasal and paranasal sinuses, accounts for 80%–90% of respiratory tract infections in children.3 Rhinosinusitis usually results from a viral infection. The viral pathogen invades the mucosa lining of the upper airway causing inflammation, resulting in the closure of the paranasal sinus, with subsequent nasal congestion, loss of drainage, and rhinorrhea. Although acute bacterial rhinosinusitis can develop as a result of primary viral rhinosinusitis, it is rare and occurs only in 5%–10% of all cases in children.4 In general, most uncomplicated cases of viral rhinosinusitis last 5–7 days. Although upper respiratory tract infections may occur anytime during the year, in the United States the