Computed tomography imaging of the maxillary and ethmoid sinuses in children with short-duration purulent rhinorrhea
R H Schwartz1, A Pitkaranta, B Winther
1Department of Pediatrics, Inova Fairfax Hospital for Children, Virginia, USA. RHS738@aol.com
Insights
Computed tomography (CT) scans reveal sinus effusions in 90% of children with short-duration purulent rhinorrhea. Antibiotic treatment decisions for pediatric sinusitis should rely on clinical evaluation, not solely on CT findings.
Area of Science:
- Pediatric Radiology
- Otolaryngology
- Infectious Diseases
Background:
- Adults with common colds frequently exhibit paranasal sinus effusions on CT scans.
- Comparable data for children with similar presentations are lacking.
- This study addresses the need for data on sinus CT findings in children with acute purulent rhinorrhea.
Purpose of the Study:
- To document computed tomographic (CT) findings of the paranasal sinuses in children presenting with short-duration purulent rhinorrhea.
- To establish baseline CT characteristics for this pediatric population.
- To inform clinical decision-making regarding treatment.
Main Methods:
- Thirty children aged 3-12 years with purulent rhinorrhea (duration < 9 days) underwent CT scans of maxillary and ethmoid sinuses.
- Initial CT scans were performed at enrollment, with follow-up scans obtained 3-4 weeks later in cooperative participants.
- Institutional Review Board (IRB) approval and informed parental consent were secured prior to the study.
Main Results:
- At presentation, 90% of children showed maxillary sinus opacification or air/fluid levels; ethmoid sinuses were only affected when maxillary sinuses were also involved.
- Follow-up CT scans in 17 children revealed normalization in 58%, improvement in 32% (bilateral or unilateral), with no worsening.
- Clinically, 24 of 27 children with positive initial CT scans showed improvement after three weeks.
Conclusions:
- Pansinus opacification was observed in 70% of children with short-duration purulent nasal drainage on CT scans.
- An additional 20% had isolated maxillary sinus effusions, and 10% had no effusion.
- Given the high rate of CT abnormalities and spontaneous improvement, antibiotic treatment decisions for pediatric sinusitis should be based on clinical presentation alone.
Introduction:
Adults with a common cold often have paranasal sinus effusions detected by computed tomographic (CT) scans. There are no comparable data for children. The purpose of this study was to document the sinus CT findings in children with short-duration purulent rhinorrhea.
Design:
Thirty children, 3 to 12 years of age (median age, 7 years), with purulent rhinorrhea for a mean duration of 5 days (and always less than 9 days) were enrolled in the study. The children were otherwise well. Institutional Review Board (IRB)-approval was obtained before enrollment of the first patient. Informed written consent was obtained from each child's parent. CT imaging of the maxillary and ethmoid sinuses was obtained on the day of the initial visit (occasionally, the following day). Follow-up CT scans were obtained from cooperative children/parents, 3 to 4 weeks later.
Results:
Opacification or an air/fluid level in the maxillary sinuses was seen in 27 (90%) of 30 study children at study entry. Ethmoid sinuses were not opacified without opacification of a maxillary sinus. Three weeks later, 24 of 27 study children, who had positive CT scans on study entry, improved clinically. Of 17 follow-up CT scans, 10 (58%) normalized, 4 had improvement of bilateral disease, and 3 improved with unilateral disease. None appeared worse than baseline.
Conclusions:
Pansinus opacification (ethmoid and maxillary sinuses), on CT scans in children with short-duration purulent nasal drainage was seen in 70% of children. An additional 20% had isolated maxillary sinus effusions (10% had no effusion). Three-week follow-up CT scans on 17 children were normal in 60% and improved (partial clearance) in 40%. In this patient population, the decision to treat with antibiotics should be made on clinical grounds alone.
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