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Underdiagnosis and undertreatment of chronic sinusitis in children
W Richards1, R M Roth, J A Church
1Childrens Hospital of Los Angeles, Division of Allergy and Clinical Immunology, California 90054.
Insights
Many patients suffer prolonged sinusitis symptoms, often misdiagnosed as allergies or asthma. Prompt antibiotic treatment effectively resolves sinusitis, improving quality of life.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Otolaryngology
Background:
- Sinusitis is frequently underdiagnosed, leading to prolonged patient suffering.
- Patients with asthma may experience exacerbated symptoms due to concurrent sinusitis.
- A rising number of referrals for
- worsening allergy
- actually indicate underlying sinusitis.
Purpose of the Study:
- To review cases of sinusitis in pediatric outpatients.
- To highlight the impact of delayed diagnosis and treatment.
Main Methods:
- Retrospective review of 34 outpatient cases diagnosed with sinusitis.
- Analysis of symptom duration, prior diagnoses, and treatment outcomes.
Main Results:
- Mean symptom duration was six months, with significant incapacitation.
- Approximately one-third of patients lacked allergic rhinitis or asthma.
- All patients showed improvement with appropriate antibiotic therapy.
Conclusions:
- Early diagnosis and treatment of sinusitis are crucial for better patient outcomes.
- Sinusitis can be a primary cause of prolonged respiratory symptoms, distinct from allergies or asthma.
Abstract:
A review of outpatients diagnosed with sinusitis during the previous year by the allergy services of Childrens Hospital of Los Angeles and Kaiser Permanente, Orange County, revealed 34 patients who had protracted discomforting and debilitating symptoms. The mean duration of symptoms was approximately six months (range 1-14 months). None had been previously diagnosed as having sinusitis or received appropriate treatment. Although all were referred for evaluation of allergic rhinitis and/or asthma, approximately 1/3 were found to have neither of these conditions. Among patients who had asthma, their asthmatic symptoms were aggravated by the sinusitis. All patients eventually responded favorably to appropriate antibiotic therapy. Earlier diagnosis and appropriate therapy would have foreshortened the course of this very discomforting condition. In recent years, we have observed a marked increase in the number of patients referred with the chief complaint of "worsening allergy" and who were subsequently found to have sinusitis. Most of the patients experienced significant incapacitation for protracted periods before a correct diagnosis was made and treatment instituted. In all but a few cases, prompt and sustained improvement followed appropriate therapy. The purpose of this report is to present a retrospective review of 34 illustrative cases.