Sinusitis in children

Sinusitis is common in allergic children. We are now aware that the commonest presentation of this disorder in the pediatric age group is persistent cough and purulent rhinorrhea. Headache and facial tenderness, frequently noted in adults with sinusitis, are not common. Much remains to be learned about diagnostic techniques and therapy of sinusitis. Nasal cytology can be valuable for discriminating between allergic and infectious disease, but lacks both sensitivity and specificity. Although there is a high correlation between radiographs showing significant sinus membrane thickening or clouding and recovery of bacteria from antral taps, it is possible to see positive films in asymptomatic individuals. Similarly, films may be unremarkable, although the history and physical examination yield convincingly positive evidence for sinus infection. The clinician must sometimes decide on therapy when the diagnosis is not definitive. Antimicrobial therapy for sinusitis should be given for 3 to 4 weeks in many cases. Amoxicillin remains a good choice for therapy, but antibiotics capable of clearing infections by beta lactamase-producing bacteria should be considered in refractory situations. The value of antihistamines, decongestants, nasal steroids, and cromolyn sodium are unstudied at this time. If several antibiotic courses fail to alleviate the signs and symptoms of sinusitis, surgery is indicated. Antral lavage and creation of nasoantral windows is the usual approach in children. Patients with sinusitis often have concurrent middle ear disease. Patients with current sinusitis have a higher incidence of immunoglobulin disorders than found in a normal pediatric sample. It appears that patients with sinusitis are more often allergic than would be expected from 2 typical population distribution. More evaluation is needed to clarify these associations.