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Acute maxillary sinusitis in children

E R Wald, G J Milmoe, A Bowen

    The New England Journal of Medicine
    |March 26, 1981
    PubMed
    Summary
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    Children with upper-respiratory-tract symptoms and abnormal maxillary radiographs often have bacterial sinusitis. Streptococcus pneumoniae, Haemophilus influenzae, and Branhamella catarrhalis were the most common bacteria found in sinus aspirates.

    Area of Science:

    • Pediatric Infectious Diseases
    • Otolaryngology
    • Microbiology

    Background:

    • Maxillary sinusitis is a common condition in children.
    • Accurate diagnosis relies on correlating clinical, radiographic, and bacteriologic findings.
    • Distinguishing bacterial sinusitis from viral infections is crucial for appropriate treatment.

    Purpose of the Study:

    • To correlate clinical, radiographic, and bacteriologic findings in pediatric maxillary sinusitis.
    • To identify common bacterial pathogens in children diagnosed with maxillary sinusitis.
    • To assess the utility of nasopharyngeal and throat cultures in predicting sinus aspirate findings.

    Main Methods:

    • Prospective study of 30 children with upper-respiratory-tract symptoms and abnormal maxillary radiographs.

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  • Collection of sinus aspirates for bacterial culture and colony counts.
  • Correlation of clinical signs (cough, nasal discharge, fetid breath, fever, facial pain, headache) with bacteriologic results.
  • Comparison of sinus aspirate cultures with nasopharyngeal and throat cultures.

    • Main Results:

    • Bacterial pathogens were identified in 23 of 30 children (76.7%).
    • High bacterial colony counts (≥10^4 CFU/mL) were found in 34 of 47 aspirates.
    • Streptococcus pneumoniae, Haemophilus influenzae, and Branhamella catarrhalis were the most frequently isolated species.
    • Fever was inconsistently present; facial pain and headache were more common in older children.
    • Poor correlation was observed between upper respiratory tract cultures and sinus aspirate isolates.
    • No anaerobic bacteria or significant viral presence were detected.

    Conclusions:

    • Children presenting with upper-respiratory-tract symptoms and abnormal maxillary radiographs frequently have bacterial sinusitis.
    • Sinus aspirate culture is essential for identifying causative pathogens, as nasopharyngeal/throat cultures are unreliable predictors.
    • Commonly implicated bacteria include Streptococcus pneumoniae, Haemophilus influenzae, and Branhamella catarrhalis.