Chronic sinusitis in children

In children, sinusitis is a common, generally uncomplicated, and self limiting disease which drops with age. The diagnosis is difficult because of relatively non specific signs and symptoms that overlap with viral upper respiratory infection and allergy. Plain paranasal sinus radiographs are not adequate, in determining the extent of involvement in recurrent or chronic sinusitis and so CT scan has become the standard. Viral illness appears to be the most common predisposing factor. Immune defects (mainly IG2 and IGA) may exist in a significant percentage of children. The role of allergy seems less important. With advances in the genetic field of cystic fibrosis, genetic factors are advocated in chronic or recurrent sinusitis. The most common bacterial pathogens in pediatric sinusitis patients are SP (Streptococcus Pneumoniae), HI (Hemophilus Influenza) and MC (Moraxella Catarrhalis). Other less frequent bacterial species include group A streptococcus, group C streptococcus, streptococcus viridans, peptostreptococcus, moraxella species and Eikenella corrodens. Respiratory anaerobes are not common. Antibiotics resistant to the action of the beta-lactamase are the cornerstone in medical treatment. In recurrent acute sinusitis prophylactic antimicrobials may be helpful. The indication for surgery remains controversial. To date, we have no prospective studies comparing surgical to medical therapy in order to guide us in deciding surgical indication. It is therefore recommended to follow a conservative track and to limit surgical procedures in children with suppurative complications, nasal obstruction from polyposis or refractory sinusitis aggravating chronic pulmonary disease such as asthma.