Sinusitis
Suzan Schneeweiss
Introduction
Often underdiagnosed because it presents as a spectrum of nonspecific symptoms
Unlike adults, children do not complain of sinus congestion, pain, or headache
Complicates 5-13% of upper respiratory tract infections in children (viral URTI usually lasts 5-7 days); less commonly allergic rhinitis
Up to 50% gradually resolve spontaneously (usually within 4 weeks) without use of antimicrobials
Peak age 3-6 years
Sinus Development
Maxillary and ethmoid sinuses present at birth and continue to grow until adolescence; the most frequently infected sinuses
Sphenoid sinuses develop during first few years of life (by 5 years) and are rarely affected without involvement of other sinuses
Frontal sinuses appear by 7-8 yrs and continue to develop until late adolescence; isolated frontal sinusitis rare, but may be a focus of spread to orbit or CNS
Clinical Presentations
Persistent
Persistent respiratory symptoms that last > 10 days and < 30 days and have not begun to improve
Severe
Cold that seems more severe than usual
High fever (temp > 39°C) and purulent nasal discharge for 3-4 days
Clinical Criteria for Diagnosing Acute Sinusitis
Symptoms present > 10 days
Common
Nasal congestion
Purulent nasal discharge or pharyngeal discharge
Cough: wet or dry; must be present in the daytime
Periorbital edema
Less Common
Ear or throat pain
Throat clearing
Halitosis
Fever (often low grade)
Fatigue
Older Children/Teens
Headache/facial pain, tooth pain, hyposmia
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