18 - Sinusitis

Abstract

Sinusitis is a common condition in children that most frequently manifests as acute disease but sometimes becomes chronic, recurrent, and burdensome, and rarely has severe sequelae due to extension into nearby structures such as the orbit and central nervous system. This chapter on sinusitis in children provides an overview of the pathogenesis, evaluation, and management of acute and chronic sinus disease. Although acute sinusitis has been substantially investigated, relatively little is known about chronic sinusitis in children. The pathogenesis may include viral and bacterial infection, biofilm formation, and immunopathology, which differs in young children with chronic sinusitis compared with adults. The diagnosis of sinusitis in children can be challenging due to overlap of symptoms with other upper respiratory tract infections; computed tomography is a useful adjunct in recurrent, chronic, or complicated disease. Empiric treatment of acute sinusitis is targeted to the primary bacterial pathogens, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Antral irrigation can be helpful to provide specific microbiological diagnosis to guide antimicrobial therapy for recurrent or chronic sinusitis. Surgical intervention, in addition to antimicrobial therapy, is frequently required for complicated disease.