A Developmental Study of the Nasal Accessory Sinuses

Abstract

IT has been and is common teaching that infants do not have infection of the paranasal sinuses as the sinuses are too small, and if one should find infection in older children it must be considered a fairly normal condition. These two statements would seem to be in opposition to each other and not well founded. In fact, there are already plenty of observations recorded in medical literature by careful workers to refute these statements. Warren Davis reports the necrotic destruction of the anterior bony wall of an antrum in a child 13 days of age, and an orbital abscess from ethmoidal infection in another infant 8 weeks of age. Dean records the death of infants from paranasal sinusitis at 2 months, 6 weeks, and 16 months. Andrews had a case with necrosis of the sphenoid at 6 years. Byfield found asthma in children with sinus infection at 8, 11 and 12 years of age. Haike reports 62 necropsies in infants and children from 9 months to 13 years of age in which 52 showed paranasal sinus disease; 47 were infections of the antra. Of 50 cases coming in for tonsil and adenoid operation, White found 41 had sinus infestion, and concludes that the sinuses are not too small to be infected in infants. These observations, then, place paranasal sinusitis before us as being of considerable seriousness and of frequent occurrence. Certainly the subject will bear careful investigation and perhaps greater emphasis. Let us consider first the paranasal sinuses in animals. These are found to develop gradually until the extinct sloths had air spaces surrounding the upper, back and side walls of the head (Holden). The elephant has similar large sinuses surrounding the brain. In the ox the frontal sinuses extend into the parietal and occipital bones and out into the horns. The horse has well-developed sinuses, and other animals vary according to species. Chauveau concludes that these sinuses have nothing to do with olfaction or respiration and are intended only to give additional volume, without additional weight, and to add strength on the principle of the hollow girder. They are, however, concerned with the development of the teeth and the resonance of the voice (O'Malley). It is interesting to note that many animals have paranasal sinus infection. Youatt writes of frontal sinus infection resulting in infection of the brain in the horse, and describes a chronic as well as acute forms of paranasal sinusitis. Some animals are known to have their sinuses infested with maggots. It would seem, then, that the human being is not alone in the affliction of paranasal sinusitis and that there are good explanations for the finding of sinuses varying from small to very large size in the present-day race. Radiographs of the heads of mummies show similar conditions of the sinuses as to size and position as found in the people of to-day, and also considerable evidence of infection.