Diagnosis and management of sinusitis in children

Abstract

Acute bacterial sinusitis is a common clinical problem. The usual predisposing events are either viral upper respiratory infection or allergic inflammation. Patients present with either persistent or severe respiratory symptoms. Subacute and chronic sinusitis are characterized by very protracted respiratory symptoms that include nasal discharge, cough, or both. A precise diagnosis of bacterial sinusitis is made when sinus aspiration is performed and yields pus and bacteria in high colony count. Images, either plain radiographs or computer tomographic scans, can be used to confirm the diagnosis of bacterial sinusitis in patients whose signs and symptoms suggest the diagnosis. Streptococcus pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis are the usual pathogens retrieved from patients with acute, subacute, and recurrent acute sinusitis. These same pathogens cause acute exacerbations of chronic sinusitis. In patients with chronic persistent sinusitis, the role of bacterial agents is less clear. The prescription of antimicrobials is the backbone of the medical management of acute bacterial sinusitis. Clinical improvement is prompt in nearly all children treated with an appropriate agent.