The Roentgen Treatment of Subacute Sinusitis in Children

Abstract

The problem of subacute sinusitis in children deserves more attention than it has received, not only as to treatment, but also as to the education of our colleagues. It is with more than a little amazement that I have heard the statement that a child is too young to have sinusitis. Certainly if an infant is born with sinuses, as he is, he has the anatomical structures which make him a potential candidate for sinusitis. When a child has an upper respiratory infection that lasts for more than five or six days, the infection is certainly not an ordinary head cold. The tonsils, the adenoids, or the sinuses may be infected and, to complicate matters, there may be an associated allergy. It is not easy, and many times not possible, to arrive at a diagnosis. One of the simplest tests, although not an unfailing one, is the nasal smear to determine the presence and predominance of pus cells or eosinophils. The condition of the tonsils is fairly easy to evaluate at almost any age, but infection of the adenoids in the very young is difficult to determine. A single film of the sinuses can be taken regardless of age, and this procedure, as is well known, is of considerable diagnostic value. We have treated over four thousand children for sinus infection in the past ten years. Many of these had infected tonsils and adenoids. Many had known allergies. The ages ranged from one to thirteen, the majority of the patients being from four to seven years old. It is the children in this age group—four to seven—who have the most trouble. They are at a stage when their contacts with the outside world are increasing but as yet they have established little immunity. This is also the age when many tonsillectomies are performed on the basis of repeated severe upper respiratory infections. Yet in some cases, despite the absence of tonsils and adenoids, trouble still persists. These children are often suffering primarily from sinus infection. Out of our four thousand cases, we have selected nine hundred which, as accurately as can be determined, are cases of subacute sinusitis. Some of this group had tonsils and adenoids removed; others did not. The latter did not have marked infection in these areas. The nasal smears of all were negative for evidence of allergy, and none had a definite history of allergy. In all, sinus films showed varying degrees of infection in the maxillary and ethmoid sinuses. The clinical history was usually that of a moderately severe upper respiratory infection, stuffy nose, low-grade fever, loss of appetite, and irritability. Cough, often most marked at night, was quite common. Rest, extra fluids, and nose drops of the shrinking type, sulfa or penicillin, would tend to alleviate the symptoms, but the sniffles and cough never entirely disappeared. Recurrences of the more severe form of the infection occurred at intervals of six to eight weeks.