Diagnosis Of Sinusitis In Children Research Articles

Comparison of B-mode Ultrasonography and CT-Scan in Diagnosis of Children’s Maxillary Sinusitis

: Background: Sinusitis is a common medical problem, especially in children. Diagnosis of sinusitis in children is usually based on clinical symptoms and clinicians usually tend to avoid X- ray study especially less than 6 years of age. Nowadays, the gold- standard for the diagnosis of sinusitis is CT scan but other modalities including plain X-ray and MRI are also useful. In the literature, there are few studies about the use of ultrasound for diagnosis of sinusitis as a safe, inexpensive and radiation-free method but most of these studies are limited to adults. Objectives: Therefore this study has been designed to show the accuracy of ultrasound in diagnosis and follow up of sinusitis in the pediatric age group. Patients and Methods: All children in the age range of 2-14 years who were clinically suspected for sinusitis and referred to Tabriz children’s hospital for CT scan were enrolled in this study and maxillary sinus sonography was performed for all of them before CT. Revonta method was used and sonography was done with Sonix-OP machine (by using linear- L14-5MHz and microconvex-C9-5/10MHz probes). Totally, 58 patients (116 maxillary sinuses) were evaluated over a 6 months period. Results: Based on CT findings, patients were divided into four groups: 1) normal, 2) slight mucosal thickening, 3) considerable mucosal thickening (more than 50% of the surface), 4) fluid retention in association with mucosal thickening. According to the statistical analysis undertaken in this study, and extracted cut off point, accuracy of ultrasound in group 1 is about 90% with ultrasound quantitative criteria and about 82% with qualitative criteria. In group 3 and 4 the accuracy of ultrasound is above 90% by using qualitative criteria and 75% with quantitative criteria. Conclusions: Ultrasound study of maxillary sinuses in children is easily achievable if operator has enough skills and experience. Since qualitative criteria are more operator dependent, quantitative study is more accurate and more practical. Using these results, the accuracy of ultrasonography in the diagnosis of maxillary sinusitis in children is considerably high and acceptable, therefore ultrasound can be used not only as a precise diagnostic tool for primary diagnosis of sinusitis but also it can be used as a safe, accurate, practical and repeatable tool for follow up and post treatment monitoring of these patients.

The diagnosis of pediatric sinusitis

Although most clinicians now agree that sinusitis can afflict children of all ages, appropriate diagnosis remain controversial. Sinusitis is one of the most challenging diagnoses for a clinician, because there is a lack of validated diagnostic criteria for acute rhinosinusitis. Symptoms generally include nasal congestion, purulent nasal discharge, and cough .The physical examination is often unsuccessful in confirming the diagnosis. If purulent discharge is seen oozing from the middle meatus, the diagnosis of acute rhinosinusitis is almost certain. Purulent drainage may also be seen in the posterior pharynx and accompanied by halitosis. Absence of light by transillumination may indicate acute rhinosinusitis. Imaging studies are not necessary to confirm the diagnosis of sinusitis in children younger than 6 years and should be used sparingly in children older than 6 years. Sinus radiographs still have several advantages over CT scanning including the relatively low cost and the ability to obtain films without the use of sedation in younger children. Positive findings of sinusitis on plain film include air-fluid levels, complete opacification, or mucosal thickening greater then 4 mm. The CT scan however, is significantly more sensitive then plain films in detecting these abnormalities. Although recovery of bacteria from a sinus aspiration is considered reference standard for diagnosis in pediatric rhinosinusitis, its routine used by pediatricians is not practical and therefore is not recommended.

The ten-day mark as a practical diagnostic approach for acute paranasal sinusitis in children

Sinusitis is one of the diseases most frequently overlooked by the primary practitioner. We suspected the diagnosis of sinusitis in children with respiratory symptoms that persisted for > 10 days: the 10-day mark. A radiographic projection of maxillary sinuses (Water's view) was indicated, and patients with abnormal radiographs were diagnosed as having sinusitis. After antimicrobial treatment for 2 weeks, we evaluated clinical outcome and follow-up radiographs. The 10-day mark culled 146 suspected children from 2013 outpatients with respiratory complaints. Water's view radiographs revealed sinusitis in 135 patients (92.5% of the suspected children). They included 35 patients with allergy. After treatment only 4 patients in the allergy group (11%) improved completely. In contrast 61 nonallergic patients (61%) were completely improved. The 10-day mark is a simple and practical diagnostic basis for acute paranasal sinusitis. The associated allergic respiratory diseases respond infrequently to antimicrobial treatment.

Diagnosis of sinusitis in children: Emphasis on the history and physical examination

Sinusitis can occur as an acute, subacute, recurrent acute, or chronic clinical disease process in children. Sinusitis most often manifests as a prolongation or complication of a viral upper respiratory tract infection. Because children average six to eight upper respiratory tract infections per year, sinusitis is probably a more frequent diagnosis in the pediatric age group compared with adults who average two to three upper respiratory infections per year. Upward of 5 to 13% of children may experience sinusitis, but precise incidence data are not available because many imaging techniques currently available are inappropriate procedures for a prospective pediatric survey. Symptoms of acute sinusitis in children can vary from the more common persistent, purulent rhinorrhea and cough to the less common symptoms of fever, headache, facial pain, and swelling. Recurrent acute and chronic sinusitis may be associated with another condition such as a host-defense defect, cystic fibrosis, asthma, or a local condition that predisposes to obstruction of the sinus ostia such as nasal polyps, deviated septum, foreign body, or allergic inflammation. Diagnosis of sinusitis can be made on the basis of a careful history and physical examination with radiography reserved for confirmation of clinical impression or documentation of disease. Although fiberoptic rhinoscopy is used more frequently as an adjunct in adults for the evaluation and management of sinusitis, more studies, need to be performed to document its clinical usefulness in children.

Pneumatisation of the maxillary sinus in normal and symptomatic children.

The pattern of pneumatisation and normal width of the maxillary sinus in 191 Nigerian infants and children whose age range was 6 months to 14 years was determined. Fifty-four percent of children with no respiratory tract or sinus infection had an opaque maxillary sinus. A figure of 44.5% was obtained amongst children with suspected bronchopneumonia. Only 41.5% of suspected cases of sinusitis, acute and chronic middle ear disease had opaque sinuses. The highest rate of sinus opacity was seen in children under 2 years who were asymptomatic. The mean maximal width of the normally aerated sinus was 8.74 mm for children under 2 years, 16.5 mm for 3-6 years, 21.5 mm for 7-11 years and 25 mm for children 12 years and above. We conclude that maxillary sinus opacity in our experience is an unreliable index for the diagnosis of sinusitis in children.

Sinusitis in paediatrics.

The authors discuss the problem of the diagnosis of sinusitis in children from the viewpoint of the practising paediatrician, on the basis of 106 children and adolescents aged between 6 and 17 years, and suffering from sinusitis. Maxillary sinusitis (56.5%) and a combination of maxillary and ethmoidal sinusitis (24.5%) were commonest, and pan-sinusitis occurred in about 10% of cases. The commonest complaints in the history were cough, headache, pyrexia and rhinitis. The commonest clinical findings were pharyngitis, retropharyngeal drip, tenderness to pressure over the sinus points, otitis media, a deterioration in the general condition, enlarged tender angular lymph nodes, bronchitis and rhinitis. The result of treatment of sinusitis in childhood with the antibiotic used here, doxycycline, are assessed. A successful result was obtained in 94.3% of cases; cure in 77 patients (72.6%) and marked improvement in 23 (21.7%). There were six failures (5.7%). In the majority of children - 72 cases (68%), the duration of treatment was 15-21 days. It was 10-14 days in 18 children (17%) and more than 3 weeks in 16 children (15%). Rapid subjective improvement was seen in 65 cases (61.3%), and rapid objective improvement in 80 (75.5%). The tolerance of doxycycline was very good in nearly all patients. Mild symptoms of gastrointestinal intolerance were seen in two cases.