Sinusitis In Children Research Articles

Orbital complications of rhinosinusitis

Orbital complications were observed in 53 patients (1.35%, n=53/3912 of all treated patients; 11.04%, n= 53/480 of hospitalized patients). Complications in the orbit can occur in 3-5% of adults with the inflammatory condition of sinuses, while the percentage in children ranges from 0.5-8%. The objective of our work was to determine the frequency of the occurence of orbital complications of the rhinosinal inflammatory origin in a group of adults and children. The retrospective analysis of patients treated of rhinosinusitis in the period 1992 to 2007, in the Clinical Center in Kragujevac. In the period of 15 years, a total number of 3912 patients were treated for inflamatory conditions of paranasal cavities. Orbital complications were found in 53 patients (1.35%, n=53/3912 of all treated patients). The number of children showing orbital complications caused by rhinosinusitis was 0.79%, while the number of adults was 1,88%. Acute rhinosinusitis in children was manifested as orbital complication in 14 patients (n=14/15, 93.33%), while 33 adults (n=33/38, 86.84%) had the exarcerbation of the chronic rhinosinusitis at the time of diagnosis of orbital complication. 80% of examined children had the maxillary and ethmoid sinus infected (n=12/15), while the adults most often had polysinusitis (n=22/38, 57.89%). In the juvenile age the most frequent complication was the cellulitis of the orbite (n=7/15, 46.66%), while in the adults it was the subperiostal absces (n=14/38, 36.84%). The adults were mostly treated surgically (n=31/38, 81.58%), while the children were treated by using conservative treatment (n=13/15, 86.67%). There were no cases of mortality. The prevention of complications is based on the adequate and timely treatment of acute sinusitis in children, as well as the curative treatment of chronical processes in adults.

Azythromicin Versus Amoxicillin-clavulanate in the Treatment of Acute Sinusitis in Children

In this prospective study we compared the efficiency of azithromycin and amoxicillin-clavulanate in treatment of acute sinusitis in children. Seventy patients were included in the age between 5 and 15 years. Beside ENT and pediatricians examination, nasal and throat smear on culture and antibiogram is taken from all the patients, as well as, X-ray of paranasal sinuses and laboratory findings, followed by check-up of nasal and throat smear and X-ray of paranasal sinuses. Azithromycin in single daily dose of 10 mg/kg during three days showed same efficiency as amoxicillin-clavulanate given three times per day in dose of 45 mg/kg during ten days.

Failures of Adenoidectomy for Chronic Rhinosinusitis in Children: For Whom and When Do They Fail?

Ramadan HH, Tiu J. Laryngoscope. 2007;117(6):1080–1083 PURPOSE OF THE STUDY. To determine which children who undergo adenoidectomy for chronic rhinosinusitis will subsequently undergo endoscopic sinus surgery. STUDY POPULATION. Children who had adenoidectomy for treatment of refractory chronic rhinosinusitis over a 10-year period at a tertiary pediatric facility were included in the study. Excluded children were those with immunodeficiency, cystic fibrosis, or previous sinus surgery. All patients had an extensive preoperative workup to rule out allergy, immunodeficiency, and cystic fibrosis. METHODS. Charts were reviewed, and data were collected retrospectively. All patients underwent adenoidectomy via the suction electrocautery technique. Children were followed monthly for 3 months after adenoidectomy and then every 3 months. Data collected included age, presence of allergy or asthma, severity of sinusitis as indicated on computed tomography (CT) scans, and dates of adenoidectomy and subsequent sinus surgery. Endoscopic sinus surgery was performed for persistent symptoms despite adenoidectomy and medical management with radiographic evidence of sinusitis on CT scans. RESULTS. A total of 143 children had adenoidectomy for sinusitis, and follow-up data were available for 121 children. Adenoidectomy failed for 61 (50%) children, with data available from 55 who had subsequent endoscopic sinus surgery. The mean time between adenoidectomy and endoscopic sinus surgery was 24 months (range: 4.4–77.4 months). Children with asthma had a mean of 19 months between surgeries, whereas those without asthma had an interval of 28 months (P = .04). Children younger than 7 years of age had sinus surgery a mean of 15 months after adenoidectomy, compared with an interval of 27.5 months between surgeries for children ≥7 years (P = .01). The presence of allergy, severity of sinusitis as indicated by CT scans, and gender did not seem to affect the time of failure of adenoidectomy. CONCLUSIONS. At least 50% of children with rhinosinusitis will benefit from an adenoidectomy without the need for subsequent sinus surgery. Children who have persistent sinusitis that requires endoscopic sinus surgery after adenoidectomy tend to be younger children and/or children with asthma, with a mean of 24 months between surgeries. REVIEWER COMMENTS. Adenoidectomy is a simple procedure that is effective for treating children with rhinosinusitis whose conditions fail medical therapy, but a number of children do go on to have more extensive surgical procedures. The retrospective nature of this study and limited information on how sinusitis symptoms were stratified, as well as how treatment failure was defined, affect our ability to generalize the conclusions of this study. The shorter interval between adenoidectomy and endoscopic sinus surgery in children with asthma may reflect a more aggressive approach to surgical management of sinusitis in the presence of pulmonary disease rather than an actual difference in the natural history of sinusitis in these children. The shorter interval between adenoidectomy and endoscopic sinus surgery in the younger children suggests more severe sinus symptoms in this group, although it may just reflect the natural history of sinusitis and upper respiratory infections in children, with eventual resolution expected for many older children regardless of treatment.

Complications of Acute Bacterial Sinusitis in Children

<P>A 15-year-old male presents to the emergency room with lethargy and frontal headache. He has had two days of intermittent low grade fever and poor appetite. Physical exam reveals that he is afebrile and slightly tachycardic. His neurologic and ophthalmologic examinations are normal. Examination of the nares reveals diffuse bilateral mucosal edema and muco-purulence under the middle turbinates. A computerized tomography (CT) scan of the sinuses and brain are obtained (see Figure 1 and Figure 2).</P> <H4>ABOUT THE AUTHORS</H4> <P>Natalie E. Edmondson, MD; and Sanjay R. Parikh, MD, FAAP, FACS, are with the Department of Otorhinolaryngology-Head and Neck Surgery, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, N.Y.</P> <P>Address correspondence to: Sanjay R. Parikh, MD, Department of Otorhinolaryngology, Head and Neck Surgery, Children’s Hospital at Montefiore, 3400 Bainbridge Ave, 3rd Floor, Bronx, NY 10467.</P> <P>Dr. Edmondson and Dr. Parikh have disclosed no relevant financial relationships.</P> <H4>EDUCATIONAL OBJECTIVES</H4> <OL> <LI>Review the anatomy of the paranasal sinuses in children and the pathogenesis of sinus disease in this population.</LI> <LI>Provide a classification system for serious complications of sinusitis in children.</LI> <LI>Discuss the necessity of a team approach to management of serious complications of sinus disease in children.</LI> </OL>

S246 – Chronic Sinusitis in Children: Which Sinuses Are Involved

Objectives 1) Learn which paranasal sinuses are involved in chronic rhinosinusitis in children. 2) Be able to customize surgical treatment based on those findings. Methods Retrospective review of children who had sinus surgery over a period of 10 years. 76 children whose age ranged between 3 and 14 years had their CT scans reviewed to determine which sinuses were diseased. All children had a CT scan because of failure of medical management and were considered for surgery. Outcome was to determine which sinuses were developed and of those, which ones were diseased and what was the severity of the disease. Results The maxillary sinuses were the most common sinuses involved in children with chronic rhinosinusits (92%). The ostiomeatal complex was next most common area involved in these children (88%). Conclusions The maxillary sinuses, followed by the ostiomeatal complex, were the most common areas involved in children with chronic rhinosinusitis. Initial surgical management of these children should then be based on those findings.

Nasal mucus transportability in children with cleft palate

Children with cleft palate (CP) have a high prevalence of sinusitis. Considering that nasal mucus properties play a pivotal role in the upper airway defense mechanism, the aim of the study was to evaluate nasal mucus transportability and physical properties from children with CP. Hospital for Rehabilitation of Craniofacial Anomalies, School of Dentistry, University of São Paulo, Bauru, SP, Brazil and Laboratory of Experimental Air Pollution, School of Medicine, University of São Paulo, São Paulo, SP, Brazil. Nasal mucus samples were collected by nasal aspiration from children with CP and without CP (non-CP). Sneeze clearance (SC) was evaluated by the simulated sneeze machine. In vitro mucus transportability (MCT) by cilia was evaluated by the frog palate preparation. Mucus physical surface properties were assessed by measuring the contact angle (CA). Mucus rheology was determined by means of a magnetic rheometer, and the results were expressed as log G* (vectorial sum of viscosity and elasticity) and tan delta (relationship between viscosity and elasticity) measured at 1 and 100 rad/s. Mucus samples from children with CP had a higher SC than non-CP children (67+/-30 and 41+/-24 mm, respectively, p<0.05). Mucus samples from children with CP had a lower CA (24+/-16 degrees and 35+/-11 degrees , p<0.05) and a higher tan delta 100 (0.79+/-0.24 and 0.51+/-0.12, p<0.05) than non-CP children. There were no significant differences in mucus MCT, log G* 1, tan delta 1 and log G* 100 obtained for CP and non-CP children. Nasal mucus physical properties from children with CP are associated with higher sneeze transportability. The high prevalence of sinusitis in children with CP cannot be explained by changes in mucus physical properties and transportability.

Sinusitis in children and adolescents with chronic or recurrent headache: a case–control study

The aim of this study was to determine the frequency of misdiagnosis of sinus headache in migraine and other primary headache types in the children and adolescents with chronic or recurrent headaches. Children with chronic or recurrent headaches (n = 310) were prospectively evaluated. Data collection for each patient included history of previously diagnosed sinusitis due to headache, and additional sinusitis complaints (such as fever, cough, nasal discharge, postnasal discharge) at the time of sinusitis diagnosis, and improvement of the headache following treatment of sinusitis. If sinus radiographs existed they were recorded. The study included 214 patients with complete data. One hundred and sixteen (54.2%) patients have been diagnosed as sinusitis previously and 25% of them had at least one additional complaint, while 75% of them had none. Sinusitis treatment had no effect on the headaches in 60.3% of the patients. Sinus graphy had been performed in 52.8%, and 50.4% of them were normal. The prevalence of sinus headache concomitant with primary headache, and only sinus headache was detected in 7 and 1%, respectively, in our study. Approximately 40% of the patients with migraine and 60% of the patients with tension-type headache had been misdiagnosed as “sinus headache”. Children with chronic or recurrent headaches are frequently misdiagnosed as sinus headache and receive unnecessary sinusitis treatment and sinus graphy.

Intracranial Complications of Sinusitis in Children and Adolescents and Their Outcomes

Germiller JA, Monin DL, Sparano AM, Tom LWC. Arch Otolaryngol Head Neck Surg. 2006;132:969–976 PURPOSE OF THE STUDY. To evaluate the presentation, imaging, microbiology, treatment, and outcome of intracranial complications of sinusitis in children. STUDY POPULATION. The study included 25 consecutive children and adolescents treated for intracranial complications of sinusitis over a 5-year period. METHODS. This was a retrospective chart review of patients who were identified by screening admission diagnoses for central nervous system infections including intracranial abscesses, meningitis, encephalitis, and dural sinus thrombophlebitis. These records were cross-referenced for both procedure codes for external and endoscopic sinus surgery and diagnosis of acute or chronic sinusitis. RESULTS. Twenty-five consecutive patients were identified, with ages ranging from 4 to 18 years; 19 patients were male and 6 were female. There were 35 intracranial complications: 13 epidural abscesses, 9 subdural empyemas, 6 meningitis, 2 dural sinus thromboses, and 1 middle cerebral artery ischemia. Nine patients (36%) had &amp;gt;1 intracranial complication. Ten patients (44%) also had at least 1 extracranial complication: 5 with orbital cellulites, 4 with orbital/periorbital abscess, 1 with forehead abscess, and 1 with forehead edema. Seventy percent of the patients with extracranial complications had epidural abscess as their intracranial complication. In addition, 12 patients (48%) presented with neurologic signs and symptoms, most commonly change in mental status (9 patients) or hemiparesis (5 patients). Of the 13 who presented without neurologic signs and symptoms, 9 (69%) had epidural abscess as their only intracranial complication. Fifteen patients had computed tomography imaging with contrast, identifying 12 (63%) of 19 complications in those patients. MRI was performed in 19 patients, identifying 26 (93%) of 28 complications in those patients. Cultures grew multiple organisms in more than one half of the patients, 53% of which were Streptococcus species. Outcomes were divided into 3 groups. No patient in group 1 (14 patients) had neurologic deficits or events. All the patients in group 1 underwent endoscopic sinus surgery (100%), and 7 (50%) underwent a neurosurgical procedure. By definition, there were no short-term or long-term sequelae for the children in group 1. Group 2 included 8 patients who experienced short-term neurologic sequelae only. Seven patients of group 2 underwent endoscopic sinus surgery (88%), and 5 (63%) underwent a neurosurgical procedure. Group 3 included 3 patients who experienced permanent neurologic deficits (bilateral sensorineural hearing loss for one and hemiparesis, expressive aphasia, and seizures for the other) or death. Two patients in group 3 underwent endoscopic sinus surgery (67%), and 1 (33%) underwent a neurosurgical procedure. CONCLUSIONS. Intracranial complications of sinusitis in children present diagnostic challenges, because many patients lack a history of sinusitis and present with vague, nonlocalizing signs and symptoms. Aggressive medical and surgical management may limit morbidity and improve outcomes. Early imaging is crucial to diagnosis, and MRI is the most useful test. REVIEWER COMMENTS. Intracranial complications of sinusitis remain uncommon; even in this review from a tertiary pediatric center only 5 patients per year were identified. A high index of clinical suspicion, particularly in adolescent boys, should lead to early imaging for diagnosis. Medical therapy combined with neurosurgical and otolaryngological surgical interventions may improve outcomes and reduce short-term and long-term sequelae.

Identifying Intracranial, Intraorbital Sinusitis in Children Helps Outcomes

Identifying Intracranial, Intraorbital Sinusitis in Children Helps Outcomes

Outcome of Endoscopic Sinus Surgery in Children With Allergic Rhinitis

Ramadan HH, Hinerman RA. Am J Rhinol. 2006;20:438–440 PURPOSE OF THE STUDY. To compare results of endoscopic sinus surgery for treatment of chronic rhinosinusitis in children with and without documented allergy. STUDY POPULATION. One hundred forty-one children (aged 3–13 years) with chronic rhinosinusitis who were followed for at least 12 months after endoscopic sinus surgery and had symptoms assessed by caregiver questionnaire were included in this study. All children were evaluated for allergy, immunoglobulin deficiency, and cystic fibrosis before surgery. A total of 77 children had documented allergy, and 64 had negative allergy evaluations. The allergic and nonallergic children were similar with regard to gender distribution, tobacco exposure, and disease severity, but asthma was more than twice as prevalent in the allergic group (56% vs 23%). Children with cystic fibrosis, immunodeficiency, fungal infection, or previous sinus surgery were excluded from the study. Surgery usually consisted of middle meatal antrostomy and anterior ethmoidectomy. METHODS. Symptoms were evaluated by the caregiver using a nonvalidated questionnaire before surgery and every 3 months for at least 12 months after surgery. The results of the questionnaire 12 months after surgery were used to create 2 groups: (1) cured or improved subjects were categorized as successful, and (2) subjects with unchanged or worsened symptoms and those who required additional surgery were categorized as treatment failures. Medical treatment for sinusitis included long-term antibiotics, intranasal steroids, decongestants, antireflux treatment, systemic steroids, and allergy management. Allergy management consisted of antihistamines and intranasal steroids in all allergic children and immunotherapy in 25%. One third of allergic patients underwent endoscopic sinus surgery before initiation of allergy treatment. RESULTS. The overall success rate for endoscopic sinus surgery was 80%. The allergic group had a 77% success rate after sinus surgery, whereas the nonallergic group had an 84% success rate, a difference that was not statistically significant. Multivariate analysis was performed, and the presence of allergy did not predict a poorer outcome. Allergic children who underwent sinus surgery without preoperative allergy treatment had a 62% success rate, compared with a success rate of 84% for children who were treated for allergy before surgery. CONCLUSIONS. The presence of allergy does not predict poorer outcomes after sinus surgery in children. Preoperative treatment of such allergy improves surgical results. REVIEWER COMMENTS. This article demonstrated that endoscopic sinus surgery can effectively treat refractory sinusitis in children even when allergy is documented. The standard practice of allergy evaluation and treatment before sinus surgery in children was also supported, although the details of such evaluation were not addressed in this article. Because this was a cohort study, not a randomized, controlled trial, we cannot assess the effects of allergy management alone on children with chronic sinusitis. It is curious that the group of children who had allergy treatment before surgery had better surgical results at a 12-month follow-up than the others with allergy, because we would suspect that all children diagnosed with allergy would be treated for allergy at some point before or after surgery. The indications for endoscopic sinus surgery in children, and the extent of such surgery, remain debated. This article adds to evidence that such surgery is effective for refractory sinusitis, even in allergic children.

Sinusitis in Children

Sinusitis is a frequent cause of morbidity in children. Although the diagnosis of sinusitis is largely clinical based on suggestive history and physical examination, nasal cytology and sinus imaging may provide useful additional information in select patients. Treatment of sinusitis includes appropriate antibiotics (with choice based on likely causative micro-organisms) and adjunctive medications to help encourage ostial drainage (including nasal saline, nasal corticosteroids, newer generation antihistamines, leukotriene antagonists, and on occasion, even oral corticosteroids). Recurrent or chronic sinusitis in children should prompt consideration of possible underlying allergic rhinitis, anatomic defects, gastroesophageal reflux, immunodeficiency, or even cystic fibrosis. Subtle sinus disease may be an important factor in persistent asthma or middle ear disease.

Imaging techniques in the diagnosis and management of rhinosinusitis in children

Sinusitis in children is a common problem. The diagnosis of both acute and chronic rhinosinusitis in the pediatric population, should be made first of all clinically, and not on the basis of imaging findings alone. Plain radiography may be used as a screening method for various pathological conditions of sinuses, but computed tomography (CT) remains the study of choice for the imaging evaluation of acute and chronic rhinosinusitis. In acute sinusitis, CT is indicated in patients with symptoms persisting after 10 days of appropriate therapy and in patients with suspected complications (especially in the brain and in the orbit). In addition to CT scanning, magnetic resonance (MR) imaging of the sinuses, orbits, and brain should be performed whenever extensive or multiple complications of sinusitis are suspected. In chronic sinusitis, CT scanning is the 'gold standard' for the diagnosis and the management, because it also provides an anatomic road map, when surgery is required. Nuclear medicine studies and ultrasound are rarely indicated in acute and chronic rhinosinusitis.

Prior antibiotic therapy for acute sinusitis in children and the development of subperiosteal orbital abscess

To determine the pattern of pre-hospitalization antibiotic use in children developing a subperiosteal orbital abscess (SPA) as a complication of acute sinusitis. Ten-year retrospective chart review in a tertiary pediatric center of children under the age of 18 years requiring operative drainage of a SPA as a complication of acute sinusitis. There were 39 children (M 25; F 14). Ten children (26%) received antibiotic therapy prior to admission, for a median duration of 1.6 days. On presentation, 72% had rhinorrhea and/or fever, for average durations of 3.9 and 2.5 days, respectively. Streptococcal species sensitive to penicillin were grown from 51% of SPA cultures. Although few children in this series received antibiotics prior to their presentation with a SPA, prodromal sinusitis symptoms were of too short a duration to warrant institution of antibiotic therapy based on the American Academy of Pediatrics guidelines for acute sinusitis. SPA may not be a preventable complication of acute sinusitis in children.

Relieving Symptoms of Chronic Sinusitis in Children By Adenoidectomy

Relieving Symptoms of Chronic Sinusitis in Children By Adenoidectomy

Frequency of recovery of pathogens from the nasopharynx of children with acute maxillary sinusitis before and after the introduction of vaccination with the 7-valent pneumococcal vaccine

To compare the proportion of recovery of pathogens in the nasopharynx of children with acute maxillary sinusitis in the 5 years period before to the 5 years period following the introduction of vaccination with the 7-valent pneumococcal vaccine (PCV7). Nasopharyngeal cultures were obtained from 428 children with acute maxillary sinusitis, 208 between 1996 and 2000, and 220 between 2001 and 2005. The PCV7 was administered to 174 (79%) of the 220 children seen between 2001 and 2005. One hundred and thirty eight potentially pathogenic organisms were isolated from 208 children between 1996 and 2000. Organisms were isolated in 114 patients (55%). The predominant organisms were Streptococcus pneumoniae (59 or 43% of all isolates), Haemophilus influenzae non-type b (46 or 33%), Moraxella catarrhalis (18 or 13%), Streptococcus pyogenes (9 or 7%), and Staphylococcus aureus (6 or 4%). One hundred and sixty five potentially pathogenic organisms were isolated from 220 patients between 2001 and 2005. Organisms were isolated in 121 patients (55%). The predominant organisms were H. influenzae non-type b (68 or 41% of all isolates), Streptococcus pneumoniae (41 or 25%), M. catarrhalis (23 or 14%), Streptococcus pyogenes (20 or 12%), and Staphylococcus aureus (13 or 8%). Significant statistical differences were noted in the rates of recovery of Streptococcus pneumoniae (p<0.05). A decrease occurred in the recovery of Streptococcus pneumoniae resistant to penicillin from 44% between 1997 and 2000 to 27% between 2000 and 2005. An increase was noted in the isolation of beta-lactamase producing H. influenzae from 37% between 1997 and 2000 to 44%. However, neither of these changes was statistically significant. This data illustrates that a significant shift occurred in the causative pathogens of acute maxillary sinusitis in children in the 5 years after the introduction of vaccination of children with the PCV7 as compared to the previous 5 years. While the proportion of Streptococcus pneumoniae declined by 18%, the proportion of H. influenzae increased by 8%.

Acute Sinusitis in Children - A retrospective study of orbital complications

SummaryAmong the complications of sinusitis, those that involve the orbital region are the most frequent.AimThe objective of this paper is to show an incidence of orbital cellulites (OC) secondary to acute sinusitis in children. Study design: retrospective.MethodsAfter board approval, the charts of all pediatric patients diagnosed with orbital complications secondary to sinusitis, seen at the Pediatric and at the ENT clinics of the HPEV, between 1985 and 2004, were evaluated. The data was analyzed considering gender, age, clinical presentation, period of hospitalization, image study, and treatment.Resultsfrom 1985 to 2004, 25 patients were diagnosed with OC secondary to sinusitis, presenting an incidence of 6%. Males predominated, the median age was 6.5 years, and the maxillary was the most frequently involved sinus. Twenty-four patients presented mild periorbital swallowing. All 25 patients presented X-Ray alterations. One patient with proptosis had a subperiosteal abcess seen on the CT-scan. The average time of hospitalization was 4 days. All 25 patients received IV antibiotics, 2 required surgery.ConclusionThe incidence of orbital complications secondary to sinusitis is low, and although the majority of cases are early diagnosed and respond well to medication treatment, a surgical intervention may be required.

Leczenie chirurgiczne przewlekłego zapalenia zatok przynosowych u dzieci

Chronic sinusitis presents important problem in children. General approach in chronic sinusitis in children consists of: findings the proper diagnosis, optimal pharmacotherapy (oral or intravenous antibiotics), treatment coexisting allergic or systemic diseases and considering employing surgical treatment. The main surgical procedures in the treatment of chronic sinusitis in children are adenoidectomy and functional endoscopic sinus surgery (FESS). 32 children with chronic sinusitis treated in ENT Department Silesian Medical University in Zabrze in the years 2000-2005 were presented in this study. 26 patients were treated surgically and 6 children by pharmacotherapy. In the surgically treated patients we performed 10 Functional Endoscopic Sinus Surgery, 4 unilateral and 8 bilateral sinusoscopy of maxillary sinus, and in 4 cases we removed choanal polyps. In the group of 26 surgically treated children we did not observed the recurrence of symptoms in the 24 months follow-up period.

Intracranial Complications of Sinusitis in Children and Adolescents and Their Outcomes

Intracranial Complications of Sinusitis in Children and Adolescents and Their Outcomes

Zapalenie zatok – racjonalna antybiotykoterapia

The paper presents different forms of sinusitis in children and adults as well as the patomechanism of sinusitis of infective and non-infective origin. The role of bacterial infection has been discussed. Participation of major pathogens of URTI such as S. pneumoniae, H. influenzae and M. catarrhalis has been highlighted and the factors influencing growth of their antibiotic-resistant stains. Guidelines concerning antibiotic therapy in children and adults, depending on disease course, age and factors influencing growth of resistant stains have been presented. Causes of failure in treatment of sinusitis have been analysed eg. in case of bacterial biofilm growth or non-neutrophilic inflammation forms. Antimicrobial treatment concerns mainly acute and aggravated infections. In case of chronic sinusitis, antibiotic therapy is complementary to surgical treatment.

The management of sinusitis in children

Sinusitis is a common medical problem in children. The prevalence of penicillin-resistant S. pneumoniae infection has been increased during the last decade. The medical management is based on the choice of antimicrobial agents. This article reviews current literatures on the management of acute bacterial sinusitis and chronic sinusitis, with an emphasis on penicillin-resistant S. pneumoniae infection. This article also explores the potential pathophysiologic mechanisms of chronic sinusitis.