Acute sinusitis is diagnosed in 9% of all patients presenting to
the pediatrician's office, and in 17% of children presenting with
cough and cold symptoms.4
Normal paranasal sinuses are dependent upon the patency of the sinus
ostia, the functionality of the mucociliary apparatus, and the quality
of nasal secretions. The patency of the ostia can be affected by
many mechanisms, but most commonly is inflamed by viral or allergic
inflammation. Nasopharyngeal bacteria enter the inflamed sinuses
during times of altered intranasal pressure (i.e. sneezing), and
thickened mucosal secretions and blocked sinus ostia prevent bacterial
Appropriate clinical signs and symptoms to diagnose non-severe acute
sinusitis include prolonged URI symptoms, cough, purulent rhinorrhea,
and pain. Additional studies include sinus x-rays ($204 charge)
or screening sinus CT scan ($200 without sedation charge), and sinus
puncture with culture.
A meta-analysis of these different tests to diagnose acute sinusitis
was recently published, but focuses primarily on the adult literature.
This analysis highlights the lack of well-designed studies examining
the issue of accurately diagnosing acute sinusitis, especially in
the pediatric population.2
Jannert M, Andreasson L, Helin I, Petterson H. Acute sinusitis in
children - symptoms, clinical findings and bacteriology related
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Engels E, Terrin N, Barza M, Lau J. Meta- analysis of diagnostic
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Clement P, Bluestone C, Gordts F, Lusk R, Otten F, Goossens H, Scadding
G, Takahashi H, van Buchem F, Van Causenberge P, Wald E. Management
of rhinosinusitis in children: consensus meeting, Brussels, Belgium,
September 13, 1996. Arch of Otolaryngol Head and Neck Surgery
1998; 124: 31-34.
Aitken M, Taylor M. Prevalence of clinical sinusitis in young children
followed up by primary care pediatricians. Arch Pediatr Adolesc
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Wald, ER. Sinusitis. Seminars in Pediatric Infectious Diseases
1995; 6: 79-84