Abstract
Rhinosinusitis is a common disease in children that is often overlooked. The clinical symptoms of acute rhinosinusitis are nasal blockage or congestion, nasal discharge or postnasal drip (often mucopurulent), facial pain, headache, and reduction in/loss of smell. Direct vision by nasal fibroendoscopy may aid the diagnosis. Regarding imaging criteria, recent consensus documents state that plain sinus x-rays are of limited utility, and CT remains the technique of choice, particularly in children with complications or very persistent or recurrent infections that are unresponsive to medical management. Antibiotics are the primary form of medical treatment for acute bacterial rhinosinusitis, but they should be used when acute bacterial rhinosinusitis presents as persistent or severe disease. This will minimize the number of children with uncomplicated viral upper respiratory tract infections who are treated with antimicrobials. Topical corticosteroids may reduce nasal edema and improve ostial drainage and ventilation of the sinus.
Similar content being viewed by others
References and Recommended Reading
Fokkens WJ, Lund VJ, Mullol J: European Position Paper on Rhinosinusitis and Nasal Polyps. Rhinology 2007, 45(Suppl 20):1–139.
National Center for Health Statistics: Health, United States, 2005. With Chartbook on Trends in the Health of Americans. Hyattsville, MD: National Center for Health Statistics; 2005.
Collins JG: Prevalence of selected chronic conditions: United States, 1990–92. Vital Health Stat 10 1997, Jan:1–89.
Blackwell DL, Collins JG, Coles R: Summary health statistics for US adults: National Health Interview Survey 1997. Vital Health Stat 10 2002, May:1–109.
Shashy RG, Moore EJ, Weaver A: Prevalence of the chronic sinusitis diagnosis in Olmsted County, Minnesota. Arch Otolaryngol Head Neck Surg 2004, 130:320–323.
Maresh MM, Washburn A: Paranasal sinuses from birth to late adolescence. Clinical and roentgenographic evidence of infection. Am J Dis Child 1940, 60:841–861.
Gordts F, Clement PAR, Buisseret T: Prevalence of sinusitis signs in a non-ENT population. Otorhinolaryngology 1996, 58:315–319.
Bolger WE: Anatomy of the paranasal sinuses. In Diseases of the Sinuses: Diagnosis and Management. Edited by Kennedy DW, Bolger WE, Zinreich SJ. Hamilton, Ontario, Canada: Decker; 2001:1–11.
Slavin RG, Spector SL, Bernstein IL: The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol 2005, 116:S13–S47.
American Academy of Pediatrics. Subcommittee on Management of Sinusitis and Committee on Quality Improvement: Clinical practice guideline: management of sinusitis. Pediatrics 2001, 108:798–808.
Wald ER: Sinusitis. Pediatr Ann 1998, 27:811–818.
Nash D, Wald E: Sinusitis. Pediatr Rev 2001, 22:111–116.
Isaacson G: Sinusitis in childhood. Pediatr Otolaryngol 1996, 43:1297–1318.
Wald ER: Beginning antibiotics for acute rhinosinusitis and choosing the right treatment. Clin Rev Allergy Immunol 2006, 30:143–152.
Fireman P: Diagnosis of sinusitis in children: emphasis on the history and physical examination. J Allergy Clin Immunol 1992, 90:433–436.
Gwaltney JM Jr, Hendley JO, Simon G, et al.: Rhinovirus infection in an industrial population. II. Characteristics of illness and antibody response. JAMA 1967, 202:494–500.
Gwaltney JM Jr, Buier RM, Rogers JL: The influence of signal variation, bias, noise and effect size on statistical significance in treatment studies of the common cold. Antiviral Res 1996, 29:287–295.
O’Brien KL, Dowell SF, Schwartz B, et al.: Acute sinusitis: principles of judicious use of antimicrobial agents. Pediatrics 1998, 101:174–177.
Edmondson NE, Parikh SR: Complications of acute bacterial sinusitis in children. Pediatr Ann 2008, 37:680–685.
Botting AM, McIntosh D, Mahadevan M, et al.: Paediatric pre- and post-septal peri-orbital infections are different diseases: a retrospective review of 262 cases. Int J Pediatr Otorhinolaryngol 2008, 72:377–383.
Taylor A: Sinusitis. Pediatr Rev 2006, 27:395–398.
Hakim HE, Malik AC, Aronyk K, et al.: The prevalence of intracranial complications in pediatric frontal sinusitis. Int J Pediatr Otorhinolaryngol 2006, 70:1383–1387.
Qurashi H, Zevallos JP: Subdural empyema as a complication of sinusitis in the pediatric population. Int J Pediatr Otorhinolaryngol 2006, 70:1581–1586.
Glickstein JS, Chandra RK, Thompson JW: Intracranial complications of pediatric sinusitis. Otolaryngol Head Neck Surg 2006, 134:733–736.
Nageswaran S, Woods CR, Benjamin DK Jr, et al.: Orbital cellulitis in children. Pediatr Infect Dis J 2006, 25:695–699.
Goldberg AN, Oroszlan G, Anderson TD: Complications of frontal sinusitis and their management. Otolaryngol Clin North Am 2001, 34:211–225.
Herrmann BW, Forsen JW Jr: Simultaneous intracranial and orbital complications of acute rhinosinusitis in children. Int J Pediatr Otorhinolaryngol 2004, 68:619–625.
Ho CF, Huang YC, Wang CJ, et al.: Clinical analysis of computed tomography-staged orbital cellulitis in children. J Microbiol Immunol Infect 2007, 40:518–524.
Oxford LE, McClay J: Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children. Int J Pediatr Otorhinolaryngol 2006, 70:1853–1861.
Lindbaek M, Hjortdahl P: The clinical diagnosis of acute purulent sinusitis in general practice—a review. Br J Gen Pract 2002, 52:491–495.
Wald ER, Chiponis D, Ledesma-Medina J: Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. Pediatrics 1986, 77:795–800.
Diament MJ: The diagnosis of sinusitis in infants and children: x-ray, computed tomography, and magnetic resonance imaging. Diagnostic imaging of pediatric sinusitis. J Allergy Clin Immunol 1992, 90:442–444.
McAlister WH, Kronemer K: Imaging of sinusitis in children. Pediatr Infect Dis J 1999, 18:1019–1020.
Chow AW: Acute sinusitis: current status of etiologies, diagnosis, and treatment. Curr Clin Top Infect Dis 2001, 21:31–63.
Triulzi F, Zirpoli S: Imaging techniques in the diagnosis and management of rhinosinusitis in children. Pediatr Allergy Immunol 2007, 18(Suppl 18):46–49.
Conrad DA, Jenson HB: Management of acute bacterial rhinosinusitis. Curr Opin Pediatr 2002, 14:86–90.
Garbutt JM, Goldstein M, Gellman E, et al.: A randomized, placebo-controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis. Pediatrics 2001, 107:619–625.
Wald ER: Sinusitis in infants and children. Ann Otol Rhinol Laryngol Suppl 1992, 155:37–41.
Novembre E, Mori F, Pucci N, et al.: Systemic treatment of rhinosinusitis in children. Pediatr Allergy Immunol 2007, 18(Suppl 18):56–61.
Wald ER, Reilly JS, Casselbrandt M, et al.: Treatment of acute maxillary sinusitis in childhood: a comparative study of amoxicillin and cefaclor. J Pediatr 1984, 104:297–302.
Anon JB: Acute bacterial rhinosinusitis in pediatric medicine: current issues in diagnosis and management. Paediatr Drugs 2003, 5(Suppl):25–33.
Sahay JN, Ibrahim NB, Chattergee SS, et al.: Long-term study of flunisolide treatment in perennial rhinitis with special reference to nasal mucosal histology and morphology. Clin Allergy 1980, 10:451–457.
Druce HM: Adjuncts to medical managements of sinusitis. Otolaryngol Head Neck Surg 1990, 103:880–883.
Barlan IB, Erkan E, Bakir M, et al.: Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children. Ann Allergy Asthma Immunol 1997, 78:598–601.
Meltzer EO, Bachert C, Staudinger H: Treating acute rhinosinusitis: comparing efficacy and safety of mometasone furoate nasal spray, amoxicillin, and placebo. J Allergy Clin Immunol 2005, 116:1289–1295.
McCormick DP, John SD, Swischuk LE, et al.: A double-blind, placebo-controlled trial of decongestantantihistamine for the treatment of sinusitis in children. Clin Pediatr (Phila) 1996, 35:457–460.
Spector SL, Bernstein IL, Li JT, et al.: Parameters for the diagnosis and management of sinusitis. J Allergy Clin Immunol 1998, 102:S107–S144.
Dagan R, Sikuler-Cohen M, Zamir O, et al.: Effect of a conjugate pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day-care centre attendees. Pediatr Infect Dis J 2001, 20:951–958.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Leo, G., Mori, F., Incorvaia, C. et al. Diagnosis and management of acute rhinosinusitis in children. Curr Allergy Asthma Rep 9, 232–237 (2009). https://doi.org/10.1007/s11882-009-0034-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11882-009-0034-1