Diagnosis and Management of Acute and Chronic Sinusitis in Children

Chapter

Key Points

■ The clinical signs and symptoms of acute bacterial sinusitis overlap with that of non-specific upper respiratory tract viral infection (strong evidence).

■ Children under the age of 6 years should not undergo sinus radiographs due to their limited sinus development (moderate evidence).

■ Sinus radiographs are moderately sensitive to diagnose acute bacterial sinusitis compared with sinus puncture and culture (moderate evidence).

■ Sinus CT is highly sensitive to diagnose acute bacterial sinusitis but specificity is low in part due to vaguely defined diagnostic criteria in the literature (limited evidence).

■ Definitive imaging criteria are the presence of frothy air–fluid levels or complete sinus opacification but do not include mucosal thickening (limited evidence).

■ Despite relatively high sensitivity and specificity, imaging is not indicated in the initial diagnostic workup for acute uncomplicated sinusitis, due to cost and radiation dose (strong evidence).

■ CT scan is indicated for patients that fail to respond to medical management or with severe symptoms suspicious for complications related to acute sinusitis (moderate evidence).

■ In chronic sinusitis, computed tomography is a modality of choice as it provides anatomical roadmaps much better than plain radiography or ultrasound (limited to moderate evidence). Although rare, for children suspected of serious complications, such as intracranial or orbital abscess, MR with contrast is recommended to assist surgical treatment planning.

Keywords

Migraine Influenza Neutropenia Meningitis Rhinitis 

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of Washington Medical CenterSeattleUSA

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