Pediatric sinusitis: update.

Sinusitis in children is a very common condition. It is being seen more and more by primary care physicians and pediatricians. Children average six to eight colds per year. Of those, 0.5 to 5% will develop a sinus infection. Symptoms of a cold or allergy overlap with those of rhinosinusitis in the child. Distinguishing rhinosinusitis from a cold or allergy may be challenging. It is agreed that if cold symptoms are not improving by 7 to 10 days, a sinus infection should be seriously considered. Plain radiographs can be helpful for maxillary sinusitis especially if an air-fluid level is seen; otherwise, the sensitivity and specificity of plain radiographs are poor. Computed tomography (CT) should not be used for diagnostic purposes. The role of CTis mainly in children with chronic rhinosinusitis when surgery is being considered. In cases of complicated sinusitis, a CT scan is necessary. Treatment of most rhinosinusitis cases in children is medical. Antibiotics constitute the mainstay of medical treatment. Medical treatment should be with an appropriate antibiotic and for at least 14 days. Adjunctive treatment with saline irrigations and topical and systemic decongestants may be helpful. Surgical intervention is necessary for complicated cases and for cases that do not respond to prolonged course of medical management. Currently adenoidectomy and endoscopic sinus surgery are the most common procedures used. Children needing surgical intervention are a small percentage because of the success of medical treatment. When and which surgical procedure to use are discussed in detail.