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Rhinosinusitis is the term used for infections
that involve both the nose and sinuses. Bacterial sinusitis may
be an acute, subacute, or chronic infection. Acute bacterial sinusitis
is a bacterial infection of the paranasal sinuses with complete
resolution in <30 days.="" subacute="" bacterial="" sinusitis="" is="" defined="" by="" resolution="" between="" 30="" and="" 90="" days,="" and="" chronic="" sinusitis="" lasts="">90 days.1 The most common predisposing factor
for bacterial sinusitis is a viral upper respiratory infection (URI).
The incidence of viral URIs in children ages 6 months to 35 months
is approximately six episodes per patient-year, with approximately
8% of those becoming complicated by acute bacterial sinusitis.
Bacterial sinusitis in children is most common in the 12 to 23 months
age group, probably because these children are most likely to be
in day care, predisposing them to URIs.2 In 1996,
health care costs in the U.S. incurred from treating sinusitis in
children <12 years of age had been estimated at $1.8
billion a year.3
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The sinuses are air cavities lined with ciliated columnar epithelium
that helps mucus clearance by pushing mucus and debris out of the
sinus ostia into the nasal cavity. Blockage of the ostia by mucus
and inflammation predisposes to bacterial sinusitis. The ethmoid
and maxillary sinuses are present at birth and are most commonly
involved in sinusitis in children. The sphenoid sinuses form at
3 to 5 years of age. The frontal sinuses do not appear until 7 to
8 years of age and remain incompletely pneumatized until late adolescence.
The most common predisposing factors for acute bacterial sinusitis
are diffuse mucositis secondary to viral rhinosinusitis in 80% of
cases and allergic inflammation in 20% of cases.4 Less
common predisposing factors include nonallergic rhinitis, cystic
fibrosis, dysfunctional or insufficient immunoglobulins (Igs), ciliary
dyskinesia, and anatomic abnormalities.5
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The most common pathogen of acute bacterial sinusitis is Streptococcus pneumoniae, recovered
in 30% of children with acute sinusitis. Nontypeable Haemophilus
influenzae and Moraxella catarrhalis are
recovered in 20% of children each.5,6 In
addition to the more common pathogens, chronic sinusitis may also
be caused by Staphylococcus aureus, anaerobes,
and, rarely in children, fungus, including Aspergillus, Fusarium, Bipolaris, Curvularia
lunata, and Pseudallescheriaboydii.7
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Children with acute bacterial sinusitis typically present with
high fever and purulent nasal discharge. Headache, particularly
behind the eye, is a variable presenting symptom, whereas complaints
of facial pain in children are rare.1 The physical
examination findings of acute bacterial sinusitis are often similar
to those of uncomplicated viral sinusitis, with swollen and erythematous
turbinates and mucopurulent discharge. However, reproducible unilateral
tenderness to percussion or direct pressure of the frontal or maxillary
sinus may indicate acute bacterial infection, and periorbital edema
might indicate ethmoid sinusitis.1 Transillumination
of the maxillary sinuses is unreliable in children <10 years of
age.8
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Although the gold standard for diagnosis of acute bacterial sinusitis
is the recovery of ≥104 colony-forming units/mL
of bacteria from the paranasal sinus,5 sinus ...