Sinusitis in Children: Define the condition and management strategies.

Resident: Roberts
Date:3/19/10
Author: Jane Desforges
Journal: Currrent concepts
Volume:326 No. 5
pages: 319-323

Sinusitis in Children: Define the condition and management strategies.
The condition:
Upper respiratory tract infections are the most common clinical problem encountered by primary care doctors. It has been estimated that between 5 and 10 percent of upper respiratory tract infections in early childhood are complicated by acute sinusitis. The maxillary, anterior ethmoidal, and frontal sinuses drain into the middle meatus, wheras the posterior ethmoidal and sphenoidal sinuses drain into the superior meatus. The lacrimal duct drains into the inferior meatus. The maxillary sinus has an awkward position which impedes gravitational drainage and predisposes patients to viral upper respiratory infections. The ethmoidal sinus has a number of small air cells separated by thin layer of bone which serves as a conduit into the enthomoidal sinus. If the mucosal lining is inflamed even a little by a viral respiratory infection, then an obstruction is likely. The sphenoidal and frontal sinisuses are not commonly associated with isolated obstructions but rather involved with episodes of parasinusitis. In order to maintain normal physiologic functioning of the sinuses one must have: patency of the ostia, functioning of the ciliary apparatus, and good quality of the secretions.

Management:
Persistant symptoms that last more than 10 but do not show signs of improving in less than 30 days are signs of acute sinusitis. The nasal discharge may be of any quality(thick, thin, clear, mucoid), cough present during the day and worse at night. The child may present with bad breath. The child may have a evident upper respiratory infection. The most common pathogen is strep. Pneumoniae, which accounts for 30 to 40 percent of all cases. H. influenza are similar and account for 20 percent of cases. Antimicrobial agents are the most comprehensive coverage for children with acute sinusitis. Amoxicillin, erythromycin, and cefuroximine are common choices. Sinus aspiration can be done but only in cases that do not respond to multiple courses of antibiotics.

Assesment: Interesting article