2. DEFINITION:
Sinusitis is the inflammation of sinuses.
3. EPIDEMIOLOGY
Although the exact incidence of sinusitis in the
pediatric population is unclear, it is diagnosed
commonly, most often following a viral URTI.
Approximately 5-13% of URTIs are complicated
by bacterial sinusitis.
It affects only 1% of infants and 5% of children
aged 5-9 years, while 15% of the adolescent
population is affected.
Allergic rhinitis is one of the most common
predisposing factors for sinusitis.
4. CAUSES:
Acute and subacute pathogens Streptococcus
pneumoniae - 20-30%
Haemophilus influenzae - 15-20%
Streptococcus pyogenes (beta-hemolytic) - 5%
Staphylococcus aureus
Anatomical abnormalities: Several anatomical
abnormalities of the lateral nasal wall can
predispose to sinusitis.
Deviated septum
5. CONTD…
GER may lead to inflammation of the eustachian
tube orifices or sinus ostia secondary to mucosal
irritation.
Polypoid mass or mucosal changes associated
with allergic fungal sinusitis
6. CLINICAL MANIFESTATIONS:
ACUTE SINUSITIS
URTI symptoms persisting longer than 7-10 days
suggest acute sinusitis.
Daytime cough and rhinorrhea are the 2 most
common symptoms.
Other common signs and symptoms include the
following:
Nasal congestion
Infrequent low-grade fever
Otitis media (50-60% of patients)
Irritability
Headache
7.
8. CONTD…
Subacute sinusitis:
This condition is defined as signs and
symptoms lasting between 30-90 days.
Chronic sinusitis:
Chronic sinusitis is defined as low-grade
persistence of signs and/or symptoms lasting
longer than 90 days without improvement.
Nighttime cough is more prevalent.
9. DIAGNOSTIC EVALUATION:
Head and neck
examination
Otoscopy
Anterior rhinoscopy
Nasal endoscopy
CT scan
Plain radiography
MRI
Ultrasonography can be
used to evaluate the
maxillary sinuses
10. CONTD..
Maxillary sinus puncture-This test is the criterion
standard for obtaining maxillary sinus cultures.
Middle meatal swab Cultures
11. MEDICAL MANAGEMENT:
Antibiotic therapy for acute sinusitis -Because of
the growing problem of bacterial resistance, do
not administer antibiotics indiscriminately or
without confirmation of history by physical
examination.
Treat for 10-14 days or for 1 week
12. CONTD..
Saline sinus irrigation has demonstrated efficacy
in the treatment of acute and chronic sinusitis. It
mechanically clears secretions, decreases
bacterial counts, and clears allergens and
environmental irritants from the nose.
Nasal steroids are essential for patients with
concurrent allergic rhinitis.
Nasal decongestants are variably effective.
Topical decongestants may improve patients'
level of comfort.
13. CONTD..
Mucolytics are variably effective.
Antihistamines
Immunotherapy is effective for patients with
known specific allergies who have symptoms not
responsive to other forms of traditional medical
therapy.
14. SURGICAL MANAGEMENT:
Adenoidectomy
Functional endoscopic sinus surgery
Balloon sinuplasty
Consider surgery as a last resort in the pediatric
population.
15. SUPPORTIVE MANAGEMENT:
Patients with GER should eliminate caffeine,
chocolate, and acidic beverages from their diets.
Also, patients should not lie supine after meals,
and no food should be consumed for 2 hours
before bedtime.
With food allergies, which are common in the
pediatric population, appropriate restrictions are
necessary.