Pediatric Sinusitis

As both the immune response and the anatomy are developing in children, there is reason to believe that the pathophysiology of pediatric sinusitis is different from sinusitis in adults. The average child has between 6 and 8 URI's per year, making sinusitis a common problem in the pediatric population.

The understanding of chronic sinusitis in the pediatric population is limited by the multifactorial nature of the disease. The clinical presentation of sinusitis in the pediatric patient is quite variable.

In younger patients there are no specific localizing symptoms and complaints often overlap with those heard in patients with nasal obstruction or allergies, making diagnosis difficult. There is a lack of precise definitions and diagnostic criteria.

Very few studies have examined the microbiology of chronic sinusitis in the pediatric population, and studies that have addressed the issue have supported different conclusions.

The role of tonsillectomy and adenoidectomy in the treatment of chronic sinusitis remains unclear. Tonsil and adenoid hypertrophy may present with many of the same symptoms as chronic sinusitis. Investigations have shown an association with adenotonsillitis and sinusitis; however, most of these papers were retrospective and/or lacked follow-up.

Obstructive adenoid tissue may predispose to nasal obstruction and sinusitis, but no well- designed work supports this premise in a scientific fashion. The effectiveness of antral lavage has had mixed reviews in the literature.

Endoscopic ethmoidectomy in children is a relatively new modality and the indications for surgery are still not well defined. Most patients have undergone maximal medical therapy as well as appropriate workup for allergies, cystic fibrosis and underlying immune deficiencies.