In this section
Rhinosinusitis is inflammation of the epithelial lining in the
paranasal sinuses. It is common in children and is probably
under-diagnosed, however it resolves spontaneously in the majority
There are a number of causes;
Haemophilus Influenzae (non typeable)
If recurrent or severe, consider rarer causes:
This usually follows a viral infection. Mucosal inflammation and
thick secretions block the normal sinus drainage resulting in
secondary bacterial infection.
Diagnosis in younger children is more difficult as the signs and
symptoms are non specific. Persistent nasal discharge (beyond 10
days) is usually the predominant symptom. There are a number of
causes of this presentation including sequential URTI's, allergic
rhinitis and adenoidal hypertrophy.
CT is the imaging modality of choice. Air-fluid levels,
opacification and mucosal thickening may be seen, however, these
findings are non-specific.
CT is not used routinely but may be indicated in the following
Culturing nasal secretions is not indicative of sinus flora and
is therefore not helpful. The 'Gold Standard' would be sinus
puncture for culture. This is invasive and painful and should only
be done in an ENT setting.
The addition of steroid sprays, decongestants, or antihistamines
to antibiotic treatment has been shown to have no benefit in
Surgery is very rarely needed.