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 of cases.
There are a number of causes;
Haemophilus Influenzae (non typeable)
If recurrent or severe, consider rarer causes:
Acute bacterial sinusitis
This usually follows a viral infection. Mucosal inflammation and thick secretions block the normal sinus drainage resulting in secondary bacterial infection.
|Nasal discharge (purulence is of little significance)
||Inflamed nasal mucosa |
||Pus exuding from the middle meatus |
||Maxillary transillumination (over 9yo) |
|Unilateral facial pain
||Associated middle ear changes |
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.
- Orbital Complications:
Periorbital cellulitis , orbital cellulitis
Orbital Cellulitis Guideline)
- Intracranial Complications:
Cerebral abscess, cavernous sinus thrombosis, meningitis, encephalitis, subdural / epidural empyema
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 situations:
- failed medical management
- possible orbital / intracranial complication
- if surgery is being contemplated
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.
||amoxycillin (15mg/kg/dose tds) for 10days
(Cephalexin if penicillin allergic)
||amoxycillin/clavulanic acid (if pt has had amoxycillin in the last month) |
|If orbital / intracranial signs
||IV flucoxacillin (50mg/kg/dose 6 hourly) and IV Ceftriaxone 50 mg/kg/dose (2g) iv 12H and refer to ophthalmolgy/neurosurgery |
The addition of steroid sprays, decongestants, or antihistamines to antibiotic treatment has been shown to have no benefit in sinusitis.
Surgery is very rarely needed.