Acute bacterial rhinosinusitis in children: Clinical features and diagnosis
- Ellen R Wald, MD
Ellen R Wald, MD
- Professor of Pediatrics
- University of Wisconsin School of Medicine and Public Health
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Department of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
Acute rhinosinusitis is an illness that results from infection of one or more of the paranasal sinuses. A viral infection associated with the common cold is the most frequent etiology of acute rhinosinusitis, more properly called viral rhinosinusitis. (See "The common cold in children: Clinical features and diagnosis" and "The common cold in children: Management and prevention".)
Uncomplicated viral rhinosinusitis usually resolves without treatment in 7 to 10 days. Although acute bacterial rhinosinusitis (ABRS) also may resolve without treatment, treatment with antibiotics hastens recovery [1,2]. It is important to distinguish between uncomplicated viral rhinosinusitis and ABRS to prevent unnecessary use of antibiotics (table 1).
The clinical features and diagnosis of ABRS in children will be discussed here. The microbiology and treatment of ABRS in children and acute sinusitis and rhinosinusitis in adults are discussed separately. (See "Acute bacterial rhinosinusitis in children: Microbiology and treatment" and "Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis" and "Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment".)
The paranasal sinuses develop as outpouchings of the nasal cavity (figure 1) . The onset and duration of development of the paranasal sinuses vary depending upon the location, as described below. Development of the paranasal sinuses may not be fully completed until 20 years of age; however, by 12 years of age, the nasal cavity and paranasal sinuses in most individuals have nearly reached adult proportions .
●The maxillary sinuses are present at birth and expand rapidly by four years of age . Ciliary activity is necessary for drainage of secretions from the maxillary sinus into the nose because the ostia are located high on the medial walls of the maxillary sinus .
- Wald ER, Chiponis D, Ledesma-Medina J. Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. Pediatrics 1986; 77:795.
- Wald ER, Nash D, Eickhoff J. Effectiveness of amoxicillin/clavulanate potassium in the treatment of acute bacterial sinusitis in children. Pediatrics 2009; 124:9.
- Cherry JD, Mundi J, Shapiro NL. Rhinosinusitis. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed, Cherry JD, Harrison GJ, Kaplan SL, et al (Eds), Elsevier Saunders, Philadelphia 2014. p.193.
- Wolf G, Anderhuber W, Kuhn F. Development of the paranasal sinuses in children: implications for paranasal sinus surgery. Ann Otol Rhinol Laryngol 1993; 102:705.
- Wald ER. Rhinitis and acute and chronic sinusitis. In: Pediatric Otolaryngology, 2nd ed, Bluestone CD, Stool SE, Sheetz MD (Eds), Saunders, Philadelphia 1990. p.729.
- Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54:e72.
- Wald ER, Applegate KE, Bordley C, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics 2013; 132:e262.
- Slavin RG, Spector SL, Bernstein IL, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol 2005; 116:S13.
- Shapiro GG, Virant FS, Furukawa CT, et al. Immunologic defects in patients with refractory sinusitis. Pediatrics 1991; 87:311.
- Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics 1991; 87:129.
- DeMuri GP, Gern JE, Moyer SC, et al. Clinical Features, Virus Identification, and Sinusitis as a Complication of Upper Respiratory Tract Illness in Children Ages 4-7 Years. J Pediatr 2016; 171:133.
- Marom T, Alvarez-Fernandez PE, Jennings K, et al. Acute bacterial sinusitis complicating viral upper respiratory tract infection in young children. Pediatr Infect Dis J 2014; 33:803.
- Arruda LK, Mimica IM, Solé D, et al. Abnormal maxillary sinus radiographs in children: do they represent bacterial infection? Pediatrics 1990; 85:553.
- Evans FO Jr, Sydnor JB, Moore WE, et al. Sinusitis of the maxillary antrum. N Engl J Med 1975; 293:735.
- Shapiro ED, Wald ER, Doyle W, Rohn D. Bacteriology of the maxillary sinus of rhesus monkeys. Ann Otol Rhinol Laryngol 1982; 91:150.
- Revai K, Dobbs LA, Nair S, et al. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics 2007; 119:e1408.
- Wald ER, Dashefsky B, Byers C, et al. Frequency and severity of infections in day care. J Pediatr 1988; 112:540.
- Rachelefsky GS, Katz RM, Siegel SC. Chronic sinusitis in children with respiratory allergy: the role of antimicrobials. J Allergy Clin Immunol 1982; 69:382.
- Rachelefsky GS, Katz RM, Siegel SC. Chronic sinusitis in the allergic child. Pediatr Clin North Am 1988; 35:1091.
- Furukawa CT. The role of allergy in sinusitis in children. J Allergy Clin Immunol 1992; 90:515.
- Carson JL, Collier AM, Hu SS. Acquired ciliary defects in nasal epithelium of children with acute viral upper respiratory infections. N Engl J Med 1985; 312:463.
- Manning SC. Pediatric sinusitis. Otolaryngol Clin North Am 1993; 26:623.
- Shapiro GG. The role of nasal airway obstruction in sinus disease and facial development. J Allergy Clin Immunol 1988; 82:935.
- Lusk RP, Stankiewicz JA. Pediatric rhinosinusitis. Otolaryngol Head Neck Surg 1997; 117:S53.
- Wald ER, Milmoe GJ, Bowen A, et al. Acute maxillary sinusitis in children. N Engl J Med 1981; 304:749.
- DeMuri GP, Wald ER. Clinical practice. Acute bacterial sinusitis in children. N Engl J Med 2012; 367:1128.
- Gwaltney JM Jr, Hendley JO, Simon G, Jordan WS Jr. Rhinovirus infections in an industrial population. II. Characteristics of illness and antibody response. JAMA 1967; 202:494.
- Kogutt MS, Swischuk LE. Diagnosis of sinusitis in infants and children. Pediatrics 1973; 52:121.
- Williams JW Jr, Simel DL. Does this patient have sinusitis? Diagnosing acute sinusitis by history and physical examination. JAMA 1993; 270:1242.
- Fireman P. Diagnosis of sinusitis in children: emphasis on the history and physical examination. J Allergy Clin Immunol 1992; 90:433.
- Pappas DE, Hendley JO, Hayden FG, Winther B. Symptom profile of common colds in school-aged children. Pediatr Infect Dis J 2008; 27:8.
- Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol 2004; 114:155.
- Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: Developing guidance for clinical trials. Otolaryngol Head Neck Surg 2006; 135:S31.
- Thomas M, Yawn BP, Price D, et al. EPOS Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps 2007 - a summary. Prim Care Respir J 2008; 17:79.
- Wald ER. Sinusitis. Pediatr Ann 1998; 27:811.
- Lindbaek M, Hjortdahl P, Johnsen UL. Use of symptoms, signs, and blood tests to diagnose acute sinus infections in primary care: comparison with computed tomography. Fam Med 1996; 28:183.
- Brook I. Microbiology and antimicrobial treatment of orbital and intracranial complications of sinusitis in children and their management. Int J Pediatr Otorhinolaryngol 2009; 73:1183.
- Clayman GL, Adams GL, Paugh DR, Koopmann CF Jr. Intracranial complications of paranasal sinusitis: a combined institutional review. Laryngoscope 1991; 101:234.
- Goytia VK, Giannoni CM, Edwards MS. Intraorbital and intracranial extension of sinusitis: comparative morbidity. J Pediatr 2011; 158:486.
- Hicks CW, Weber JG, Reid JR, Moodley M. Identifying and managing intracranial complications of sinusitis in children: a retrospective series. Pediatr Infect Dis J 2011; 30:222.
- Sable NS, Hengerer A, Powell KR. Acute frontal sinusitis with intracranial complications. Pediatr Infect Dis 1984; 3:58.
- Wassermann D. Acute paranasal sinusitis and cavernous sinus thrombosis. Arch Otolaryngol 1967; 86:205.
- Whitaker CW. Intracranial complications of ear, nose, and throat infections. Laryngoscope 1971; 81:1375.
- Germiller JA, Monin DL, Sparano AM, Tom LW. Intracranial complications of sinusitis in children and adolescents and their outcomes. Arch Otolaryngol Head Neck Surg 2006; 132:969.
- Bair-Merritt MH, Shah SS, Zaoutis TE, et al. Suppurative intracranial complications of sinusitis in previously healthy children. Pediatr Infect Dis J 2005; 24:384.
- Sultész M, Csákányi Z, Majoros T, et al. Acute bacterial rhinosinusitis and its complications in our pediatric otolaryngological department between 1997 and 2006. Int J Pediatr Otorhinolaryngol 2009; 73:1507.
- Soon VT. Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review. Am J Otolaryngol 2011; 32:62.
- Bambakidis NC, Cohen AR. Intracranial complications of frontal sinusitis in children: Pott's puffy tumor revisited. Pediatr Neurosurg 2001; 35:82.
- Sàez-Llorens X, Guevara JN. Parameningeal infections. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed, Cherry JD, Harrison GJ, Kaplan SL, et al (Eds), Elsevier Saunders, Philadelphia 2014. p.462.
- Diament MJ, Senac MO Jr, Gilsanz V, et al. Prevalence of incidental paranasal sinuses opacification in pediatric patients: a CT study. J Comput Assist Tomogr 1987; 11:426.
- Kronemer KA, McAlister WH. Sinusitis and its imaging in the pediatric population. Pediatr Radiol 1997; 27:837.
- Diament MJ. The diagnosis of sinusitis in infants and children: x-ray, computed tomography, and magnetic resonance imaging. Diagnostic imaging of pediatric sinusitis. J Allergy Clin Immunol 1992; 90:442.
- American College of Radiology. ACR Appropriateness Criteria. Sinusitis -- Child. http://www.acr.org/secondarymainmenucategories/quality_safety/app_criteria/pdf/expertpanelonpediatricimaging/sinusitischilddoc8.aspx (Accessed on March 27, 2012).
- Kristo A, Alho OP, Luotonen J, et al. Cross-sectional survey of paranasal sinus magnetic resonance imaging findings in schoolchildren. Acta Paediatr 2003; 92:34.
- Glasier CM, Mallory GB Jr, Steele RW. Significance of opacification of the maxillary and ethmoid sinuses in infants. J Pediatr 1989; 114:45.
- Kovatch AL, Wald ER, Ledesma-Medina J, et al. Maxillary sinus radiographs in children with nonrespiratory complaints. Pediatrics 1984; 73:306.
- Gwaltney JM Jr, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. N Engl J Med 1994; 330:25.
- McIntosh D, Mahadevan M. Failure of contrast enhanced computed tomography scans to identify an orbital abscess. The benefit of magnetic resonance imaging. J Laryngol Otol 2008; 122:639.
- Younis RT, Anand VK, Davidson B. The role of computed tomography and magnetic resonance imaging in patients with sinusitis with complications. Laryngoscope 2002; 112:224.
- Adame N, Hedlund G, Byington CL. Sinogenic intracranial empyema in children. Pediatrics 2005; 116:e461.
- Wald ER, Reilly JS, Casselbrant M, et al. Treatment of acute maxillary sinusitis in childhood: a comparative study of amoxicillin and cefaclor. J Pediatr 1984; 104:297.
- Wald ER. Staphylococcus aureus: is it a pathogen of acute bacterial sinusitis in children and adults? Clin Infect Dis 2012; 54:826.
- Wald ER. Microbiology of acute and chronic sinusitis in children. J Allergy Clin Immunol 1992; 90:452.
- Gwaltney JM Jr. Acute community-acquired sinusitis. Clin Infect Dis 1996; 23:1209.
- Shaikh N, Hoberman A, Colborn DK, et al. Are nasopharyngeal cultures useful in diagnosis of acute bacterial sinusitis in children? Clin Pediatr (Phila) 2013; 52:1118.
- Gordts F, Abu Nasser I, Clement PA, et al. Bacteriology of the middle meatus in children. Int J Pediatr Otorhinolaryngol 1999; 48:163.
- PREDISPOSING FACTORS
- CLINICAL FEATURES
- Symptoms and signs
- Clinical course
- - Uncomplicated URI
- - Acute bacterial rhinosinusitis
- RADIOLOGIC FEATURES
- Uncomplicated ABRS
- Complicated ABRS
- Microbiologic studies
- DIFFERENTIAL DIAGNOSIS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS