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
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
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.
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
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.