Chronic sinusitis among pediatric patients with chronic respiratory complaints

https://doi.org/10.1016/0091-6749(93)90059-OGet rights and content

Abstract

We examined the prevalence of chronic sinusitis among children who presented to allergy clinics with chronic (⩾ 3 months) respiratory symptoms. Ninety-one patients, ranging from 2 to 17 years of age with 62% male and 72% white, completed the study. Fifty-nine percent of patients had positive skin test results, and 25.3% had chronic asthma. Paranasal sinuses were examined by coronal sinus computed tomographic scan. Sixty-three percent (58 of 91) had chronic sinusitis, 5.5% (5 of 91) had concha bullosa, 1% (1 of 91) had foreign body, and 19% (19 of 91) had deviated nasal septums. Among symptoms of sneezing nasal congestion, postnasal drip, coughing, wheezing rhinorrhea, and headache, no single symptom was an acceptable predictor o f abnormality on computed tomographic scan examinations. Combining the symptoms of moderate to severe rhinorrhea and cough with minimum sneezing had a specificity of 95 % and a sensitivity of 38% in predicting the presence of chronic sinusitis. Allergic rhinitis (p = 0.27), mild deviated nasal septum (p = 0.11), unobstructive concha bullosa (p = 0.13), and passive exposure to cigarette smoke (p = 0.53) were not risk factors associated with sinus abnormalities. Age (r = 0.30, p = 0.004) in pediatric patients with chronic respiratory symptoms was the single risk factor significantly associated with abnormalities on sinus computed tomographic scan. Seventy-three percent of children 2 to 6 years of age, 74% of children 6 to 10 years of age, and 38% of children older than 10 had chronic sinusitis. Chronic sinusitis is common among pediatric patients with chronic respiratory symptoms. Because the clinical symptoms are not acceptably sensitive, imaging studies of the sinus such as a Waters' view roentgenogram should be considered as part of an allergy evaluation, especially in a high-risk group o f patients from 2 to 10 years of age.

References (39)

  • B. Zimmerman et al.

    Prevalence of abnormalities found by sinus x-rays in childhood asthma: lack of relation to severity of asthma

    J Allergy Clin Immunol

    (1987)
  • E.R. Wald et al.

    Upper respiratory tract infection in young children: duration of and frequency of complications

    Pediatrics

    (1991)
  • C.B. Bluestone
  • E.R. Wald

    Sinusitis in children

    Pedaitr Infect Dis

    (1988)
  • N.L. Ott et al.

    Childhood sinusitis

  • R. Patterson

    Allergic diseases: diagnosis and management

  • G.G. Shapiro

    Role of allergy in sinusitis

    Pediatr Infect dis

    (1985)
  • W. Richards et al.

    Underdiagnosis and undertreatment of chronic sinusitis in children

    Clin Pediatr

    (1991)
  • J. Pepys

    Skin' testing

    Br J Hosp Med

    (1975)
  • Cited by (76)

    • Pediatric Chronic Rhinosinusitis

      2021, Cummings Pediatric Otolaryngology
    • Evolution of sinonasal clinical features in children with cystic fibrosis

      2019, International Journal of Pediatric Otorhinolaryngology
      Citation Excerpt :

      Then, we collected the ENT physical examination data: Nasal polyp (NP) size, with the Lildholdt scale, validated by Johansson [19]: 0 = no polyp; 1 = small polyps not reaching the lower edge of the middle turbinate; 2 = polyps extending between the upper and lower edges of the inferior turbinate; 3 = large polyps extending below the lower edge of the inferior turbinate. The presence of obstructive lesions: inferior turbinate hypertrophy, bulging of medial wall of the maxillary sinus, septum deviation, adenoid and tonsil hypertrophy.

    • ACR Appropriateness Criteria <sup>®</sup> Sinusitis-Child

      2018, Journal of the American College of Radiology
      Citation Excerpt :

      Inflammation of the mucosal lining of the nose and paranasal sinuses secondary to viral infection sets the stage for bacterial superinfection [10], thus making viral infections the most common predisposing factor for acute bacterial sinusitis, followed by allergic rhinitis [1,3-5]. Other noninfectious factors that may lead to sinusitis in children include nasal airway obstruction, immunodeficiency, ciliary dysfunction, cystic fibrosis, and odontogenic infections [1,3-9,11-13]. The American Academy of Pediatrics (AAP) defines acute bacterial sinusitis as a persistent illness with nasal discharge of any quality and/or daytime cough lasting for >10 days without improvement, a worsening clinical course, a severe onset of symptoms with concurrent fever (temperature ≥39°C), and purulent nasal discharge for at least 3 consecutive days [14].

    • The Role of Allergy in Chronic Rhinosinusitis

      2017, Otolaryngologic Clinics of North America
      Citation Excerpt :

      The prevalence of allergic rhinitis (AR) in the general population is between 10% and 30%.3,4 Some studies have shown that patients with sinusitis have a higher incidence of positive allergy skin prick tests (SPTs) than the general population,5–7 other studies do not support this.8,9 Likely, the 2 disease processes often coexist, but the data supporting the role or association of allergy and CRS are mixed.10

    • Pediatric Chronic Rhinosinusitis

      2014, Cummings Pediatric Otolaryngology
    View all citing articles on Scopus
    View full text