Rhinosinusitis in children: Avoiding diagnostic pitfalls

About 5% to 10% of children's upper respiratory tract infections develop into acute rhinosinusitis. Ostial obstruction, ciliary dysfunction, and abnormal mucus secretion increase the risk of rhinosinusitis and may result from infection, allergy, abnormal facial structure, foreign-body impaction, or immune deficiency. Attendance at day care is also a risk factor. Persistence of respiratory symptoms such as nasal discharge and cough suggest acute bacterial rhinosinusitis. Other symptoms include periorbital edema and fever; 40% to 60% of patients have signs of otitis media. Sinus cavity opacification, air-fluid levels, and mucosal thickening are key sinus film clues. Precise diagnosis is made by culture, but this is rarely indicated.