Acute and chronic sinusitis in children

There is one subject in recent publications on pediatric sinusitis on which most authors agree, and that is that the public cannot continue to receive antibiotics on demand solely because of purulent nasal discharge, and that clinicians cannot continue to prescribe broad-spectrum and expensive antibiotics for minimal indications. Two publications show that the prevalence of various anatomical variations is no greater in children with rhinosinusitis than in a control group. This mirrors recent work in adults and implies that immunity and the way the mucosa reacts to pathogens is likely to be of primary importance, rather than the anatomy. Several good reviews on the management of rhinosinusitis in children all emphasize the need for medical and not surgical management of these patients except in cases in which the complications of sinusitis develop. The fact that computed tomography is poor at diagnosing sinusitis in children is also a recurring theme.