Sinusitis in Children

Acute bacterial sinusitis (ABS) mostly occurs as a complication of acute viral upper respiratory tract infection (URI), which is a common condition encountered in an outpatient setting. ABS manifests with three different presentations, most commonly as persistent symptoms of viral URI (nasal drainage and or cough) for more than 10 days. ABS is also diagnosed when the patient presents with severe symptoms of a URI accompanied by fever >102.2 degrees F and purulent nasal drainage for at least 3 days. Lastly, ABS can complicate viral URI around day 6 or 7 of illness after initial improvement in the symptoms of URI. Imaging studies are not recommended for diagnosing ABS, unless intracranial or orbital complications are suspected. Signs of proptosis, restriction of eye movements, ophthalmoplegia, and visual impairment are very specific for orbital involvement. Treatment of ABS with antibiotics is recommended based on the clinical scenario and has been shown to have higher cure rates as compared to placebo.