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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Allergic rhinitis in children is often complicated by bacterial sinusitis, which can lead to chronic illness and dysfunction. Sinus disease manifests differently in children than in adults, with cough, rhinorrhea, and middle ear disease being common and pain, headache, and fever being uncommon. Sinusitis may exacerbate asthma, and as many as 70% of children with allergy and chronic rhinitis have abnormal findings on sinus x-ray studies. Nasal cytologic specimens showing large numbers of polymorphonuclear cells with intracellular bacteria are also evidence of sinusitis. Obstruction of the nasal airways by allergic rhinitis or enlarged adenoids can lead to deviations in facial growth, specifically increased facial length. With the removal of the obstruction and a return to nasal breathing, facial length may become more normal. Sinusitis in children is treated with antibiotics, usually for 3 to 4 weeks, to eliminate the infection. Adjunctive therapy with antihistamines, decongestants, cromolyn, and corticosteroids may also be helpful. Topical steroids, such as flunisolide and beclomethasone, can be very useful in pediatric patients. These steroids decrease edema and prevent the release of allergic mediators that may be responsible for an environment favoring the bacterial infection causing sinusitis.
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PMID:The role of nasal airway obstruction in sinus disease and facial development. 305 46

We sought to correlate the clinical, radiographic, and bacteriologic findings in maxillary sinusitis in 30 children who had both upper-respiratory-tract symptoms and abnormal maxillary radiographs. Cough, nasal discharge, and fetid breath were the most common signs, but fever was present inconsistently. Facial pain or swelling and headache were prominent symptoms in older children. Bacterial colony counts of greater than or equal to 10(4) colony-forming units per milliliter were found in 34 of 47 sinus aspirates obtained from 23 children. The most common species recovered were Streptococcus pneumoniae, Haemophilus influenzae, and Branhamella catarrhalis. No anaerobic bacteria were isolated. Viruses were isolated from only two sinus aspirates. There was a poor correlation between the predominant species of bacteria recovered from either the nasopharyngeal or throat culture and the bacteria isolated from the sinus aspirate. This study demonstrates that children with both upper-respiratory-tract symptoms and abnormal sinus radiographs are likely to harbor bacteria in their sinuses, suggesting that such children have bacterial sinusitis.
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PMID:Acute maxillary sinusitis in children. 697 Mar 33

Thirty children in the age group of 2 to 12 years were brought with a history of recurrent non-seasonal moderate to severe wheezy episodes associated with symptoms of nasal congestion, sneezing and occasional headache. All of them had maxillary or pan sinusitis with 26 having associated right, left or bilateral lower lobe pneumonitis or bronchiectasis. Serum immunoglobulins were normal in 22 and was not done in eight. There was positive (2 to 4+ above negative control) skin test response to dust and dust mite in 15 of the 22 children tested. Throat swabs/sputum or nasal secretions grew B-hemolytic streptococcus or streptococcus pneumoniae in twenty-seven. All the children were put on bactericidal drugs for 6 to 8 weeks and bronchodilators were used when needed. At the end of 6 to 8 weeks follow-up X-ray of sinuses and chest showed significant clearing of the lesions which coincided with marked clinical improvement. Sinus X-ray should be considered in bronchial asthma resistant to medical management since untreated bacterial sinusitis can be an underlying cause of chronic poorly controlled asthma.
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PMID:Sino-bronchial syndrome in children with asthma. 1083 76

Respiratory tract infections (RTIs), the most common indication for outpatient antimicrobial therapy, impose a heavy medical and societal burden and present a difficult therapeutic challenge in the face of increasing pathogen resistance worldwide. Gatifloxacin is a new broad-spectrum fluoroquinolone with excellent activity against prevalent respiratory bacteria, including penicillin-resistant Streptococcus pneumoniae and atypical pathogens. A multicenter, open-label, noncomparative surveillance study carried out in Mexico evaluated the safety and efficacy of oral gatifloxacin 400 mg once daily in 17,923 adult outpatients with community-acquired pneumonia (CAP) (n = 3322), acute exacerbations of chronic bronchitis (AECB) (n = 5885), and acute bacterial sinusitis (n = 8716). Voluntary, unpaid physician participation contributed to an unbiased study design. Physician-assessed global rate of cure or improvement was 96.3%; efficacy was 95.8% in CAP, 96.1% in AECB, and 96.4% in sinusitis. The incidences of relapse (1.5%) and therapeutic failure (0.7%) were low. The most commonly reported adverse events, nausea (2.76%), headache (2.20%), and dizziness (1.33%), were generally mild and self-limited. Oral gatifloxacin 400 mg once daily is effective and safe for patients with CAP, AECB, and acute sinusitis.
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PMID:Multicenter evaluation of the efficacy and safety of gatifloxacin in Mexican adult outpatients with respiratory tract infections. 1131 29

'Sinus headache' is a term used by many patients and primary-care physicians and, contrary to popular belief, sinus headaches are uncommon. Headaches that are due to sinusitis are confined to a minority of patients who have acute frontal sinusitis or sphenoiditis. The International Headache Society classification is robust in qualifying the term sinus headache and says that "chronic sinusitis is not validated as a cause of headache and facial pain unless relapsing into an acute stage". The vast majority of people who present with a symmetrical frontal or temporal headache, sometimes with an occipital component, have tension-type headache. Unilateral, episodic headaches are often vascular in origin. The idea that sinusitis can trigger migraine is misplaced, as the whole symptom complex is vascular and coexisting nasal congestion is due to vasodilation of the nasal mucosa that is sometimes part of the vascular event. The use of nasal endoscopy and imaging of the paranasal sinuses have advanced our appreciation that these patients are suffering from a vascular event. When these patients are asked to attend a clinic when they are symptomatic, the vast majority are found not to have a sinus infection. Sinusitis rarely causes headache, let alone facial pain, except when there is an acute bacterial infection when the sinus in question cannot drain, and it is usually unilateral due to increased pressure and inflammation caused by pus trapped within the sinus cavity. These patients usually have a history of a viral upper respiratory infection immediately before this and they have pyrexia with unilateral nasal obstruction. The vast majority of patients with acute sinusitis respond to antibiotics. Recurrent bacterial sinusitis is rare and anyone with more than two episodes of genuine bacterial sinusitis in 1 year should be investigated for evidence of poor immunity. Patients with chronic bacterial sinusitis rarely have any pain unless the sinus ostia are blocked and their symptoms are then the same as in acute sinusitis. Within the medical literature, there are texts that report that sphenoid sinusitis can cause headaches and, as with other acute sinus infections, intracranial or ophthalmolgical complications can occur. First, acute sphenoid sinusitis is rare and second, most of these patients respond to antibiotics. Batotrauma can cause short-lived pain in the sinus involved but there is always a clear history associated with diving or flying and, as the pressure within the sinus equalizes, the pain resolves within a few hours. Headaches are rarely due to sinusitis.
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PMID:Sinus headaches: avoiding over- and mis-diagnosis. 1934 97

Although sinusitis is common, controversy exists regarding terminology, diagnostic criteria, indications for imaging, and treatment guidelines. Patients who are diagnosed with bacterial sinusitis should be started on amoxicillin-clavulanate unless an allergy to penicillin is reported, in which case doxycycline or a respiratory fluoroquinolone is indicated for non-pregnant patients. Patients who fail to respond to antibiotic therapy should be suspected of having chronic sinusitis, which may requirea dditional therapy, including endoscopic surgery. Referral of these patients to an otolaryngologist for further evaluation is recommended. Patients with severe systemic symptoms including altered mental status or severe headaches should be suspected of having fungal sinusitis and to an otolaryngologist acutely because this condition has high mortality if not treated emergently.
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PMID:Rhinosinusitis. 2443 80

Headache and rhinosinusitis are 2 of the most common conditions seen in clinical practice. In general, chronic and disabling headaches, especially if migraine features are present, are not due to sinus abnormalities. In suspected cases of bacterial sinusitis, computed tomography and magnetic resonance imaging are both effective in demonstrating the infection. Although most cases of sinusitis are fairly easy to diagnose, sphenoid sinusitis may be overlooked, and can present with progressive or thunderclap headache in adults. Contact-point headache should be considered in patients with focal headaches and a contact point on the lateral nasal wall.
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PMID:Headaches caused by nasal and paranasal sinus disease. 2470 42

The prompt identification of sepsis in children is challenging, but once sepsis is identified, initiation of care and determination of proper disposition may be insufficient to ensure optimal outcomes. The best opportunity for full recovery also requires rapid identification and treatment of the infectious source. Acute bacterial sinusitis is common in the pediatric population, and although intracranial complications of sinusitis are rare, they are associated with significant morbidity and mortality. History and physical examination may be imperfectly sensitive for the presence of acute bacterial sinusitis and its intracranial complications. We present a case of pediatric sepsis in which the diagnosis of intracranial extension of bacterial sinusitis was not made during the first phase of care and describe complications that followed. Emergency physicians should consider subdural empyema in patients presenting with fever, nausea and headache with worrisome vital signs and laboratory values suggestive of a severe infection.
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PMID:Delayed Diagnosis of Subdural Empyema in a Septic Child. 2623 Jan 10

Complications of acute bacterial sinusitis mostly occur in children and adolescents. In particular, intracranial spread of the infection can lead to severe even fatal courses of the disease. This article is a case report about a 13-year-old boy suffering from left-sided headache, meningismus and exophthalmos as presenting symptoms. Cranial magnetic resonance imaging (MRI) showed merely right-sided sphenoid sinusitis; however, the diffusion-weighted MRI sequence indicated a left-sided cavernous sinus thrombosis, which could be confirmed by computed tomography (CT) angiography. Cerebrospinal fluid diagnostics showed significant leukocytosis confirming secondary meningitis. Finally, exophthalmos was explained by parainfectious cavernous sinus thrombosis and periorbital edema. This case report highlights the importance of extended and specific diagnostic imaging in cases of clinically suspected complications in children and adolescents with sinusitis and the diagnostic significance of diffusion-weighted MRI.
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PMID:[Cavernous sinus thrombosis as a rare cause of exophthalmos in childhood : A case report]. 2740 67

Approximately 0.5-2% of upper viral infections are com-licated by secondary acute bacterial sinusitis and may in rare cases evolve into more serious complications such as meningitis and intracranial abscess. Symptoms are often subtle and nonspecific as fever, headache, scalp tenderness, nausea and altered mental status. In this case report of a 12-year-old boy with an epidural abscess secondary to sinusitis we intend to increase the knowledge to these rare, but potentially life-threatening complications to ensure the optimal and timely treatment.
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PMID:[Epidural abscess secondary to sinusitis]. 2804 46


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