Acute and Chronic Sinusitis: Diagnosis and Management
Ellen R. Wald MD1
1 University of Pittsburgh, School of Medicine, Children's Hospital of Pittsburgh, Divisions of Infectious Disease and Ambulatory Care, Pittsburgh, PA 15213
Acute (less than 30 days' duration) infections of the paranasal sinuses are seen in children, usually as complication of viral upper respiratory tract infections or allergic inflammation. Chronic (more than 30 days' duration) sinusitis may result when acute sinusitis is not recognized as such or is inadequately treated. Although there are few data on which to base an estimate of the frequency of these disorders, acute sinusitis is commonly encountered in pediatric practice, and chronic sinusitis is not rare.
EMBRYOLOGY, ANATOMY, AND PHYSIOLOGY
A brief review of the embryology, anatomy, and physiology of the paranasal sinuses will facilitate an understanding of the clinical manifestations of acute and chronic sinusitis. All of the sinuses develop as outpouchings of the nasal mucosa. The maxillary and ethmoid sinuses develop between the third and fifth months of gestation and are pneumatized soon after birth. Although the frontal and sphenoid sinuses also develop during gestation, they remain primitive for several years. The frontal sinuses are not distinct from the anterior ethmoid sinuses until they reach the superior orbital ridge at about 2 years of age; they assume a supraorbital position at 2 to 4 years of age and are in the frontal position at about 6 years of age. The sphenoid sinuses first become well pneumatized at 2 to 3 years of age.
