ABSTRACT
I. Introduction 493
II. Etiologic Factors 494
III. Symptoms and Signs 496
IV. Radiology and Imaging 497
V. Microbiology 499
VI. Additional Investigations 500
A. Allergy Testing 500
VII. Medical Management 501
VIII. Surgical Management 503
IX. Complications of Functional Endoscopic Sinus Surgery 505
X. Surgical Management of Complications of Sinusitis 505
A. Periorbital Abscess 505
B. Intracranial Suppurative Complications 506
C. Nasal Polyposis 507
XI. Post-operative Management 507
XII. Summary 508
Acknowledgment 508
References 508
I. Introduction
Chronic sinusitis is persistent disease that cannot be alleviated by medical
therapy alone and involves radiographic evidence of mucosal hyperplasia.
In children, it is defined as 12 weeks of persistent symptoms and signs or six
episodes per year of recurrent acute sinusitis, each lasting at least 10 days, in
association with persistent changes on computed tomography (CT), 4 weeks
after medical therapy without intervening acute infection. The Consensus
Meeting on Management of Rhinosinusitis in Children held in Brussels
(September 1996) believed, however, that CT scanning in all children with sus-
pected chronic rhinosinusitis is not feasible and omits that part of the definition.
The true incidence of chronic sinusitis in childhood is not known, and there are
controversies about its nature and where rhinitis ends and sinusitis begins.
Acknowledging this, the Consensus Panel prefers to use the term rhinosinusitis
to define a continuum of disease.
