LYCOS RETRIEVER 
Sinusitis: Bacteria
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To develop the clinical practice guideline on the management of acute bacterial sinusitis, the American Academy of Pediatrics subcommittee partnered with the Agency for Healthcare Research and Quality and colleague organizations from family practice and otolaryngology. The Agency for Healthcare Research and Quality worked with the New England Medical Center Evidence-based Practice Center, as one of several centers that focus on conducting systematic reviews of the literature. A full report was produced by the New England Medical Center on the diagnosis and management of acute sinusitis.15 However, because there were only 5 randomized studies in children, a supplemental analysis was conducted that included nonrandomized pediatric trials. The subcommittee used both reports to form the practice guideline recommendations but relied heavily on the pediatric supplement.16
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Complications of sinusitis are more common in children than in adults. If your child has had sinusitis and has swelling around the cheekbone or eyelid, it may be facial cellulitis (bacterial infection of the skin and soft tissue) or periorbital cellulitis (infection of the tissue surrounding the eye). If you notice these symptoms, take your child to see your GP who may refer them to an ENT specialist. Alternatively, you can call NHS Direct on 0845 46 47 for further information and advice.
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Fluid levels are the most common finding in acute bacterial sinusitis and are not generally seen in other forms of sinusitis. Mucosal thickening represented by parallel soft tissue opacity along the bony walls of the sinuses may be seen. Mucous retention cysts are represented by soft tissue opacity with a surface convex towards the cavity of the sinus, along any of the walls.
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Subacute sinusitis is defined by the persistence of mild to moderate and often intermittent respiratory symptoms (nasal discharge, daytime cough, or both) for between 30 and 90 days. The nasal discharge may be of any quality, and cough is often worse at night. Low-grade fever may be periodic but is usually not prominent. The microbiology of subacute sinusitis is the same as that observed in patients with acute bacterial sinusitis.29
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The role of viruses in the etiology of acute sinusitis has ... been documented. In one study, sinus cavity abnormality occurred in 87% of patients with early common viral rhinitis. Bacterial sinusitis complicated up to 2% of viral rhinitis cases.
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Patients with recurrent acute bacterial sinusitis are defined as having had 3 episodes of acute bacterial sinusitis in 6 months or 4 episodes in 12 months. The response to antibiotics is usually brisk and the patient is completely free of symptoms between episodes.
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