CLINICAL CLASSIFICATION AS A GUIDE TO TREATMENT OF SINUSITIS IN CHILDREN

Evaluation of all 153 children undergoing CT scan of the paranasal sin uses for recalcitrant sinusitis symptoms between January 1988 and July 1942 was performed. Clinical categorization into groups of patients p resenting with chronic sinusitis (CS) and recurrent acute sinusitis (R AS) was based upon pattern of disease and presentation. Clinical sympt oms and signs, radiological examination, treatment, and outcome were c ompared between these distinct clinical groups. Eighty-two (55%) child ren were categorized as RAS and 68 (45%) as CS. Children with CS prese nted more frequently with a persistent cough, purulent nasal discharge , immune deficiency, and more severe mucosal disease on CT than childr en with EAS. Medical therapy successfully controlled the symptoms of s inusitis in 79 (96%) with RAS versus 27 (40%) with CS. Surgery was per formed in 44 children: 3 (3.6%) with RAS versus 41 (60%) with CS, p < 0.01. At a mean follow-up of 2.0 years, >80% of all the children were either asymptomatic or improved regardless of treatment modality. Thes e data support the use of clinical classification as a guide to medica l versus surgical therapy in children with sinusitis.