Computed tomography imaging of the maxillary and ethmoid sinuses in children with short-duration purulent rhinorrhea

INTRODUCTION: Adults with a common cold often have paranasal sinus effusion s detected by computed tomographic (CT) scans. There are no comparable data for children. The purpose of this study was to document the sinus CT findi ngs in children with short-duration purulent rhinorrhea. DESIGN: Thirty children, 3 to 12 years of age (median age, 7 years), with p urulent rhinorrhea for a mean duration of 5 days land always less than 9 da ys) were enrolled in the study The children were otherwise well. Institutio nal Review Board (IRB)-approval was obtained before enrollment of the first patient, Informed written consent was obtained from each child's parent, C T imaging of the maxillary and ethmoid sinuses was obtained on the day of t he initial visit (occasionally, the following day). Follow up CT scans were obtained from cooperative children/parents, 3 to 4 weeks later. RESULTS: Opacification or an air/fluid level in the maxillary sinuses was s een in 27 (90%) of 30 study children at study entry. Ethmoid sinuses were n ot opacified without opacification of a maxillary sinus. Three weeks later, 24 of 27 study children, who had positive CT scans on study entry, improve d clinically, Of 17 follow-up CT scans, 10 (58%) normalized, 4 had improvem ent of bilateral disease, and 3 improved with unilateral disease. None appe ared worse than baseline. CONCLUSIONS: Pansinus opacification (ethmoid and maxillary sinuses), on CT scans in children with short-duration purulent nasal drainage was seen in 7 0% of children. An additional 20% had isolated maxillary sinus effusions (1 0% had no effusion). Three-week follow-up CT scans on 17 children were norm al in 60% and improved (partial clearance) in 40%. In this patient populati on, the decision to treat with antibiotics should be made on clinical groun ds alone.