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who are poor surgical candidates, such as the elderly, the minimally symptomatic, or patients with AIDS. With the increase in such patients, an alternative to open surgical procedures may now be available.
Significance of Opacification of the Maxillary and Eth- moid Sinuses in Infants. CM Glasier, GB Mallory, RW Steele. J Pediatr 1989; 114:45-50
The diagnosis of sinusitis in the pediatric patient is often suggested by physical signs, including fever, fa- cial tenderness, and periorbital swelling. Since these symptoms and signs of infection may be difficult to elicit in young patients, the more subtle signs of chronic cough and nasal stuffiness may also be important. Tra- ditionally, sinus radiographs have been obtained to confirm the clinical diagnosis of sinusitis; however, the specificity of radiographic findings, particularly in young children, has been controversial. This study evaluates the incidence and significance of radio- graphic sinus opacification in children, using CT of the ethmoids and maxillary sinus in 100 infants from birth to 12 months of age. CT was performed for indications other than sinusitis. Prospective histories were also ob-
tained, as well as physical examinations of the upper respiratory tract. Of 100 infants, 16 had hypoplasia of the maxillary sinus; 81% of these were less then 2 months of age. Of the 100 infants, 70 had CT sinus opacification, including 67% of those without historic physical evidence of upper respiratory tract infection. Although it has been accepted that the maxillary and ethmoid sinuses are present before birth, aeration may not occur until 3 to 4 months postnatally. The data in this paper demonstrates that a significant percentage of young infants (16% of this total population and 32% of those less than 2 months of age) appear to have no dis- cernable maxillary sinus. The authors conclude that al- though sinusitis probably occurs in infants, little if any clinical data are available to support this diagnosis. Ra- diographic examination is of limited value because of the small size of the sinuses. Although 87% of the pa- tients with a URI had sinus opacification, 88% of clin- ically normal infants had opaque sinuses. Radiography, even with CT, did not clinically separate normal from abnormal infants. The authors conclude that in infants, opacification of the maxillary and ethmoid sinuses ap- pears to be common and unaccompanied by evidence of infection.