Imaging Studies

The diagnosis of acute and chronic sinusitis remains primarily a clinical diagnosis.1 Although it is now clear that plain films do not adequately image the pediatric sinuses, some clinicians continue to use plain films in the acute setting.2 In general, plain films are not warranted to make the diagnosis of acute sinusitis.1 This approach, however, is not accepted in many parts of the developed world.

In Europe, ultrasound continues to be used to make the diagnosis of acute sinusitis and to follow its resolution.3 Haapaniemi4 recently reported that a negative ultrasound finding excludes the presence of sinusitis. The study was more useful if the findings were negative; positive results were not of significant use. A major flaw of this study4 is that ultrasound was compared with plain films of the maxillary sinus, and previous studies have not supported the accuracy of plain films.2 Unfortunately, ultrasound and plain films image only the maxillary sinus, and we know from previous studies that the eth-moids are involved with equal frequency and that approximately 25% of affected children will have only ethmoid disease.5'6 In the acute setting, we would expect these studies to be positive, and therefore of little use, because the infection is not limited to the nasal cavity. Gwaltney's and Glasier's work showed a high incidence of opacification of the anterior ethmoid and maxillary sinuses with acute rhinovirus infections.7,8

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