Is Pediatric Rhinosinusitis An Obstructive Process

The role of OMC obstruction, and therefore of sinus surgery, has been restated so often that the doctrine has rarely been chal-lenged—at least by otolaryngologists. However, proof of a role for ostial obstruction in the routine case of sinusitis is lacking. An occasional case of pediatric sinus disease has an obvious obstructive component. Most cases, however, do not. It has been our impression that children with widely patent (postsurgical) sinus ostia do not differ significantly in the incidence of acute rhinosinusitis or the radiographic presentation of individual cases from that of children without enlarged ostia. In other words, mucosal disease, with damage to the ultrastructural integrity, is the key pathologic change in acute rhinosinusitis, and will be largely unaffected by ostial surgery.

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