Acute Bacterial Rhinosinusitis: Pediatric and Adult

  • Abdülkadir Imre
  • Sedat Ozturkcan
  • Livije Kalogjera


The fifth most common indication for antibiotic treatment is rhinosinusitis. It brings a heavy financial cost. Rhinosinusitis is inflammation affecting the mucosae +/− the underlying osteal tissue of the nasal cavity and paranasal sinuses, which results in symptoms. At present, rhinosinusitis is considered a more apt term to describe the condition than sinusitis, since sinusitis without accompanying inflammation in the nose is seldom seen, and the mucosa adjacent to the sinusal ostia is virtually invariably inflamed in the condition. Acute bacterial rhinosinusitis (ABRS) typically occurs in association with an upper respiratory tract infection (URTI) of viral aetiology, but atopy, malignancy, infections associated with the teeth, environmental conditions, and variable anatomy all may increase the risk of infection being bacterial in origin. There may be differences on how adults and children present with ABRS. In fact, accurately diagnosing children with ABRS is rendered more challenging by the fact that other diseases present an overlapping symptomatology, the history relies extensively on the views of the parents and physical examination of children is complex. However, progress has been made in reducing uncalled-for radiological investigations and overprescription of antibacterial agents, thanks to the development of evidence-based guidelines and RCTs looking at diagnostic practice and clinical management.


Acute bacterial rhinosinusitis Pediatric Adult Nasal cavity and paranasal sinuses 


  1. 1.
    Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;50:1–298.CrossRefGoogle Scholar
  2. 2.
    Rosenfled RM, Piccirillo JF, Chanrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis executive summary. Otolaryngol Head Neck Surg. 2015;152(4):598–609.Google Scholar
  3. 3.
    Fokkens W, Lund V, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl. 2007:1–136.Google Scholar
  4. 4.
    Gwaltney JM Jr, Wiesinger BA, Patrie JT. Acute community-acquired bacterial sinusitis: the value of antimicrobial treatment and the natural history. Clin Infect Dis. 2004;38:227.PubMedGoogle Scholar
  5. 5.
    Rosenfeld RM, Andes D, Battacharyya N, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137:S1–31.PubMedGoogle Scholar
  6. 6.
    Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children:duration of and frequanecy of complications. Pediatrics. 1991;87:129–33.PubMedGoogle Scholar
  7. 7.
    Gwaltney JM Jr, Hendley JO, Simon G, et al. Rhinovirus infections in an industrial population. II. Characteristics of illness and antibody response. JAMA. 1967;202:494–500.PubMedGoogle Scholar
  8. 8.
    LaCroix JS, Ricchetti A, Lew D. Symptoms and clinical and radiologic signs predicting the presence of pathologic bacteria in acute rhinosinusitis. Acta Otolaryngol. 2002;122:192–6.PubMedGoogle Scholar
  9. 9.
    Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clin Proc. 2011;86(5):427–43.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997;117(3 Pt 2):S1–7.PubMedGoogle Scholar
  11. 11.
    Chow AW, Benninger MS, Brook I, et al. IDSA clnical practice guideline for acute bacterail rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72–e112.PubMedGoogle Scholar
  12. 12.
    Wald ER, Applegate KE, Bordley C, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262–80.PubMedGoogle Scholar
  13. 13.
    Kern RC, Decker JR. Functional defence mechanisms of the nasal respiratory epithelium. In: Onerci TM, editor. Nasal physiology and pathopyhsiology of nasal disorders. 1st ed. Berlin: Springer; 2013.Google Scholar
  14. 14.
    Antunes MB, Gudis DA, Cohen NA. Epithelium, cilia, and mucus: their importance in chronic rhinosinusitis. Immunol Allergy Clin N Am. 2009;29:631–43.Google Scholar
  15. 15.
    Nocon CC, Baroody FM. Acute rhinosinusitis in children. Curr Allergy Asthma Rep. 2014;14(6):443.PubMedGoogle Scholar
  16. 16.
    Brook I, Foote PA, Hausfeld JN. Frequency of recovery of pathogens causing acute maxillary sinusitis in adults before and after introduction of vaccination of children with the 7-valent pneumococcal vaccine. J Med Microbiol. 2006;55:943–6.PubMedGoogle Scholar
  17. 17.
    Hwang SY, Tan KK. Streptococcus viridans has a leading role in rhinosinusitis complications. Ann Otol Rhinol Laryngol. 2007;116:381–5.PubMedGoogle Scholar
  18. 18.
    Brook I. Microbiology of acute and chronic maxillary sinusitis associated with an odontogenic origin. Laryngoscope. 2005;115:823–5.PubMedGoogle Scholar
  19. 19.
    Milgrim LM, Rubin JS, Rosenstreich DL, et al. Sinusitis in human immunodeficiency virus infection: typical and atypical organisms. J Otolaryngol. 1994;23:450–45.PubMedGoogle Scholar
  20. 20.
    Benninger MS, Ferguson BJ, Hadley JA, et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg. 2003;129(3):S1–S32.PubMedGoogle Scholar
  21. 21.
    Benninger MS, Payne SC, Ferguson BJ, et al. Endoscopically directed middle meatal cultures versus maxillary sinus taps in acute bacterial maxillary rhinosinusitis: a meta-analysis. Otolaryngol Head Neck Surg. 2006;134:3–9.PubMedGoogle Scholar
  22. 22.
    Clement PAR, Vlaminck S. Rhinosinusitis in children. B-ENT. 2007;3(Suppl 6):59–68.Google Scholar
  23. 23.
    Cornelius RS, Martin J, Wippold FJ, et al. ACR appropriateness criteria sinonasal disease. JACR. 2013;10:241–6.PubMedGoogle Scholar
  24. 24.
    Kristo A, Uhari M, Luotonen J, et al. Paranasal sinus findings in children during respiratory infection evaluated with magnetic resonance imaging. Pediatrics. 2003;111(5 Pt 1):e586–9.PubMedGoogle Scholar
  25. 25.
    Gordts F, Clement PA, Destryker A, et al. Prevelance of sinusitis signs on MRI in a non-ENT pediatric population. Rhinology. 1997;35(4):154–7.PubMedGoogle Scholar
  26. 26.
    Hoxworth JM, Glastonbury CM. Orbital and intracranial complications of acute sinusitis. Neuroimag Clin North Am. 2010;20:511–26.Google Scholar
  27. 27.
    Leung R, Kern RC, Conley DB, et al. Establishing a treshold for surgery in recurrent acute rhinosinusitis: a productivity-based analysis. Otolaryngol Head Neck Surg. 2012;146(5):829–33.PubMedGoogle Scholar
  28. 28.
    Leung R, Almassian S, Kern R, et al. Patient level decision making in recurrent acute rhinosinusitis: a cost-benefit treshold for surgery. Laryngoscope. 2013;123(1):11–6.PubMedGoogle Scholar
  29. 29.
    Ambati BK, Ambati J, Azar N, et al. Periorbital and orbital cellulitis before and after the advent of Haemophilus influenza type B vaccine. Ophthalmology. 2000;107:1450–3.PubMedGoogle Scholar
  30. 30.
    van Loon JW, van Harn RP, Venekamp RP, et al. Limited evidence for effects of intranasal corticosteroids on symptom relief for recurrent acute rhinosinusitis. Otolaryngol Head Neck Surg. 2013;149(5):668–73.PubMedGoogle Scholar
  31. 31.
    Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2013;2:CD005149.Google Scholar
  32. 32.
    Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007;3:CD006394.Google Scholar
  33. 33.
    Inanlı S, Oztürk O, Korkmaz M, et al. The effects of topical agents of fluticasone propionate, oxymetazoline, and 3% and 0.9% sodium chloride solutions on mucociliary clearance in the therapy of acute bacterial rhinosinusitis in vivo. Laryngoscope. 2002;112:320–5.PubMedGoogle Scholar
  34. 34.
    Miller MC. Complementary and integrative treatments: expanding the continuum of care. Otolaryngol Clin North Am. 2013;46(3):261–76.PubMedGoogle Scholar
  35. 35.
    Bachert C, Schapowal A, Funk P, et al. Treatment of acute rhinosinusitis wtih the preperation from Pelargonium sidoides EPs 7630: a randomized, double-blind, placebo-controlled trial. Rhinology. 2009;47(1):51–8.PubMedGoogle Scholar
  36. 36.
    Kehr W, Sonnemann U, Dethlefsen U. Therapy for acute nonpurulent rhinosinusitis with cineole: results of a double-blind, randomized, placebo-controlled trial. Laryngoscope. 2004;114:738–42.Google Scholar
  37. 37.
    Mortimore S, Wormald PJ. The Groote Schuur hospital classification of the orbital complications of sinusitis. J Laryngol Otol. 1997;111:719–23.PubMedGoogle Scholar
  38. 38.
    Oxford LE, McClay J. Complications of acute sinusitis in children. Otolaryngol Head Neck Surg. 2005;133:32–7.PubMedGoogle Scholar
  39. 39.
    Chandler JR, Langenbruner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80(9):1414–28.Google Scholar
  40. 40.
    Healy GB. Chandler et al.: ‘The pathogenesis of orbital complications in acute sinusitis.’ (Laryngoscope 80(9):1414-1428). Laryngoscope. 1997;107(4):441–6.PubMedGoogle Scholar
  41. 41.
    Hermann BW, Forsen JW. Simultaneous intracranial and orbital complications of acute rhinosinusitis in children. Int J Pediatr Otorhinolaryngol. 2004;68(5):619–25.Google Scholar
  42. 42.
    Brown CL, Graham SM, Griffin MC, et al. Pediatric medical subperiosteal orbital abscess: medical management where possible. Am J Rhinol. 2004;18:321–7.PubMedGoogle Scholar
  43. 43.
    Oxford LE, McClay J. Medical and surgical management of subperiosteal orbital abscess secondary to acute sinusitis in children. Int J Otorhinolaryngol. 2006;70:1853–61.Google Scholar
  44. 44.
    Lerner DH, Choi SS, Zalzal GH, et al. Intracranial complications sinusitis in childhood. Ann Otol Rhinol Laryngol. 1995;104:288–94.PubMedGoogle Scholar
  45. 45.
    Clayman GL, Adams GL, Paugh DR, et al. Intracranial complications of paranasal sinusitis: a combined institutional review. Laryngoscope. 1991;101:234–9.Google Scholar
  46. 46.
    Lieser JD, Derkay CS. Pediatric sinusitis: when do we operate? Curr Opin Otolaryngol Head Neck Surg. 2005;13:60–6.Google Scholar
  47. 47.
    Altman KW, Austin MB, Tom LW, et al. Complications of frontal sinusitis in adolescents: case presentations and treatment options. Int J Pediatr Otorhinolaryngol. 1997;41:9–20.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Abdülkadir Imre
    • 1
  • Sedat Ozturkcan
    • 2
  • Livije Kalogjera
    • 3
  1. 1.Department of OtorhinolaryngologyIzmir Katip Celebi University, Ataturk Training and Research HospitalİzmirTurkey
  2. 2.Izmir Katip Çelebi University, Ataturk Training and Research HospitalİzmirTurkey
  3. 3.Department of Otorhinolaryngology and Head and Neck SurgeryUniversity Hospital Sestre MilosrdniceZagrebCroatia

Personalised recommendations