Recurrent acute bacterial sinusitis is defined by episodes lasting <30 days each and separated by intervals of at least 10 asymptomatic days. Chronic sinusitis lasts >90 days, and is defined by persistent residual respiratory symptoms, such as cough, rhinorrhea, or nasal obstruction [1]. In patients with recurrent or chronic sinusitis, one must consider other underlying causes such as asthma, gastroesophageal reflux, cystic The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Intracranial complications most commonly result from spread of primary infection within the frontal sinuses [19- 23,25]. This typically occurs via progression of septic thrombi through the valveless diploic veins of the skull that penetrate the dura, or, less commonly, through direct intracranial extension of osteomyelitis [21]. Symptoms that suggest intracranial complications include Pott puffy tumor, altered consciousness, seizures, hemiparesis, and cranial nerve palsy [19-23]. Ethmoid sinusitis can lead to spread of infection through the lamina papyracea, a thin bone that separates the medial orbital wall from the ethmoid sinuses [26]. Manifestations of orbital involvement include medial orbital wall subperiosteal abscess, periorbital cellulitis, and ocular findings (eg, abnormal visual examination, ophthalmoplegia, or proptosis) [21,22,26-32]. Cavernous sinus thrombosis is another rare but potentially fatal intracranial complication that can arise from infection of either the sphenoid or ethmoid sinuses [33]. Although rare, increasing frequency of fungal sinusitis has been reported in children within the past 3 decades [34].
Sinusitis Child. Recurrent acute bacterial sinusitis is defined by episodes lasting <30 days each and separated by intervals of at least 10 asymptomatic days. Chronic sinusitis lasts >90 days, and is defined by persistent residual respiratory symptoms, such as cough, rhinorrhea, or nasal obstruction [1]. In patients with recurrent or chronic sinusitis, one must consider other underlying causes such as asthma, gastroesophageal reflux, cystic The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Intracranial complications most commonly result from spread of primary infection within the frontal sinuses [19- 23,25]. This typically occurs via progression of septic thrombi through the valveless diploic veins of the skull that penetrate the dura, or, less commonly, through direct intracranial extension of osteomyelitis [21]. Symptoms that suggest intracranial complications include Pott puffy tumor, altered consciousness, seizures, hemiparesis, and cranial nerve palsy [19-23]. Ethmoid sinusitis can lead to spread of infection through the lamina papyracea, a thin bone that separates the medial orbital wall from the ethmoid sinuses [26]. Manifestations of orbital involvement include medial orbital wall subperiosteal abscess, periorbital cellulitis, and ocular findings (eg, abnormal visual examination, ophthalmoplegia, or proptosis) [21,22,26-32]. Cavernous sinus thrombosis is another rare but potentially fatal intracranial complication that can arise from infection of either the sphenoid or ethmoid sinuses [33]. Although rare, increasing frequency of fungal sinusitis has been reported in children within the past 3 decades [34].