Common illness in childhood and adolescence .
2types of acute sinusitis viral and bacterial e significant acute , chronic morbidity and serious complications.
Common cold is viral self limited rhinosinusitis
Ethmoidal and maxillary sinuses are present at birth(only ethmoid are pneumatic ).
Maxillary sinus pnumatized at 4years and sphenoid are present at 5years .
Frontal sinus begin development at 7-8 year and not completely developed until adolescence .
Aetiology
Bacterial pathogen common are strept pneumonia ,H influenza and maroxella catarlis. Stap aureus is uncommon pathogen but increase prevalence e resistant bacteria (MRSA).
Epidimiology
Sinusitis can occur at any age and increase incidence e predisposing factor (viral upper respiratory tract infection, immune deficiency ,GERD).
Acute 
duration less than one months .
Subacute 1-2month.
chronic longer than 3months.
clinical picture
Non specific complain as nasal congestion ,purulent nasal discharge(unilateral or bilateral),fever and cough .
less common (bad odour of mouth halitosis ),decrease sense of smell and peri orbital oedema.
complain of headache and fascial pain are rare in children.
Maxillary tooth discomfort and pain on pressure exacerbated on bending forward.
Diagnosis
History .
Physical examination :erythema ,swelling of nasal mucosa e purulent nasal discharge.sinus tenderness detectable in adolescence .
Sinusitis to be differentiated from common cold by :
Persistence of nasal congestion ,rhinorhea and day time cough more than 10days eout improvement.
temperature 39 c or more e purulent nasal discharge for 3days or longer .
worsening symptoms either by recurrence if symptoms after intial improvement or new symptoms of fever ,nasal discharge and day time cough .
Sinus aspirate culture :the only accurate method for diagnosis but not practical for immunocompetent ,may be necessary in immunocomprimised .
CT findings include opacification ,mucosal thickening ,air fluid level is not diagnostic and nor recommended .
Complications
Orbital complications :periorbital and orbital cellulitis may complicate acute bacterial ethmoiditis ,CTevaluation is needed in those cases and I V antibiotics .
Intracranial complications:epidural abscess,meningitis ,and brain abscess .
Osteomyelitis of frontal bone (pott puffy tumor :oedema and swelling of forehead ).
Treatment
AAP recommends antimicrobial treatment for acute bacterial sinusitis e severe onset or worsening course to promote resolution of symptoms and prevent suppurative complications ,about 50to 60%of children recover eout antimicrobial thearapy.
Intially amoxicillin 45mg/kg/day for non complicated mild to moderate cases.cefidinir , cefuroxime and ceficime are alternatives in penicillin sensitivity.
Older children can be given levofluxacin.
Azirhromycin and cotriamoxazole are no longer used .
For children e risk factors as fail to respond to amoxicillin 72 hrs , high dose of amoxicillin clavulinic 80-90mg /kg /day.
Ceftriaxon 50mg/kg /day IV or IM is given to children e vomiting or at high risk of poor compliance followed by course of oral antibiotic .
Falilure to respond to those regimes should be referred to otolaryngologists .
treatment smould be 10days or 7days after resolution of symptoms.
use of decongestants , antihistsmincs, mucolytics and nasal steroids not recommended for acute uncomplicated cases.
saline nasal wash and nasal spray helps to liquify secretions and had mild vasoconstriction.