Pediatric Unilateral Chronic Sinusitis: Clinical and Radiological Patterns Compared to Adults

Document Type : Original


1 Department of otorhinolaryngology- faculty of medicine- Minia University – Egypt.

2 Department of Diagnostic Radiology, Faculty of Medicine, Minia University, Egypt..



Upper respiratory tract infections and sinusitis are more prevalent in children than in adults. Unilateral sinusitis is not uncommon disease. Our aim was to analyze the disease characteristics in children with unilateral sinusitis and compare them with those of adults.
Materials and Methods:
This study included 124 patients with unilateral chronic sinusitis divided according to age into two groups: pediatric group ≤18 years (66 cases) and adult group >18 years (58 cases). The groups were compared in terms of demographic data, side, clinical manifestations and radiological findings.
In pediatric patients, the most common inflammatory pathology was antrochoanal polyps, followed by allergic fungal sinusitis. On the other hand, chronic sinusitis without nasal polyps is the most common in adults, followed by antrochoanal polyps. The mean duration of clinical manifestations before diagnosis in pediatric patients was significantly shorter than that in adults (P=0.001). The most common symptoms in both pediatric and adult patients were anterior nasal discharge and nasal obstruction. Proptosis was significantly higher in pediatric group than in adult group (P=0.015). On computed tomography (CT), the most commonly affected sinus in both pediatric and adult patients was the maxillary sinus followed by the anterior ethmoid sinus. Bone expansion, erosion and involvement of adjacent structures were significantly higher in pediatric patients (P=0.028, 0.027 respectively).
Pediatric patients have a high incidence of antrochoanal polyps and allergic fungal sinusitis as unilateral inflammatory lesions. These lesions require surgical management. Inflammatory paranasal sinus lesions in pediatric patients have a shorter duration of clinical manifestations and a higher incidence of bone erosion and involvement of adjacent structures; therefore, early diagnosis and management prevent complications.


Main Subjects

  1. Lund, V.J. and I.S. Mackay, Staging in rhinosinusitus. Rhinology, 1993. 31(4): p. 183-4.
  2. Salami, A.M., Unilateral Sinonasal Disease: analysis of the clinical, radiological and pathological features. Journal of the Faculty of Medicine Baghdad, 2009. 51(4): p. 372-375.
  3. Chung, H.-K.T., Chih-Jaan; Wang, Pa-Chun; Lin, Chia-Der; Tsai, Ming-Hsui, Analysis of disease patterns in patients with unilateral sinonasal diseases. 13: p. 82-88.
  4. Nair, S., et al., A review of the clinicopathological and radiological features of unilateral nasal mass. Indian J Otolaryngol Head Neck Surg, 2013. 65(Suppl 2): p. 199-204.
  5. Kaplan, B.A. and S.E. Kountakis, Diagnosis and pathology of unilateral maxillary sinus opacification with or without evidence of contralateral disease. Laryngoscope, 2004. 114(6): p. 981-5.
  6. Ahsan, F., H. El-Hakim, and K.W. Ah-See, Unilateral opacification of paranasal sinus CT scans. Otolaryngol Head Neck Surg, 2005. 133(2): p. 178-80.








  1. Rudralingam, M., K. Jones, and T.J. Woolford, The unilateral opaque maxillary sinus on computed tomography. Br J Oral Maxillofac Surg, 2002. 40(6): p. 504-7.
  2. Lee, J.Y., Unilateral paranasal sinus diseases: analysis of the clinical characteristics, diagnosis, pathology, and computed tomography findings. Acta Otolaryngol, 2008. 128(6): p. 621-6.
  3. McClay, J.E., et al., Clinical presentation of allergic fungal sinusitis in children. Laryngoscope, 2002. 112(3): p. 565-9.
  4. Lee, D.H., et al., Difference of antrochoanal polyp between children and adults. Int J Pediatr Otorhinolaryngol, 2016. 84: p. 143-6.
  5. Lee, T.J., et al., Extensive paranasal sinus mucoceles: a 15-year review of 82 cases. Am J Otolaryngol, 2009. 30(4): p. 234-8.
  6. Liu, X., et al., A retrospective analysis of 1,717 paranasal sinus fungus ball cases from 2008 to 2017. Laryngoscope, 2020. 130(1): p. 75-79.
  7. Thorp, B.D., et al., Allergic fungal sinusitis in children. Otolaryngol Clin North Am, 2012. 45(3): p. 631-42, viii.
  8. Campbell, J.M., et al., Allergic fungal sinusitis in children. Ann Allergy Asthma Immunol, 2006. 96(2): p. 286-90.
  9. Mensi, M., et al., Mycetoma of the maxillary sinus: endodontic and microbiological correlations. 2004. 98(1): p. 119-123.
  10. Yan, X., et al., One case of fungal sinusitis foreign body in nasal sinus. 2015. 29(15): p. 1385-1386.
  11. Yuca, K., et al., Evaluation and treatment of antrochoanal polyps. J Otolaryngol, 2006. 35(6): p. 420-3.
  12. Bent III, J.P.K., Frederick A, Diagnosis of allergic fungal sinusitis. Otolaryngology—Head and Neck Surgery, 1994. 111(5): p. 580-588.
  13. Wilson, D., F. Citiulo, and B. Hube, Zinc exploitation by pathogenic fungi. PLoS Pathog, 2012. 8(12): p. e1003034.
  14. Ghegan, M.D., F.S. Lee, and R.J. Schlosser, Incidence of skull base and orbital erosion in allergic fungal rhinosinusitis (AFRS) and non-AFRS. Otolaryngol Head Neck Surg, 2006. 134(4): p. 592-5.
  15. Lloyd, G., et al., Optimum imaging for mucoceles. J Laryngol Otol, 2000. 114(3): p. 233-6.