PEDIATRICS Vol. 85 No. 4 April 1990, pp. 553-558
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Abnormal Maxillary Sinus Radiographs in Children: Do They Represent Bacterial Infection?

L. Karla Arruda MD1, I. M. Mimica MD2, D. Solé MD1, L. L. M. Weckx MD3, J. Schoettler MD4, D. C. Heiner MD, PhD4, and C. K. Naspitz MD1

1 From the Division of Allergy Immunology and Rheumatology, Paulista School of Medicine, São Paulo, Brazil
2 From the Department of Microbiology, Santa Casa Medical Sciences School, São Paulo, Brazil
3 From the Division of Otorhinolaryngology, Paulista School of Medicine, São Paulo, Brazil
4 From the Harbor-UCLA Medical Center, Torrance, California

Thirty-three children with chronic tonsillitis and/or adenoid enlargement and without previous diagnosis of sinusitis were studied regarding the bacterial flora of their maxillary sinuses. Puncture of maxillary sinus was performed at surgery (adenoidectomy and/or tonsillectomy) and aspirates were cultured. Streptococcus pneumoniae was isolated from 8 of 12 (66.7%) patients whose x-rays showed completely opacified maxillary sinus. Streptococcus viridans, Streptococcus faecalis, and Staphylococcus epidermidis were recovered from 6 (28.6%) of the 21 patients with normal maxillary sinus radiographs. Bacterial titers were greater than 104 colonies/mL in all but one of the positive cultures. No anaerobic bacteria were isolated. History of bronchial asthma, presence of nasal purulent secretion, elevated blood eosinophils, and elevated serum IgE were found more frequently in children with complete opacification of maxillary sinus. Serum levels of IgG2 were low in 29% of the children, but no correlation was found between low IgG2 levels and positive cultures from maxillary sinus aspirates. We concluded that children with complete radiologic opacification of maxillary sinus had bacterial infection in almost 70% of the cases with symptoms that did not prompt their physicians to consider the diagnosis of sinusitis.

Key Words: sinusitis • maxillary sinus • respiratory tract infections • bacterial infections

Submitted on June 2, 1989
Accepted on August 8, 1989




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