Rapid Diagnosis of Bacterial Sinusitis in Young Children with Chronic Coughing and without Wheezing
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Charles H. Song, MD FAAAAI, Andrew Wong, MD
 Rationale: To study  the utility of nasal endoscoy and nasal secretion assay using urine dipstick  for young children in differentiating  bacterial sinusitis from  other  common causes of cough: upper respiratory infection, cough variant asthma, allergic rhinitis, and GERD.

Methods: We selected 21 young children under the age of 5 from the  electronic medical records, who presented in our clinic with chronic cough without wheezing  for at least 4 weeks.  Of these, nasal endoscopy were performed in 14 children. Eleven  patients had their nasal secretions assayed  with urine dipstick. Seven had pneumococcal antibodies measured. All were skin tested for food and environmental allergens.

Results:  All of 14 children evaluated with nasal endoscopy showed thick purulent discharge in the nasopharynx and eight(57%) of them had enlarged adenoid for the age.  Eight of 11(73%)  children  whose nasal secretion was assayed  demonstrated positive results for bacterial sinusitis.  All seven (100%) tested for pneumococcal antibodies had low levels for the age. Sixteen of 21 (76%) had positive skin test reactions  to foods and/or environmental allergens. Twelve of 18 children(67%) treated with antibiotics reported symptom resolution in their two week follow-up appointment . 

Conclusions:  Using such diagnostic approaches, we found that the majority of children with chronic cough had met the criteria for chronic bacterial sinusitis and had an excellent response to an appropriate antibiotic therapy. Low levels of specific antibodies and/or allergic rhinitis were associated with majority of the children. Some of these children had adenoid hypertrophy probably as a result of chronic infection