Comparison of B-mode Ultrasonography and CT-Scan in Diagnosis of Children’s Maxillary Sinusitis

Background: Sinusitis is a common medical problem, especially in children. Diagnosis of sinusitis in children is usually based on clinical symptoms and clinicians usually tend to avoid X- ray study especially less than 6 years of age. Nowadays, the gold- standard for the diagnosis of sinusitis is CT scan but other modalities including plain X-ray and MRI are also useful. In the literature, there are few studies about the use of ultrasound for diagnosis of sinusitis as a safe, inexpensive and radiation-free method but most of these studies are limited to adults.

Objectives: Therefore this study has been designed to show the accuracy of ultrasound in diagnosis and follow up of sinusitis in the pediatric age group.

Patients and Methods: All children in the age range of 2-14 years who were clinically suspected for sinusitis and referred to Tabriz children’s hospital for CT scan were enrolled in this study and maxillary sinus sonography was performed for all of them before CT. Revonta method was used and sonography was done with Sonix-OP machine (by using linear- L14-5MHz and microconvex-C9-5/10MHz probes). Totally, 58 patients (116 maxillary sinuses) were evaluated over a 6 months period.

Results: Based on CT findings, patients were divided into four groups: 1) normal, 2) slight mucosal thickening, 3) considerable mucosal thickening (more than 50% of the surface), 4) fluid retention in association with mucosal thickening. According to the statistical analysis undertaken in this study, and extracted cut off point, accuracy of ultrasound in group 1 is about 90% with ultrasound quantitative criteria and about 82% with qualitative criteria. In group 3 and 4 the accuracy of ultrasound is above 90% by using qualitative criteria and 75% with quantitative criteria.

Conclusions: Ultrasound study of maxillary sinuses in children is easily achievable if operator has enough skills and experience. Since qualitative criteria are more operator dependent, quantitative study is more accurate and more practical. Using these results, the accuracy of ultrasonography in the diagnosis of maxillary sinusitis in children is considerably high and acceptable, therefore ultrasound can be used not only as a precise diagnostic tool for primary diagnosis of sinusitis but also it can be used as a safe, accurate, practical and repeatable tool for follow up and post treatment monitoring of these patients.