- Email: [email protected]
The diagnostic value of transillumination for maxillary sinusitis in children
International Elsevier
PEDOT
Journal of Pediatric
Otorhinolaryngology
18 (1989) 9-11
9
00593
The diagnostic value of transillumination for maxillary sinusitis in children Floris W.A. Otten and Jan J. Grote Department
of Otorhinolaryngology
and Head and Neck Surgery, L.&den University Hospital, L&den (The NetherIan&)
(Received 20 March 1989) (Accepted 26 April 1989)
Key words: Transillumination;
Maxillary
sinusitis;
Child
Abstract
In 52 children between 3 and 9 years of age drainage of the maxillary sinus was performed because of chronic purulent rhinitis and opacity of the maxillary sinuses on the radiographs. The results of preoperative transillumination were compared with the drainage findings. In this selected group of children the sensitivity of transillumination for the demonstration of congestion in the maxillary sinuses was found to be limited. The authors consider transillumination to be an obsolete method for this purpose in children.
Introduction
Maxillary sinusitis occurs frequently in children, but the condition is not easy to diagnose. The main reason for this is that the clinical picture is much less distinct in children than in adults [4,5,7] but in addition supplementary diagnostic methods such as radiography and ultrasonography of the paranasal sinuses do not provide absolute certainty either [6,7]. Another method available to examine the maxillary sinuses is transillumination. Based on the principle that purulent secretion absorbs light, reduction of transillumination of the maxillary sinus could be a diagnostic parameter for purulent maxillary sinusitis. Because to the best of our knowledge no invasive controlled study had been performed to evaluate the reliability of transillumination of the maxillary sinuses in children [7], we undertook the investigation reported here,
Correspondence: F.W.A. Otten, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital, Postbox 9600, 2300 RC Leiden, The Netherlands.
0165-5876/89/$03.50
0 1989 Elsevier Science Publishers
B.V.
Leiden
10
Materials and Methods
In 52 children aged between 3 and 9 years, chronic purulent rhinitis and opacity of the maxillary sinuses on radiographic examination led to drainage of the maxillary sinuses after puncture of the sinus via the inferior nasal meatus. Transillumination was performed preoperatively for comparison of these findings with the result of drainage of the maxillary sinus. In a completely darkened room the diaphanoscope was inserted into the child’s mouth and the lips were closed around the light source. The evaluation was always done by the same investigator and the qualification ‘good’ or ‘poor’ was assigned on the basis of the subjective estimation of the degree of illumination of the soft tissue anterior to the maxillary sinuses.
Results
Of the 24 children with poor transillumination, 23 (95.8%) appeared to have a positive (purulent) maxillary sinus puncture. Of the 28 children with good transillumination, 25 (89.3%) also had a positive maxillary sinus puncture (see Table I). Complete agreement between the findings of transillumination and maxillary sinus puncture was found for 26 (23 + 3) of the complete series of 52 children (50%) (see Table I). In 51 of the children (98%), transillumination gave the same results on both sides. Only one child (2%) showed a distinct difference between the right and left sides with respect to the illumination.
Discussion
In this study poor transillumination often coincided with a positive maxillary sinus puncture, and good transillumination was seldom (10.7%) seen together with a negative puncture result. The finding that of the 48 children with a positive puncture only 23 (47.9%) had poor transillumination justifies the conclusion that the sensitivity of this method for the demonstration of purulent secretion in the maxillary sinus is low in children. Since this study was done in a selected group of
TABLE I Results of transillumination and puncture of the maxillay sinus in 52 children Transillumination
Total
Puncture negative
positive
(n)
c@
(n)
@J)
Poor
25 23
89.3 95.8
3 1
10.7 4.2
Total
48
GOOd
4
(n)
(W
28 24
100 100
52
11
children with chronic maxillary sinusitis, conclusions cannot be drawn concerning the reliability of transillumination in an unselected population group. This will remain impossible because medical ethics rule out such studies. Furthermore, the number of negative sinus punctures in this study is too small to permit calculation of the specificity. Nevertheless, the results indicate clearly that transillumination of the maxillary sinus in children is not a reliable supplementary method for evaluation of these cavities. The variable thickness of not only the soft tissues but also the bone in small children and the relatively small volume of the sinuses can be expected to limit the clinical value of transillumination in pediatrics [7]. The present study has confirmed the limitations of this supplementary method. In transillumination there is only a reference point available if a difference in transillumination exists between the left and right sides. As the present results show, this is seldom the case in children. Particularly for symmetrical transillumination it must be kept in mind that the degree of illumination of the cavities can only be assessed subjectively, which in itself is a limitation. Consensus has not been reached concerning the value of transillumination of the maxillary sinus in adults [l-3].
Conclusion
As supplementary diagnostic method for the demonstration of purulent secretion in the maxillary sinus of young children, transillumination has very little value. It may therefore be considered obsolete for this purpose in children.
References 1 Evans, F.O., Sydnor, J.B., Moore, W.E.C., Moore, G.R., Manwaring, J.L., Brill, A.H., Jackson, R.T., Hamra, S., Skaar, J.S., Holdeman, L.V., Fitz-Hugh, G.S., Sande, M.A. and Gwaltney, J.M., Sinusitis of the maxillary antrum, N. Engl. J. Med. 293 (1975) 735-739. 2 McNeil, R.A., Comparison of the findings on transillumination, X-ray and lavage of the maxillary sinus, J. Laryngol. Otol., 77 (1963) 1009-1013. 3 Mtiller, D., Nebenhohlen-Diaphanoskopie als Screeningsmethode, HNO-Praxis, 3 (1976) 193-197. 4 Mtiller, H. and Mike, F., Die Nasennebenhijhlenentztindung im Sauglings- und friihen Kindesalter, HNO 18 (1970) 86-90. 5 Mtinzel, M., Die okkulte Sinusitis im Kindesalter, HNO 28 (1980) 161-162. 6 Revonta, M. and Suonpla, J., Diagnosis of subacute maxillary sinusitis in children, J. Laryngol. Otol., 95 (1981) 133-140. 7 Wald, E.R., Special series: management of pediatric infectious diseases in office practice. Edited by J.O. Klein and S.M. Marcy, Acute Sinusitis in Children, Pediatr. Infect. Dis., 2 (1983) 61-68.
PEDOT
Journal of Pediatric
Otorhinolaryngology
18 (1989) 9-11
9
00593
The diagnostic value of transillumination for maxillary sinusitis in children Floris W.A. Otten and Jan J. Grote Department
of Otorhinolaryngology
and Head and Neck Surgery, L.&den University Hospital, L&den (The NetherIan&)
(Received 20 March 1989) (Accepted 26 April 1989)
Key words: Transillumination;
Maxillary
sinusitis;
Child
Abstract
In 52 children between 3 and 9 years of age drainage of the maxillary sinus was performed because of chronic purulent rhinitis and opacity of the maxillary sinuses on the radiographs. The results of preoperative transillumination were compared with the drainage findings. In this selected group of children the sensitivity of transillumination for the demonstration of congestion in the maxillary sinuses was found to be limited. The authors consider transillumination to be an obsolete method for this purpose in children.
Introduction
Maxillary sinusitis occurs frequently in children, but the condition is not easy to diagnose. The main reason for this is that the clinical picture is much less distinct in children than in adults [4,5,7] but in addition supplementary diagnostic methods such as radiography and ultrasonography of the paranasal sinuses do not provide absolute certainty either [6,7]. Another method available to examine the maxillary sinuses is transillumination. Based on the principle that purulent secretion absorbs light, reduction of transillumination of the maxillary sinus could be a diagnostic parameter for purulent maxillary sinusitis. Because to the best of our knowledge no invasive controlled study had been performed to evaluate the reliability of transillumination of the maxillary sinuses in children [7], we undertook the investigation reported here,
Correspondence: F.W.A. Otten, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital, Postbox 9600, 2300 RC Leiden, The Netherlands.
0165-5876/89/$03.50
0 1989 Elsevier Science Publishers
B.V.
Leiden
10
Materials and Methods
In 52 children aged between 3 and 9 years, chronic purulent rhinitis and opacity of the maxillary sinuses on radiographic examination led to drainage of the maxillary sinuses after puncture of the sinus via the inferior nasal meatus. Transillumination was performed preoperatively for comparison of these findings with the result of drainage of the maxillary sinus. In a completely darkened room the diaphanoscope was inserted into the child’s mouth and the lips were closed around the light source. The evaluation was always done by the same investigator and the qualification ‘good’ or ‘poor’ was assigned on the basis of the subjective estimation of the degree of illumination of the soft tissue anterior to the maxillary sinuses.
Results
Of the 24 children with poor transillumination, 23 (95.8%) appeared to have a positive (purulent) maxillary sinus puncture. Of the 28 children with good transillumination, 25 (89.3%) also had a positive maxillary sinus puncture (see Table I). Complete agreement between the findings of transillumination and maxillary sinus puncture was found for 26 (23 + 3) of the complete series of 52 children (50%) (see Table I). In 51 of the children (98%), transillumination gave the same results on both sides. Only one child (2%) showed a distinct difference between the right and left sides with respect to the illumination.
Discussion
In this study poor transillumination often coincided with a positive maxillary sinus puncture, and good transillumination was seldom (10.7%) seen together with a negative puncture result. The finding that of the 48 children with a positive puncture only 23 (47.9%) had poor transillumination justifies the conclusion that the sensitivity of this method for the demonstration of purulent secretion in the maxillary sinus is low in children. Since this study was done in a selected group of
TABLE I Results of transillumination and puncture of the maxillay sinus in 52 children Transillumination
Total
Puncture negative
positive
(n)
c@
(n)
@J)
Poor
25 23
89.3 95.8
3 1
10.7 4.2
Total
48
GOOd
4
(n)
(W
28 24
100 100
52
11
children with chronic maxillary sinusitis, conclusions cannot be drawn concerning the reliability of transillumination in an unselected population group. This will remain impossible because medical ethics rule out such studies. Furthermore, the number of negative sinus punctures in this study is too small to permit calculation of the specificity. Nevertheless, the results indicate clearly that transillumination of the maxillary sinus in children is not a reliable supplementary method for evaluation of these cavities. The variable thickness of not only the soft tissues but also the bone in small children and the relatively small volume of the sinuses can be expected to limit the clinical value of transillumination in pediatrics [7]. The present study has confirmed the limitations of this supplementary method. In transillumination there is only a reference point available if a difference in transillumination exists between the left and right sides. As the present results show, this is seldom the case in children. Particularly for symmetrical transillumination it must be kept in mind that the degree of illumination of the cavities can only be assessed subjectively, which in itself is a limitation. Consensus has not been reached concerning the value of transillumination of the maxillary sinus in adults [l-3].
Conclusion
As supplementary diagnostic method for the demonstration of purulent secretion in the maxillary sinus of young children, transillumination has very little value. It may therefore be considered obsolete for this purpose in children.
References 1 Evans, F.O., Sydnor, J.B., Moore, W.E.C., Moore, G.R., Manwaring, J.L., Brill, A.H., Jackson, R.T., Hamra, S., Skaar, J.S., Holdeman, L.V., Fitz-Hugh, G.S., Sande, M.A. and Gwaltney, J.M., Sinusitis of the maxillary antrum, N. Engl. J. Med. 293 (1975) 735-739. 2 McNeil, R.A., Comparison of the findings on transillumination, X-ray and lavage of the maxillary sinus, J. Laryngol. Otol., 77 (1963) 1009-1013. 3 Mtiller, D., Nebenhohlen-Diaphanoskopie als Screeningsmethode, HNO-Praxis, 3 (1976) 193-197. 4 Mtiller, H. and Mike, F., Die Nasennebenhijhlenentztindung im Sauglings- und friihen Kindesalter, HNO 18 (1970) 86-90. 5 Mtinzel, M., Die okkulte Sinusitis im Kindesalter, HNO 28 (1980) 161-162. 6 Revonta, M. and Suonpla, J., Diagnosis of subacute maxillary sinusitis in children, J. Laryngol. Otol., 95 (1981) 133-140. 7 Wald, E.R., Special series: management of pediatric infectious diseases in office practice. Edited by J.O. Klein and S.M. Marcy, Acute Sinusitis in Children, Pediatr. Infect. Dis., 2 (1983) 61-68.