A Comparison Between Ultra-Sonography and Water’s View Radiography as Confirmatory Tools for Diagnosis of Maxillary Sinusitis in Children Complaining of Cough

Diagnosis of pediatric sinusitis with puncturing as an invasive technique and culturing of the microorganisms may be substituted with less invasive imaging methods. Computerized tomography scanning as the gold standard of sinusitis diagnosis may not be a generalized method due to its devastating radiation effects; therefore, ultra-sonography and radiography seem to be methods to be evaluated in the diagnosis of maxillary sinusitis. There are limited and conflicting studies found in the literature that have evaluated the role of ultra-sonography in the diagnosis of maxillary sinusitis. The purpose of this study was to compare ultra-sonography with Water’s view radiography in the diagnosis of maxillary sinusitis in children. In this prospective study, 60 children aged over four years old with clinically diagnosed maxillary sinusitis, admitted to Lung Clinic of Mofid Children’s Hospital, were enrolled. Water’s view X-ray and ultra-sonography were performed by two expert radiologists on the same day. Data and interpretations were collected and entered in the SPSS 21 software. The patient’s mean age was 6.8 ± 1.8 years. Overall, 120 maxillary sinuses were analyzed by ultra-sonography and radiology. There was diagnostic agreement between the two techniques regarding 59 sinus sites, 49.2%. Compared to standard X-ray, ultra-sonography had a sensitivity of 56.4% and specificity of 91.7%. The diagnosis rate for normal interpretation via the ultrasound technique compared to the standard X-ray was 8.3% and considered acceptable. This method underestimated the diagnosis of fluid collection (30.4%), yet overestimated the rate of mucosa thickening (62.3%). This study revealed that ultra-sonography is not a suitable technique for detection of mild mucosal thickening yet may come to represent an alternative substitution to the more invasive methods for diagnosis of acute sinusitis with moderate to severe mucosal thickness and fluid collection in the maxillary sinuses.