Evaluating the extent of chronic sinusitis in children is critical in management of the disease and determination of the need for surgery. High- resolution computed tomography can demonstrate disease that is not shown on routine x-ray films. It can also delineate pathologic variations and demonstrate inaccessible anatomic structures. We compared plain radiographs, CT scans, and intraoperative findings for 300 pediatric patients with chronic or recurrent sinusitis. Despite an imperfect record in demonstration of sinus disease in all of our patients, computed tomography was unquestionably better than plain radiography in diagnosis of chronic sinusitis and evaluation of the need for surgery. Despite its superior performance, CT should not be used exclusively to diagnose disease or propose surgery. These determinations must be made on the basis of a combination of the patient's symptoms, physical examination findings, and CT results.
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