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Otitis media and sinusitis are common pediatric diagnoses and share common features that are described in this article. Although the anatomy, physiology, and disease processes are not identical, knowledge of the basic pathophysiology of middle ear disease often enables a clinician to have a useful working understanding of sinus disease. Recognizing these similarities provides a better understanding of their pathophysiology and treatment.

The posterior ethmoid air cells and the sphenoid sinuses have a complex anatomy that is surrounded by vital structures. To more easily protect these structures, three approaches are presented that make pediatric sphenoidotomy a safer procedure. The approaches include measuring the distance from the anterior nasal spine to the anterior and surgical posterior faces of the sphenoid sinus intraoperatively and comparing these to the patient's height and age, the use of the "ridge" to ensure a safe entry into the sphenoid, and, in patients where isolated sphenoid disease is present, the use of a powered instrument to enlarge the sphenoid ostium. The availability of measurements relating the height of the patient to the location of the sphenoid sinus, the use of the "ridge," and the use of powered instrumentation, should help the surgeon enter the sphenoid with greater confidence and achieve a more effective result.

Powered instrumentation is now available for a variety of sinonasal procedures in children. Microdebriders with continuous suction at the operative site allow increased precision for complex procedures that often were difficult in small, fragile, pediatric noses. These instruments can be used for functional endoscopic sinus surgery in children and for such procedures as benign and malignant sinonasal or base of skull tumors, choanal atresia, complicated adenoidectomies, dacrocytorinostomies, septal spurs, and recurrent respiratory papillomatosis. These instruments can remove mucosa, neoplastic tissue, cartilage, thin bony septations, nasal debris, and blood under continuous endoscopic visualization. Edematous mucosa is not stripped, but trimmed and preserved, allowing much more rapid postoperative healing because exposed bone is avoided.

Maxillary sinus disease often is exacerbated by a laterally displaced uncinate process that functionally obstructs the infundibulum and the natural ostium. The drainage pathway may be adequate during periods of wellness but with the introduction of nasal edema, the ostium/infundibulum interface is inadequate, thus preventing acceptable ventilation and drainage. Incomplete removal of the most anterior uncinate can keep the surgeon from identifying the natural ostium. Failure to relieve any obstruction from this important opening, with simultaneous creation of an MMA that does not include the natural ostium of the maxillary sinus, leads to the missed ostium sequence and continued sinus disease.

This article portrays the anatomy of the ethmoid bone and lateral nasal wall in a detailed, but easily digested form. Understanding the anatomy of the lateral wall of the nose is the cornerstone of competent paranasal sinus surgery.

Chronic sinusitis in children who do not have other underlying medical problems is a medically treatable disease, and surgery is not required often. Allergies, environmental factors, and gastroesophageal reflux are the three most important contributing causes of chronic sinusitis in children. Chronic sinusitis is not a primary infectious disease.