Sinusitis in Children

What are sinuses?

The sinuses are cavities, or air-filled pockets, near the nasal passage. Like the nasal passage, the sinuses are lined with mucous membranes. There are four different types of sinuses:

• Ethmoid sinus - located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.

• Maxillary sinus - located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues to grow.

• Frontal sinus - located inside the face, in the area of the forehead. This sinus does not develop until around 7 years of age.

• Sphenoid sinus - located deep in the face, behind the nose. This sinus does not develop until adolescence.

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What is sinusitis?

Sinusitis is an infection of the sinuses near the nose. These infections usually occur after a cold or after an allergic inflammation. There are four types of sinusitis:

• Acute - symptoms of this type of infection last less than four weeks and get better with the appropriate treatment.

• Subacute - this type of infection does not get better with treatment initially, and symptoms last four to eight weeks.

• Chronic - this type of infection happens with repeated acute infections or with previous infections that were inadequately treated. These symptoms last eight weeks or longer.

• Recurrent - three or more episodes of acute sinusitis a year.

What causes sinusitis?

Sometimes, a sinus infection happens after an upper respiratory infection (URI) or common cold. The URI causes inflammation of the nasal passages that can block the opening of the paranasal sinuses, and result in a sinus infection. Allergies can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus. There are other possible conditions that can block the normal flow of secretions out of the sinuses and can lead to sinusitis including the following:

• Abnormalities in the structure of the nose

• Enlarged adenoids

• Diving and swimming

• Infections from a tooth

• Trauma to the nose

• Foreign objects stuck in the nose

• Cleft palate

• Gastroesophageal reflux disease (GERD)

• Secondhand smoke

When the flow of secretions from the sinuses is blocked, bacteria may begin to grow. This leads to a sinus infection, or sinusitis. The most common bacteria that cause sinusitis include the following:

• Streptococcus pneumonia

• Haemophilus influenzae

• Moraxella catarrhalis

What are the symptoms of sinusitis?

The symptoms of sinusitis depend greatly on the age of the child. The following are the most common symptoms of sinusitis. However, each child may experience symptoms differently. Symptoms may include:

• Runny nose

  • Lasts longer than seven to 10 days

  • Discharge is usually thick green or yellow, but can be clear

• Nighttime cough

• Occasional daytime cough

• Swelling around the eyes

• Usually no headaches younger than 5 years of age

• Runny nose or cold symptoms lasting longer than seven to 10 days

• Drip in the throat from the nose

• Headaches*

• Facial discomfort

• Bad breath

• Cough

• Fever

• Sore throat

• Swelling around the eye, often worse in the morning

The symptoms of sinusitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

*One 2002 study has found that nine out of 10 physician-diagnosed or self-described sinus headaches are actually migraine-related. The researchers found that the participants described the classic symptoms of pain in the front of the face and pressure under the eyes. However, the participants lacked other symptoms of a true sinus infection, including yellow or green discharge and fever. In addition, not every migraine has telltale symptoms of nausea, vomiting, and sensitivity to light. Always consult your child's physician for a diagnosis.

How is sinusitis diagnosed?

Generally, your child's physician can diagnose sinusitis based on your child's symptoms and physical examination. In some cases additional tests may be performed to confirm the diagnosis. These may include:

• Sinus X-rays - diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. (X-rays are not typically used, but may help assist in the diagnosis.)

• Computed tomography (also called CT or CAT scan) - a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

• Cultures from the sinuses - laboratory tests that involve the growing of bacteria or other microorganisms to aid in diagnosis.

Treatment for sinusitis:

Specific treatment for sinusitis will be determined by your child's physician based on:

• Your child's age, overall health, and medical history

• Extent of the infection

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the infection

• Your opinion or preference

Treatment of sinusitis may include the following:

• Antibiotics, as determined by your child's physician (antibiotics are usually given for at least 14 days)

• Acetaminophen (for pain or discomfort)

• A decongestant (for instance, pseudoephedrine [Sudafed] and/or mucus thinner such as guaifenesin [Robitussin])

• Cool humidifier in your child's room

• Nasal spray to reduce inflammation

• Medications to treat GERD

• Surgery to remove the adenoids

• Endoscopic sinus surgery

Antibiotics may be withheld for 10 to 14 days, unless severe symptoms develop, such as: fever, facial pain or tenderness, or swelling around the eye. Surgery should be considered only if other treatments have failed.

Referral to an allergist/immunologist is often needed, particularly for people with chronic or recurrent sinusitis and for patients who have had sinus surgery, but still experience sinusitis.

Antihistamines do not help the symptoms of sinusitis unless an allergy is involved.