Pediatric Sinusitis

Sinusitis is an infection of the sinuses. These infections usually happen after a cold or with allergies. There are three types of sinusitis:

• Short-term (acute). Symptoms of this type of infection last less than 12 weeks and get better with the correct treatment.
  
• Long-term (chronic). These symptoms last longer than 12 weeks.
  
• Recurrent. This means the infection comes back again and again. It means three or more episodes of acute sinusitis in a year.

The sinuses are air-filled spaces (cavities) near the nose. They are lined with mucous membranes. There are four different sinuses:

• Ethmoid sinus. Located around the bridge of the nose. This sinus is present at birth and continues to grow.
  
• Maxillary sinus. Located around the cheeks. This sinus is also present at birth and continues to grow.
  
• Frontal sinus. Located in the area of the forehead. This sinus does not develop until around age 7.
  
• Sphenoid sinus. Located deep behind the nose. This sinus does not develop until the teen years.

A sinus infection sometimes happens after an upper respiratory infection or common cold. The cold causes swelling that can block the opening of the sinuses. This can cause a sinus infection. Allergies can also lead to sinusitis because of swelling and increased mucus. Other possible conditions that can lead to sinusitis include:

• Abnormal shape of the nose
• Infection from a tooth
• Nose injury
• Foreign object in the nose
• Birth defect with abnormality of the roof of the mouth (cleft palate)
• Problem with stomach acids (gastroesophageal reflux disease or GERD)

When the sinuses are blocked with discharge, bacteria may begin to grow. This leads to a sinus infection or sinusitis.

The most common bacteria that cause acute sinusitis include:

• Streptococcus pneumonia
• Haemophilus influenzae
• Moraxella catarrhalis

There are things that can help your child avoid sinusitis. They include:

• Have your child use saline sprays, washes or both. Use these often to keep the nose as moist as possible.
• Use a humidifier in dry indoor environments.
• Keep your child away from cigarette and cigar smoke.
• Keep your child away from things that cause allergy symptoms.
• Don't force water into the sinuses. For example, your child should not jump into water.
• Limit time in chlorinated pools; chlorine can irritate the nose and sinuses.
• Practice good hand hygiene.
• Keep you and your child up to date with immunizations.
• Avoid close contact with people who have colds or others upper respiratory infections.

The following are the most common symptoms of sinusitis:

• Stuffy nose
• Thick, colored drainage in the nose
• Drainage down the back of the throat (postnasal drainage)
• Headache
• Cough
• Pain or soreness over sinuses
• Fever
• Loss of smell

The symptoms of sinusitis can be similar to other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

Your healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may also have tests, such as:

• Sinus X-rays. X-ray exam of the sinuses may help with the diagnosis.
• CT scan of the sinuses . A CT scan shows detailed images of any part of the body. They are more detailed than X-rays.
• Cultures from the sinuses. A swab of discharge from the nose may be taken. The sample is checked for bacteria or other germs.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Acute sinusitis

Acute sinusitis may get better on its own. If it doesn’t, your child’s healthcare provider may prescribe:

• Antibiotics. If your child’s sinuses are infected with bacteria, antibiotics are given to kill the bacteria. If your child’s symptoms haven’t improved after three to five days, your healthcare provider may try a different antibiotic.
• Allergy medicines. For sinusitis caused by allergies, antihistamines and other allergy medicines can reduce swelling.

Note: Don’t use over-the-counter decongestant nasal sprays without checking with your child’s healthcare provider. These sprays may make symptoms worse.

Recurrent sinusitis is also treated with antibiotic and allergy medicines. Your child’s healthcare provider may refer you to an ear, nose and throat (ENT) specialist for testing and treatment.

Chronic sinusitis

Treatment for chronic sinusitis may include:

• ENT specialist visit. Your child may be referred to an ENT specialist.
• Antibiotics. Your child may need to take antibiotics for a longer time. If bacteria aren’t the cause, antibiotics won’t help.
• Inhaled corticosteroid medicine. Nasal sprays or drops with steroids are often prescribed.
• Other medicines. Nasal sprays with antihistamines and decongestants, saline sprays or drops, or medicines to loosen and clear mucus may be prescribed.
• Allergy shots or immunotherapy. If your child has nasal allergies, shots may help reduce his or her reaction to allergens such as pollen, dust mites or mold.
• Surgery. Surgery for chronic sinusitis is an option, although it is not done very often in children.

Care may also include:

• Fluids. A glass of water or juice every hour or two is a good rule. Fluids help thin mucus, allowing it to drain more easily. Fluids also help prevent dehydration
• Saline wash. This helps keep the sinuses and nose moist. Ask your child’s healthcare provider or nurse for instructions
• Warm compresses. Apply a warm, moist towel to your child’s nose, cheeks and eyes to help relieve pain in the face

Acute sinusitis can result in a brain infection, but this is very rare.