Sinusitis

Sinuses                                                Symptoms of Sinusitis
Sinusitis                                               Diagnosis of Sinusitis
Causes of Sinusitis                                Treatment of Sinusitis
Children at Risk for Getting Sinusitis

Sinuses

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

• Ethmoid sinuses - located inside the face, around the area of the bridge of the nose. These sinuses are present at birth, and continue to grow. 
• Maxillary sinuses - located inside the face, around the area of the cheeks. These sinuses are also present at birth, and continue 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 sinuses - located deep in the face, behind the nose. These sinuses do not develop until adolescence.

 Sinusitis 

Sinusitis means an inflammation or irritation of the sinuses. This inflammation can be caused by a number of factors including a bacterial infection, viral infection and allergies. 

• Acute sinusitis - occurs quickly and improves with the appropriate treatment. 
• Chronic sinusitis - occurs with repeated acute infections or with previous infections that do not completely get better. The symptoms last longer than three months.

Causes of Sinusitis

In children, a sinus infection often occurs after an upper respiratory infection or common cold. Viruses cause these respiratory infections. Respiratory infection causes swelling of the nasal passages that can block the opening of the sinuses, and result in a sinus infection.

In children, a bacterial infection may follow closely after this viral 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 
• Trauma to the nose 
• Foreign objects stuck in the nose 
• Problems with the immune system  
• Cystic fibrosis

Children at Risk for Getting Sinusitis

The following are some of the factors that may increase your child's risk of developing sinusitis: 

• Spends time in a daycare setting  
• Being around someone who smokes
• Family history of sinusitis 
• Having a cold
• A poor immune system

Symptoms of Sinusitis

The symptoms of sinusitis are somewhat different in children than adults and depend on the age of the child. The following are the most common symptoms of sinusitis. 

• Runny nose that lasts longer than seven to 10 days - The discharge is usually thick green or yellow, but can be clear. Since viral infections and bacterial infections of the sinuses often look the same and viral infections are more common, it is customary not to treat a runny nose in most children unless it has persisted longer that 7 to 10 days. Viral infections will resolve on their own. Antibiotics will not help viral infections get better quicker. 
• Nighttime cough
• Occasional daytime cough
• Bad breath
• 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.

Diagnosis of Sinusitis

The diagnosis of sinusitis is made by taking a history and examining your child. Some additional tests may be ordered for children who have difficulty with sinusitis. The tests may include:

• Allergy testing – is generally done in the Asthma and Allergy Clinic located one floor above the Pediatric.
• Otolaryngology Clinic at Children's Hospital
• Computerized tomography (also called CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, and can let your pediatric otolaryngologist see the "inside" of the sinuses and nose to determine if there are specific causes for your child's sinusitis. 
• Nasal endoscopy – your child's pediatric otolaryngologist has special, very small-lighted scopes which allow him to examine the inside of your child's nose and sinuses in the clinic. 
• Cultures from the sinuses - laboratory tests that involve the growing of bacteria or other microorganisms to aid in diagnosis.
• Immune testing – occasionally your doctor may order test to make sure that your child's immune system is functioning adequately and not contributing to the frequent sinus infections.
• Testing for cystic fibrosis – although cystic fibrosis is rare, if your child is having frequent sinus infections your doctor may wish to test for this rare disease to make sure that it is not contributing to the sinusitis.
• Sinus x-rays - diagnostic test 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.)

Treatment of Sinusitis

1. 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 

• Antibiotics, as determined by your child's physician
• Acetaminophen (for pain or discomfort)
• A decongestant (i.e., pseudoephedrine [Sudafed®]) and/or mucus thinner (i.e., guaifenesin [Robitussin®])
• Cool humidifier in your child's room 
• Nasal spray to reduce inflammation. Antihistamines do not help the symptoms of sinusitis unless an allergy is involved.
• In children with chronic sinus infections, surgery may be needed. Surgical procedures for sinusitis include:
  • Adenoidectomy - the adenoids often contribute to sinus infection by blocking flow of secretions out of the nose and carrying bacteria that lead to sinusitis.  
  • Sinus irrigation
  • Endoscopic sinus surgery