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Pediatric Sinusitis
Your child’s sinuses are not fully developed until age 20. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms can be subtle and the causes complex.
How Do I Know When My Child Has Sinusitis?
The following symptoms may indicate a sinus infection in your child:
- a “cold” lasting more than 10 to 14 days, sometimes with a low-grade fever
- thick yellow-green nasal drainage
- post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
- headache, usually in children age six or older
- irritability or fatigue
- swelling around the eyes
Young children have immature immune systems and are more prone to
infections of the nose, sinus, and ears, especially in the first several
years of life. These are most frequently caused by viral infections
(colds), and they may be aggravated by allergies. However, when your
child remains ill beyond the usual week to ten days, a serious sinus
infection is likely.
You can reduce the risk of sinus infections for your child by reducing
exposure to known environmental allergies and pollutants such as tobacco
smoke, reducing his/her time at day care, and treating stomach acid
reflux disease.
How Will the Doctor Treat Sinusitis?
Acute sinusitis: Most children respond very well to antibiotic therapy. Nasal decongestants or topical nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function.
If your child has acute sinusitis, symptoms should improve within the
first few days. Even if your child improves dramatically within the
first week of treatment, it is important that you continue therapy until
all the antibiotics have been taken. Your doctor may decide to treat
your child with additional medicines if he/she has allergies or other
conditions that make the sinus infection worse.
Chronic sinusitis: If your child suffers from one or
more symptoms of sinusitis for at least twelve weeks, he or she may have
chronic sinusitis. Chronic sinusitis or recurrent episodes of acute
sinusitis numbering more than four to six per year, are indications that
you should seek consultation with an ear, nose, and throat (ENT)
specialist. The ENT may recommend medical or surgical treatment of the
sinuses.
Diagnosis of sinusitis: If your child sees an ENT
specialist, the doctor will examine his/her ears, nose, and throat. A
thorough history and examination usually leads to the correct diagnosis.
Occasionally, special instruments will be used to look into the nose
during the office visit. An x-ray called a CT scan may help to determine
how your child's sinuses are formed, where the blockage has occurred,
and the reliability of a sinusitis diagnosis.
When Is Surgery Necessary For Sinusitis?
Surgery is considered for the small percentage of children
with severe or persistent sinusitis symptoms despite medical
therapy. Using an instrument called an endoscope, the ENT
surgeon opens the natural drainage pathways of your child's
sinuses and makes the narrow passages wider. This also allows
for culturing so that antibiotics can be directed specifically
against your child's sinus infection. Opening up the sinuses and
allowing air to circulate usually results in a reduction in the
number and severity of sinus infections.
Also, your doctor may advise removing adenoid tissue from behind
the nose as part of the treatment for sinusitis. Although the
adenoid tissue does not directly block the sinuses, infection of
the adenoid tissue, called adenoiditis, or obstruction of the
back of the nose, can cause many of the symptoms that are
similar to sinusitis, namely, runny nose, stuffy nose,
post-nasal drip, bad breath, cough, and headache.
Summary
Sinusitis in children is different than sinusitis in adults. Children more often demonstrate a cough, bad breath, crankiness, low energy, and swelling around the eyes along with a thick yellow-green nasal or post-nasal drip. Once the diagnosis of sinusitis has been made, children are successfully treated with antibiotic therapy in most cases. If medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children.
