Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Sinustitis in Children



Sinusitis in children is now recognized as a common problem and was frequently under diagnosed in the past. Even though children's sinuses are very small and do not show up well on x-rays, they are present even before birth and become involved in infections whenever the nose is blocked or trauma occurs through the nose, such as inspiring cold or dry air or having an upper respiratory viral infection. There are a few inherited conditions in which the cilia in the nose are abnormal and lead to chronic sinus infections. Also, any abuse of the nose from chronic use of nasal decongestant sprays such as Afrin or Neosynephrine or drugs such as Cocaine can lead to chronic sinus disease. Cystic Fibrosis causes a change in the quality of mucous layer in the nose which leads to chronic recurring sinus disease. Allergy is a very common cause of chronic or recurring sinus disease because of obstruction and stagnation of the mucous secretions in the nose and sinus cavities. A few other inherited conditions such as IgA deficiency and other immune deficiencies lead to frequent sinus infections. Other causes of trauma, such as swimming or diving, and jumping into the water feet first, which may irritate the nose, can lead to sinus infections. By far, the most common cause of sinus infections in children, however, are colds (viral upper respiratory infections) and allergies.

The symptoms and signs of sinusitis in children include a protracted cold which does not seem to clear up; persistent pustular drainage from the nose and persistent post-nasal drip with a cough, (usually worse when lying down). Other presenting patterns include hoarseness which does not seem to go away (with or without a barking cough); nasal sounding speech; a decreased sense of smell; a bad taste in the back of the throat; headache or pain over the area of the sinuses around the nose and under the eyes and over the eyes; occasionally one sees drainage from the nose with sores around the nose; redness of the skin over the sinuses; tenderness over the sinuses; and finally bad breath. These are all signs and symptoms of acute sinusitis. They can also occur with chronic sinusitis (lasting for several weeks) and usually unsuspected in children except for the fact that they don't seem to get totally well. They complain of all of the above signs and symptoms as well as a chronic recurring cough night or day, soreness in the throat and pharynx, and sometimes swelling of the glands in the neck. Some children with sinusitis have fever but frequently they are without fever.

Diagnosis can be made by a doctor simply looking in the nose and recognizing the pustular discharge or by x-rays showing clouding of the sinuses and blockage of any of the different sinuses in the head with thick secretions. Once a diagnosis is made, treatment should be started immediately with an appropriate antibiotic such as Amoxillin, or for resistant infections, Septra, Bactrim, Erythromycin, Pediazole, Ceclor, Ceftin, Augmentin, or a few other new antibiotics such as Suprax to try and kill the bacteria which have built up within the sinuses. In addition to antibacterial treatment, it is important to improve drainage from the sinuses and nose and this can be done by using salt water nasal flushes, steam or warm washrags held over the sinuses. Increased hydration such as drinking more fluids, and decongestants and antihistamines are also helpful.

Some new treatments which are very effective in helping to control sinusitis include nasal sprays with Intal (the trade name is Nasalcrom) and with non-absorbable corticosteroid sprays (the trade names include Nasalide, Vancenase, Beconase). These, if used regularly, help to keep the nasal inflammation down to a minimum and prevent the recurrence of sinusitis in children. The old-fashioned ideal of flushing the nose with salt water on a daily basis is probably a very good health tip particularly for anyone with allergies or recurrent sinus infections.

If specific allergies are involved such as dust, pollen, animal dander or food allergies, these should be treated appropriately by an allergist. If the sinus disease is very serious or recurring and not responsive to a reasonable length of treatment, then referral to an ENT surgeon is recommended. There are several types of surgical treatments for sinus blockage and infection and a new procedure called endoscopy is making it much less invasive and traumatic to treat patients who have very blocked and poorly draining sinuses.

In summary, sinusitis is a disease that has always been with us and is now commonly recognized as an everyday pediatric disease. Fortunately we can diagnose and treat it easily most of the time with antibiotics and nasal drainage techniques and allow children to get back to full activity as soon as possible.