Sinusitis

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 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.
Diagram of the sinuses

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 three types of sinusitis:
  • acute sinusitis - occurs quickly and improves with the appropriate treatment.
  • subacute sinusitis - does not improve with treatment initially, and lasts less than three months.
  • chronic sinusitis - occurs with repeated acute infections or with previous infections that do not completely get better. The symptoms last longer than three months.

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
  • infections from a tooth
  • trauma to the nose
  • foreign objects stuck in the nose
  • cleft palate
  • problems with the immune system
  • cystic fibrosis
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 in children 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:

younger children:
  • 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
  • bad breath
  • swelling around the eyes
  • usually no headaches younger than 5 years of age
older children and adults:
  • 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.

How is sinusitis diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for sinusitis may include the following:
  • 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.)
  • 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, 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 (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
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