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 sinus - located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.
  • Maxillary sinus - located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues 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 sinus - located deep in the face, behind the nose. This sinus does not develop until adolescence.
Location of 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 were inadequately treated. 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.
  • Diving and swimming.
  • Infections from a tooth.
  • Trauma to the nose.
  • Foreign objects stuck in the nose.
  • Cleft palate.

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 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.

  • 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.)

  • Computed 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.

Antibiotic overuse
Antibiotic overuse in children has become a common problem, aggravated by parental pressure for the medication, according to the American Academy of Pediatrics (AAP). In 1980, 4.2 million prescriptions were written for amoxicillin, an oral antibiotic to treat ear infections. In 1992, the number of prescriptions had grown to 12.3 million (194 percent increase). Use of another antibiotic to treat ear infections, cephalosporins, increased from 876,000 prescriptions in 1980 to 6.8 million in 1992 (a 687 percent increase).

Overuse of antibiotics is leading to strains of diseases that are becoming resistant to the medication, making it harder to treat patients. All too often, antibiotics have been prescribed for conditions such as colds, fluid in the middle ear, or bronchitis, which do not respond to antibiotics, according to the Centers for Disease Control and Prevention (CDC). Antibiotics are only effective in treating bacterial infections.

The key to preventing overuse of antibiotics is education of the parents and physicians in the appropriate use of antibiotics, according to the AAP. Some tips to remember when taking antibiotics, according to the American Medical Association (AMA), include the following:

  • Take the antibiotics as prescribed.
  • Finish the full course of antibiotics, as prescribed.
  • Do not save or reuse antibiotics.

Always consult your child's physician for more information.


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