Sinusitis

Where are the sinuses?

The sinuses are air filled cavities located in the bones of the face. The sinuses are divided into groups based on their location and are named maxillary, ethmoid, frontal and sphenoid sinuses.

What is sinusitis?

Sinusitis is a condition in which your child suffers from inflammation or infection of one or more of the sinuses.

Depending on the age of your child, this may occur in the pair of sinuses located between the eyes (ethmoid) and/or the pair behind the cheekbones (maxillary), as both of these sinuses are present at birth.

As children get older, they develop a pair of frontal sinuses (in the forehead) and a pair of sphenoid sinuses (behind the nose), which can also become affected.

What are the symptoms of sinusitis?

Sinusitis has symptoms of runny nose, stuffy nose, fever, headache, cough (especially at nighttime), post nasal drip (causes frequent throat clearing), bad breath, facial swelling and changes in your child's behavior. Many times it is difficult to tell the difference between a cold and a sinus infection.

A cold has many of the same symptoms but will usually get worse around the 3rd or 4th day and be improving by a week to ten days. A sinus infection is usually worsening instead of improving at a week to ten days.

What causes sinusitis?

Sinusitis is caused by an infection within the sinus cavities. Anything which causes blockage of the natural drainage openings of the sinuses can lead to infection. This means colds, flu, allergy or bacterial infection may be responsible. Blockage may also occur from POLYPS, which may be caused by allergies or chronic infection.

Once blockage of the natural drainage passageways has occurred, mucus builds up behind the blockage. This may lead to inflammation and, eventually, infection of trapped mucus, otherwise known as acute sinusitis.

Are there any other types of sinusitis?

Another type of sinusitis is known as chronic sinusitis. Most children have acute sinusitis which resolves on antibiotics after 3 weeks. However, your child may suffer from symptoms which last for 2 to 3 months or more; this is known as chronic sinusitis. In children with chronic sinusitis, the symptoms are usually less severe, but last longer than acute sinusitis. Chronic sinusitis may be aggravated by underlying allergies or long standing illness.

How is sinusitis diagnosed?

Your doctor will diagnose sinusitis based mostly on the history you give of your child's symptoms. You probably will be asked if your child has nasal congestion (stuffy nose) or a runny nose, a cough, post-nasal drip, bad breath, headache, swelling around the eyes, or behavior changes.

Sinusitis is also diagnosed by how long the symptoms last. If the child has a simple cold or flu, symptoms will usually last from 7 to 10 days. If the symptoms described previously persist beyond ten days, sinusitis is likely to have occurred and your child should be evaluated by a physician.

What might my doctor do during an evaluation?

After noting your child's symptoms, the next step is an examination of the patient's ear, nose and throat. Occasionally special nasal endoscopes will be used to see farther into the nose. In addition, your doctor might order x-rays to completely evaluate the sinuses. These x-rays may include plain x-rays of the sinuses or a computed tomography (CAT) scan, which will give your doctor the most accurate information on your child's sinuses.

How will the doctor treat acute sinusitis?

As the first line of treatment, your doctor will probably give your child an antibiotic for several weeks to clear the sinus infection. Nasal decongestants or nasal sprays may also be prescribed. If your child has acute sinusitis, symptoms should improve within the first few days. After the first week of treatment, your child will often seem much better; however, you should continue the antibiotic therapy as described by your doctor for the full course of therapy. Otherwise, the infection may return.

If your child has a sinusitis which seems to be linked to an allergic condition, your doctor may decide to involve an allergy specialist so that the underlying allergy can be treated.

How might the doctor treat chronic sinusitis?

If your child has had several acute sinus infections in the past several years or has long standing chronic sinusitis which does not seem to go away completely with antibiotics, your doctor may recommend surgical treatment of the sinuses using FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS). Other procedures such as SINUS CULTURE or ADENOIDECTOMY may also be recommended.

Are there any complications resulting from sinusitis?

In addition to development of chronic sinusitis, serious complications of sinusitis include orbital cellulitis (an infection in the tissues around the eye), osteomyelitis (an infection in the bones), meningitis (infection in the fluid surrounding the brain and spinal cord),or brain abscess. Thankfully, especially with treatment, these complications are rare.