There are 4 paired air-filled cavities in your face and head called sinuses—maxillary (in your cheek), ethmoid (between the eyes), frontal (in your forehead) and sphenoid (behind your eyes). Children’s sinuses are not fully developed until late in the teen years. Although very small, the maxillary and ethmoid sinuses are present at birth. The frontal sinus does not develop until around 7.
Sinusitis is an infection of the sinuses. It is most commonly due to a virus but can be bacterial. These infections usually happen after a cold or with allergies. There are 3 types of sinusitis:
- Acute-- Symptoms of this type of infection last less than 12 weeks and get better with the proper treatment. Acute viral sinusitis is likely if your child has been sick for less than 10 days and is not getting worse. Acute bacterial sinusitis is likely when the sinusitis symptoms do not improve at all within 10 days of getting sick, or if your child gets worse within 10 days after beginning to get better.
- Chronic--These symptoms last longer than 12 weeks, and is usually caused by prolonged inflammation, instead of a long infection. Infection can be a part of chronic sinusitis, especially when it worsens from time to time, but is not usually the main cause.
- Recurrent. This means the infection comes back again and again more than 4-6 times in a year.
What Are the Symptoms of Pediatric Sinusitis?
Sinusitis in children can look different than sinusitis in adults. Symptoms can include:
- 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
- irritability or fatigue
How is Pediatric Sinusitis Diagnosed?
An ENT (ear, nose, and throat) specialist will examine your child’s ears, nose, and throat. A thorough history and examination usually leads to the correct diagnosis. The doctor may also look for factors that make your child more likely to get a sinus infections, including structural changes, allergies, and problems with the immune system.
Occasionally, a small lighted instrument called an endoscope will be used to look into the nose during the office visit. X-rays of the sinuses are not recommended. Unless there are complication, CT scans are not recommended for acute sinus infections. However, in children with chronic or recurrent infections who have failed treatment with medications, CT scans may be recommended.
How is Pediatric Sinusitis treated?
Most of the time, children are diagnosed with viral sinusitis that will improve by just treating the symptoms. Treatment options include:
- Saline (saltwater) sprays to thin secretion and improve mucus membrane functions.
- Nasal decongestant sprays for a short period of time to relieve stuffiness.
- Anti-inflammatory sprays can be used to decrease congestion.
- Over-the-counter decongestants and antihistamines are not generally effective for viral upper respiratory infections in children, and the role of such medications for treatment of sinusitis is not recommended. Such medications should not be given to children younger than two years old.
If your child has persistent symptoms for greater than 7-10 days, then antibiotics may be warranted. Even if your child improves dramatically within the first week of treatment, it is important that you complete the antibiotic therapy.
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.
Does my child need surgery?
In the rare child where medical therapy fails, surgery can be used as a safe and effective method of treating sinus disease in children. Typically, removal of the adenoids (adenoidectomy) is recommended first. In children who continue to have sinus problems despite appropriate management by an otolaryngologist (an ear, nose and throat—ENT—specialists) surgery may be warranted. 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.