Sinusitis

HOW DOES SINUSITIS DEVELOP?
The sinuses drain into the nasal passages through tiny ducts that easily can become blocked when the lining of the nose is inflamed in the course of a cold or similar illness. This blockage traps bacteria in the sinuses, leading to infection. Because upper respiratory illnesses occur so frequently among children, sinusitis is extremely common. According to , one recent estimate, five to ten percent of all colds and viral sore throats are complicated by sinusitis. Contributing factors include malfunction of the tiny, hairlike projections (cilia) that propel secretions out of the sinuses and abnormally thick sinus secretions. Sinusitis is common among children with cystic fibrosis, cleft palate, dental infections or nasal polyps.

WHAT CAUSES SINUSITIS?
The most common cause is Streptococcus pneumoniae, the same bacteria responsible for the largest percentage of middle ear infections. Other bacteria (Hemophilus influenzae as well as group A Streptococci or Staphylococci) are also possible causes.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS SINUSITIS?
Watch out for a severe cold or flu that fails to run its course within about ten days. Other common symptoms are a persistent daytime cough that worsens at night or on lying down. The nose may be stuffy or runny, occasionally producing pus, and the child may have foul-smelling breath. Fever may occur, although in many cases it is mild, and the child may complain of a headache. Occasionally, a child with sinusitis develops a high fever after a week or more of cold symptoms.

IS MEDICAL ATTENTION NECESSARY?
Yes. Sinusitis is not only uncomfortable but potentially dangerous, since it can lead to abscesses or bone infections.

HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS SINUSITIS?
A lingering cold that doesn't seem to get better, along with other symptoms suggesting sinusitis, may prompt the pediatrician to make the diagnosis without further testing. To be absolutely sure, the pediatrician may take X rays of the child's face and skull.

WHAT TREATMENTS ARE AVAILABLE?
Antibiotics (usually amoxicillin) are prescribed when sinusitis symptoms are severe (high fever, facial swelling and pain) or when they persist for more than 10 days. The doctor also may prescribe decongestant medication and recommend increased fluid intake to promote sinus drainage and relief of symptoms. If there is no response to a course of antibiotics, and if fever, facial pain and headache persist, the sinuses may have to be drained by insertion of a needle through the nasal passages. (Most small children need a general anesthetic or a sedative for this procedure.) Material drained from the sinus then is cultured in the laboratory so that the causative organism can be identified.

Chronic, recurrent sinusitis may require surgery to enlarge the openings between the sinuses and the nose. This surgery is currently being performed with an endoscope (a tube-shaped instrument that combines microscopic view and surgical devices), so it is relatively minor and may not require a hospital stay.

CARING FOR A CHILD WITH SINUSITIS

• Encourage rest and give plenty of fluids.

• Follow the doctor's instructions for taking antibiotics. Try not to miss any scheduled doses, and continue to give the medicine until the prescribed date (often for two or more weeks), no matter how well the child seems before that time.

• Apply hot packs to the head and face to relieve discomfort.

GETTING HELP
Call your doctor if your child:

• Develops a high fever late in the course of a cold.

• Has cold symptoms that last longer than ten days without any sign of improvement.

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.