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Pediatric Sinusitis

Dr. Ogden with little girlFor the first few years, children have very small sinuses that may not contribute much towards disease. The growth of the sinuses parallels facial growth. Sinuses reach their adult form in the early teenage years and may continue to grow until adulthood.

An otherwise healthy child experiences six-to-ten upper respiratory infections per year. A challenge for parents and medical providers is to distinguish the children who require further intervention (medication and/or surgery), from those who do not. Sinusitis, or, more accurately, pediatric rhinosinusitis can be a major problem that affects the health and well-being of the child and his or her family.

Simple and Chronic Upper Respiratory Infections

Simple upper respiratory infections are usually caused by a virus and do not require treatment with an antibiotic. It can be difficult to differentiate between viral infection and bacterial infection based upon a person's symptoms. In other words, a viral upper respiratory infection and a bacterial acute sinusitis can both cause thick foul nasal drainage, headache, face pain/pressure, fever, and generally feeling ill.

A viral upper respiratory infection usually improves with supportive care in three-to-seven days, while a bacterial infection will typically persist or worsen. An acute bacterial infection may follow a viral infection and will frequently require antibiotics to improve.

Chronic sinusitis is defined as sinusitis symptoms lasting for more than three months. There may be episodes or worsening (acute viral or bacterial infections and acute sinusitis) within this time period.

Upper Respiratory Infections and Sinusitis

A key factor in developing sinusitis is inflammation or irritation of the nose and sinus linings. This can lead to congestion, pressure, thick mucus, and infection. Many different factors can result in inflammation and there are often several at play in the same individual.

Viral upper respiratory infections occur frequently in children and are the most common predisposing factor for bacterial sinusitis. Allergy is also common and results in underlying nasal inflammation and abnormal functioning. There is a strong correlation between children with chronic rhinosinusitis and allergy. Other rare medical conditions in children can cause abnormal nasal function, worsened inflammation, and sinus infections. Such conditions include problems with the underlying immune system, cystic fibrosis, ciliary dyskinesia, asthma and possibly gastroesophageal reflux disease (GERD).

Treatment for Sinusitis

Many of the medical treatments used in children are targeted towards reducing the inflammation or irritability of the nasal linings. Allergy medication or immunotherapy (allergy shots) can reduce sinusitis frequency and/or severity by making the nasal linings less susceptible to infection. Nasal steroid sprays are safe in children and can be effective at calming the nasal linings in the setting of many different causes of irritation. Saline nasal spray or irrigations help in several ways, including rinsing thick mucus, relieving swelling, and decreasing irritability.

Adenoids are implicated in nasal and sinus problems in children. They are located in the back of the nose at the upper portion of the throat. Adenoids can be enlarged (causing blockage) and/or inflamed (irritated). A low-grade infection can persist in the adenoids, despite antibiotic treatment, and cause re-infection of the nose or sinuses. Symptoms of adenoid problems are similar to sinusitis and include congestion, runny nose, mouthbreathing, cough, and nasal sounding voice. Removing the adenoids surgically (adenoidectomy) is considered a first-line surgical therapy for recurrent or persistent sinusitis in children. This alone can significantly improve sinusitis in over two-thirds of patients. Adenoidectomy is an outpatient procedure performed under general anesthesia. Children usually recover quickly within a few days.

In a small subset of children, medications and adenoidectomy are not sufficient treatments for chronic or recurrent sinusitis. This may be due to underlying blockages in the nose, the severity of disease, or other underlying medical problems. Endoscopic sinus surgery is a consideration for these children.