When the nose and sinuses become inflamed, it is called rhinosinusitis (RS). Symptoms may include fever, nasal congestion, nasal discharge (clear, yellow or green), postnasal drip, cough, facial pressure, facial pain, headache, bad breath, irritability, fatigue, nausea, vomiting, and swelling around the eyes. These symptoms are common to many conditions of the upper respiratory tract. They may be seen with allergies, the common cold and RS. The common cold is also referred to as an upper respiratory infection (URI). The common cold is caused by a virus. Your physician will diagnose RS when the above symptoms last more than 10 days or when your child gets worse after an initial period of recovery. This is acute rhinosinusitis, which is caused by a bacterial infection. A bacterial infection is also suspected when symptoms are severe (fever [temperature ≥39°C/102.2°F] and the nasal discharge is purulent (yellow-green) for at least 3 consecutive days.
Young children are more prone to infections of the nose, sinuses, and ears. It is important to distinguish between the frequent viral infections that most children get and rhinosinusitis.
When the lining of the nose and the sinuses become swollen, the passages through which normal sinus mucus drains and the sinus ventilates may become blocked. This allows the sinus to become infected. The swelling may occur as the result of a viral infection or due to inflammation (allergies). If your child has had continuous symptoms for 12 weeks or longer, this condition is called Chronic Rhinosinusitis (CRS)
Often your physician will diagnose RS from your description of the problem. Sometimes a small endoscope will be used to examine your child’s nose (See Nasal Endoscopy). A CT (CAT) scan of the sinuses may be needed to evaluate your child if the symptoms do not improve with medical treatment. The CT scan shows how your child’s sinuses have developed. A CT scan will also reveal if any blockage or structural changes have occurred. Last, a CT scan confirms the diagnosis of sinusitis.
Adenoids are tonsil-like lymphoid tissue located in the back of the nose. If your child has recurrent sinus infections enlargement of adenoid tissue may be the underlying problem. This is likely if your child is a “mouth breather” (unable to breathe through his/her nose) or snores loudly. Other disorders also known to cause RS include allergies, acid reflux, cystic fibrosis, ciliary dyskinesis, and immunodeficiency. Additional tests and referrals may be recommended to rule out one or more of these conditions.
Acute Rhinosinusitis (ARS)
Most children with ARS respond well to antibiotic therapy. Nasal decongestant sprays or nasal saline (saltwater) may also be prescribed for short-term relief of stuffiness. Nasal saline drops, spray, and especially rinses thin secretions and improve mucus clearance. Over-the-counter decongestants, mucolytics, nasal steroid sprays and antihistamines are not recommended for the treatment of ARS. Your child should improve within the first few days of treatment. It is, however, important to complete the whole antibiotic treatment.
Chronic rhinosinusitis (CRS)
A diagnosis of CRS indicates the need for more comprehensive medical and possibly surgical treatment. The particular treatment recommendations will depend on the underlying cause(s) of the chronic inflammation. This also applies to cases of recurrent acute sinusitis. Recurrent acute rhinosinusitis is diagnosed when your child experiences more than four acute bacterial infections per year.
The risk of sinus infections may be decreased by reducing certain exposures. These include known environmental allergens and pollutants such as tobacco smoke. Reducing your child’s time at day care may also be of benefit. If he/she suffers from acid reflux disease, treatment may reduce the risk of sinus infections.
When Is Surgery Necessary For Sinusitis?
Surgery is considered for a small percentage of children with CRS. This is the case if symptoms do not improve despite comprehensive medical therapy. Most commonly, your Otolaryngologist (ENT) may advise removing adenoid tissue. The adenoid tissue does not directly block the sinuses. However, inflammation and enlargement of the adenoid tissue, can interfere with the drainage of mucus. Adenoids can also act as a reservoir for bacteria and viruses. Adenoid enlargement causes many symptoms that are similar to RS. These include stuffy nose, runny nose, post-nasal drip, bad breath and cough.
Sinus surgery may also be recommended to treat your child’s CRS. Your otolaryngologist will open and widen the blocked drainage pathways. Sinus surgery is performed using an endoscope and specialized instruments. Opening the sinuses allows for the mucus to be collected for culture. A culture can identify which bacterial are causing the infection and which antibiotics are best used to treat it. Sinus surgery usually results in a reduction in the number and severity of sinus infections.
With an upper respiratory illness children may experience fever, nasal congestion, nasal discharge, postnasal drip, cough, facial pressure, facial pain, headache, bad breath, irritability, fatigue, nausea, vomiting, and swelling around the eyes. These symptoms are common to many conditions of the upper respiratory tract, including allergies, the common cold and rhinosinusitis. An otolaryngologist can help to identify the cause and treatment strategies to address your children’s symptoms.
Copyright © 2020 by the American Rhinologic Society