Introduction
When the nose and sinuses get swollen, it’s called rhinosinusitis. Symptoms can include fever, stuffy nose, runny nose (clear, yellow, or green), dripping in the back of the throat, cough, pressure in the face, headache, bad breath, feeling cranky, tiredness, throwing up, and puffiness around the eyes. These symptoms are common in many upper respiratory tract conditions, like allergies, the common cold, and sinusitis. The common cold, also known as an upper respiratory infection (URI), is caused by a virus. Your doctor will say you have sinusitis when these symptoms last more than 10 days or if your child gets worse after starting to feel better. This is called acute rhinosinusitis, and it’s caused by a bacterial infection. A bacterial infection is also suspected when symptoms are severe (fever over 39°C/102.2°F and the runny nose is thick and yellow-green for at least 3 days in a row).
Young kids often get infections in the nose, sinuses, and ears more often. It’s important to tell the difference between the common viral infections most kids get and sinusitis.
When the lining inside the nose and sinuses gets swollen, it can block the passages where normal sinus mucus drains and the sinuses ventilate. This can lead to a sinus infection. Swelling can happen because of a viral infection or inflammation (from allergies). If your child has had ongoing symptoms for 12 weeks or more, it’s called Chronic Rhinosinusitis (CRS).
Usually, your doctor can diagnose sinusitis based on what you tell them. Sometimes, they might use a small tool called an endoscope to look inside your child’s nose. If symptoms don’t get better with medicine, your child might need a CT scan of the sinuses to see what’s going on. The CT scan shows how your child’s sinuses are doing and if there are any blockages or changes. Finally, a CT scan confirms the diagnosis of sinusitis.
Adenoids are like tonsils and are found in the back of the nose. If your child keeps getting sinus infections, enlarged adenoids might be the problem. This could be likely if your child breathes through their mouth a lot or snores loudly. Other things that can cause sinusitis include allergies, acid reflux, cystic fibrosis, ciliary dyskinesis, and immunodeficiency. Your doctor might recommend more tests or refer you to other specialists to check for these conditions.
Treatment
Acute Rhinosinusitis (ARS)
Most kids with acute sinusitis do well with antibiotics. Sometimes, doctors might also suggest nasal decongestant sprays or saline (saltwater) to help with stuffiness. Saline drops, sprays, and rinses can thin mucus and help clear it out. Over-the-counter decongestants, mucolytics, nasal steroid sprays, and antihistamines aren’t usually recommended for treating acute sinusitis. Your child should start feeling better in the first few days of treatment. It’s important to finish the whole course of antibiotics, even if your child seems better before it’s done.
Chronic rhinosinusitis (CRS)
A diagnosis of CRS means that your child might need more thorough medical treatment, and sometimes surgery might be needed too. The specific treatment suggestions will depend on what’s causing the ongoing inflammation. This is also true for cases of recurrent acute sinusitis. Recurrent acute rhinosinusitis is diagnosed when your child has more than four bacterial infections in the sinuses in one year.
Prevention
To lower the risk of sinus infections, it’s important to reduce exposure to certain things. This means avoiding allergens in the environment and pollutants like tobacco smoke. Also, reducing the time spent at day care might help if possible. If your child has acid reflux disease, getting treatment for it can also lower the risk of sinus infections.
When Is Surgery Necessary For Sinusitis?
Surgery is an option for a small number of children with CRS if their symptoms don’t improve even with thorough medical treatment. Often, the ENT doctor might suggest removing adenoid tissue. Even though adenoids don’t directly block the sinuses, when they get swollen and inflamed, they can disrupt mucus drainage. Adenoids can also hold onto bacteria and viruses, causing symptoms similar to sinusitis, like stuffy or runny nose, post-nasal drip, bad breath, and cough.
Sometimes, sinus surgery might be recommended to treat your child’s CRS. During this surgery, the ENT doctor opens and widens the blocked drainage pathways in the sinuses. They use an endoscope and special tools for this. Opening the sinuses allows the mucus to be collected for testing. By doing a culture, the doctor can figure out which bacteria are causing the infection and which antibiotics will work best to treat it. Sinus surgery often leads to fewer and less severe sinus infections.
Summary
When kids have a cold or other respiratory illness, they might have symptoms like fever, stuffy or runny nose, cough, headache, face pain, tiredness, feeling sick, or puffiness around the eyes. These symptoms are common for allergies, the common cold, and rhinosinusitis. An ENT doctor can help figure out what’s causing these symptoms and suggest treatments to help your child feel better