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Health Risks: Sinusitis in Children
Sinusitis in children is a relatively common illness. Typical symptoms seen in adults, such as facial tenderness and headaches, are not commonly seen in children with sinusitis. Any child with a cough and runny nose who does not respond to antihistamines and decongestants has a good probability of having a bacterial infection of the paranasal sinuses. Fortunately, with the use of appropriate antibiotics, a high clinical response rate is usually seen. A diagnosis of sinusitis in a child can be made by obtaining a CAT Scan or x-ray to be most sure of the diagnosis. However, practically speaking, a doctor often makes the diagnosis just from physical examination and sometimes by doing a smear of the nasal mucous. X-rays and CAT Scans are required for patients who have recurrent problems with infection or if there is a difficulty in making the diagnosis of a child with recurrent symptoms. Interestingly, sinusitis is often caused by bacteria and, therefore, does respond very well to antibiotics. Any upper respiratory viral cold can often, secondarily, cause a sinus infection. In children, a sinus infection is sometimes associated with reactive airways disease. That is, children may have coughing or wheezing with an upper respiratory infection such as sinusitis. The respiratory condition seems to clear when the sinus infection has been adequately treated. In children who have asthma, it is well known that sinusitis (or other upper respiratory infections) may trigger more asthmatic symptoms. Treating the sinus infection will help decrease the asthma symptoms quicker. It is felt by most allergists that there is an increase incidence of sinus disease among allergic children. The obvious explanation for this is that the swelling of the nasal tissue from allergies reduces the potential sinus drainage making it easier for the sinuses to get infected. Some children may have subtle immunodeficiencies such as an IgA deficiency which may lead them to more episodes of sinusitis than can be expected based on their physical examination. Sinusitis is also seen frequently in patients with cystic fibrosis.
Therapy with antibiotics has yielded good results. Clinical cure after 10 days of therapy is often not achieved, however. Sometimes the patient may need antibiotics for two and sometimes as long as 4-6 weeks to treat the sinus infection adequately to prevent its recurrence. There are many classes of antibiotics that can treat sinusitis equally well. Your doctor will make the final decision as to which antibiotic is used and for how long based on published evidence concerning the frequency of certain types of bacteria in the sinuses. Occasionally an actual sinus culture will be done, but it is only reliable when done with an actual sinus puncture by an ear, nose and throat physician.
Since sinusitis is an infection, it is very difficult to know exactly how to prevent this from occurring. For a small child, it would be ideal for the child during the day to be with a parent or a small number of other children. Exposure to viruses and bacteria in day care centers are very high due to the number of children that are in these centers. Appropriate allergy treatment with medications and, in some cases, allergy shots are helpful at reducing the incidence of sinusitis, but not helpful at reducing the chances of a viral upper respiratory infection such as the common cold.
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