Pediatric Sinusitis - Types, Causes, and Treatment

Introduction:

Sinuses comprise hollow spaces in the bones surrounding the nose and these bones are connected to the nose through small, narrow passages or channels. Since the symptoms affect both the nose and the sinuses, sinusitis is also called rhinosinusitis. Pediatric (branch of medicine dealing with children and associated illness) sinusitis can be difficult to distinguish from other conditions like viral illness or allergy. Sinuses in children may develop fully in their teenage.

What Are the Types of Sinusitis?

Different Types of Sinusitis Include:

• Short-Term or Acute: Symptoms of short-term infection last less than 12 weeks and improve with treatment.

• Subacute: Subacute infections do not respond to initial treatment and symptoms last for nearly four to 12 weeks.

• Long-Term Or Chronic: Symptoms of long-term infection extend even after 12 weeks.

• Recurrent Sinusitis: Recurrent sinusitis occurs frequently and may involve a minimum of three or more short-term episodes in a year.

What Are the Different Types of Sinuses?

There are four types of sinuses. These are:

• Ethmoid Sinus: These are honeycomb-shaped and situated around the bridge of the nose and are present at birth. It grows with age.

• Maxillary Sinus: Maxillary sinus is present at birth and is situated around the cheek region. It grows with age.

• Frontal Sinus: Frontal sinus is present in the forehead region and develops around the age of seven.

• Sphenoid Sinus: Sphenoid sinus is positioned deep behind the nose and does not develop until the teenage.

What Is the Difference Between Sinusitis and a Cold?

Sinusitis is common in children in which the nasal lining and the sinuses are inflamed. Viral sinusitis co-occurs with cold. Allergic sinusitis may be a response to allergic conditions such as hay fever (an illness affecting the nose, eyes, and throat due to the pollen from plants). Bacterial sinusitis occurs as a consequence of a cold or allergy in which bacteria are entrapped in the sinuses and is a secondary infection to the cold or allergy.

What Are Sinuses For?

The word sinus comes from the Latin word ‘sinus’ which means a bay or a hollow cavity or a curve. Sinuses serve the following purposes:

• The air entering the nose or the mouth travels through the sinus passages. The sinus manufactures mucus that lines and lubricates the nasal passages and the sinuses.

• The mucus from the sinus cavities drains into the posterior part of the throat and the nasal passages with the help of small hairs called cilia. This mucus moistens the nose and helps to filter bacteria and dust.

• Sinuses enhance voice resonance through air vibration.

• Protects the face during trauma.

• Provides insulation during temperature changes in the nose.

• Aids in immunological defense.

What Are the Causes of Sinusitis in Children?

Children are more susceptible to infections. Various causes of sinusitis are:

• Sinuses that are blocked with the presence of discharge encourage the growth of bacteria which can lead to sinusitis. The bacteria that thrive in the sinuses are Streptococcus pneumonia, Haemophilus influenza, and Moraxella catarrhalis.

• Allergies that cause inflammation of the nasal tissues are associated with increased mucus production.

• Exposure to secondhand smoke and environmental allergens.

• Pets.

• Structural abnormalities of the nose.

• Tooth infection.

• Injury to the nose.

• Foreign objects inside the nose.

• Gastroesophageal reflux disease (GERD - is a digestive disease that irritates the lining of the food pipe as a result of increased gastric secretion).

• Cleft palate (Openings or splits in the lip or the roof of the mouth).

• Compromised immune system.

What Are the Symptoms of Sinusitis in Children?

Common symptoms include:

• A cold that lasts for more than 10-14 days.

• Low or high fever.

• Nasal drainage that is yellowish green and is present continuously for at least three days.

• Post-nasal drip accompanied by sore throat, cough, nausea, vomiting, and bad breath.

• Headache in children who are six years of age or older.

• Swelling around the eyes.

• Irritability.

• Fatigue.

• Stuffy nose with loss of smell.

• Pain over the sinus regions.

• Ear pain and cough.

When the above symptoms are noticed, a physician should be consulted and self-medication should be avoided.

Is Headache a Sign of Sinusitis in Younger Children?

Cold-related headaches in young children usually do not signify sinus infections because the sinuses in the forehead develop only between nine to 12 years of age and are least likely to be infected until early adolescence.

How to Diagnose Sinusitis in Children?

After a complete physical examination and history taking regarding the child’s symptoms, the healthcare professional may advise for the following diagnostic procedures if needed.

• Sinus X-rays.

• Compute tomography (CT) of the sinuses.

• Cultures from the sinuses to check for bacteria or other microorganisms.

What Are the Treatments for Sinusitis in Children?

An ENT (expert in treating diseases of the ear, nose, and throat) or otolaryngologist will ask for the history of symptoms and physically examine the ear, nose, and throat using special instruments. They will also check for any structural abnormalities, allergies, or issues in the immune system. If required, the doctor will suggest appropriate imaging of the sinuses or related structures. Treatment modalities for pediatric sinusitis include:

• Acute Sinusitis: Bacterial sinusitis can be treated by antibiotics. Though the child improves within a week, the complete dose of antibiotic therapy should be completed. Nasal congestion can be relieved by using nasal sprays, nasal saline drops, or over-the-counter decongestants. Over-the-counter decongestants and antihistamines may not be effective in cases of viral upper respiratory tract infections in kids and are not advisable in kids under two years of age. Doctors may prescribe additional medications if sinusitis is due to allergies or give allergy shots to reduce the child’s response to allergens such as mites, pollen, and so on.

• Chronic Sinusitis: If the symptoms of sinusitis persist for more than 12 weeks with four to six or more episodes of acute sinusitis occurring in a year, then it is a case of chronic sinusitis and requires an appointment with the ENT doctor. In children in whom medications have failed, mild surgery might be done to treat severe and chronic sinusitis. Surgery is not usually recommended. Surgery such as the removal of the adenoids (a patch of tissue at the back of the nasal passage which is a part of the immune system) may be performed.

Adenoids themselves do not cause sinusitis but infection of the adenoids (adenoiditis) can cause inflammation resulting in a runny, stuffy nose, post-nasal drip, bad breath, headache, and cough. Other types of surgery include widening the draining pathways of the sinuses. This helps in identifying the specific bacteria causing infection in the child’s sinuses by taking a culture and administering specific antibiotics. It also improves the circulation of air and medications and reduces the severity of infections. Taking fluids such as a glass of water or juice every 1 or 2 hrs can be very helpful in thinning the mucus and increasing their drainage efficiency besides preventing dehydration. Warm compresses can be given on the nose, face, and cheeks to relieve the pain.

How to Prevent Pediatric Sinusitis?

Sinusitis can be prevented by following certain simple measures:

• A room humidifier can be used in dry indoor environments.

• Refrain from smoking in the surroundings of the children.

• Regular immunization schedules must be followed in children.

• Proper hand hygiene should be practiced.

• Children must be avoided getting close to people with symptoms of cold and cough.

• Children must be prevented from getting exposed to allergy-causing agents such as pollen.

• Saline sprays or nose washes should be kept handy and used regularly to keep the nose moist.

• Water should not be forced into the sinuses like jumping into the water.

• Too much time in chlorinated pools should be avoided as chlorine can irritate the nose and sinuses.

• Encouraging a healthy diet with ample fluid intake in children and following physical exercise regularly.

Conclusion:

Sinusitis in children is not the same as in adults. Children can be fussy, irritable, and cranky due to the discomfort caused by sinusitis. Over-the-counter medications and nasal decongestants must not be given to children without the physician’s recommendation. An appointment with the ENT doctor should be made if symptoms persist for long. Simple preventive measures can protect the child from frequent exposure to sinusitis.