Sinusitis

What is it?

The sinuses are empty spaces in the bones that form the head and face. Adults have sinuses behind the cheek bones, in the forehead above the eyes, and behind the nose. Sinuses grow larger as a child gets older. Newborn babies have very small sinuses, and none at all above the eyes. As the child grows, the face gets larger faster than the rest of the head. Much of this new space is filled with the newly enlarging sinuses. Sinuses connect with the nose and throat through tiny tubes. They are lined with the same kind of mucous membranes as the nose. This means that anything that causes irritation or swelling of tissue in the nose will also cause swelling in the sinuses. If the tubes leading to the sinuses swell closed, pressure in the sinuses can’t balance itself with the outside air. Fluid then builds up in the sinus. If the fluid becomes infected, the body sends white blood cells from the blood to fight the infection. "Sinusitis" is the term doctors use for an inflamed and infected sinus. Without treatment, sinusitis can become a very severe bacterial illness, so it is important to catch it early and treat it.

The two main concerns in sinusitis are controlling the pain and congestion, and killing the bacterial germs that cause the infection. Untreated, the infection can spread to the other sinuses. Doctors use the term "pan-sinusitis" for the condition in which most or all of the sinuses are infected. This can be very dangerous, because some of the sinuses are only millimeters away from the brain. If pus under pressure breaks through the thin bone, it can enter the brain space itself. This produces meningitis, an infection of the brain and its coverings.

In most cases, sinusitis is fairly mild and most doctors do not order X-rays or special tests. If there’s concern about severity, your doctor may order a CT or MRI scan of the sinuses. Doctors can treat most children with sinusitis at home with pain relievers, decongestants, and antibiotics. More severe cases of sinusitis may require IV antibiotic treatment.

It’s important to follow all of your doctor’s directions to be sure you treat the sinusitis completely. Because the sinuses are closed space, it’s difficult to drain them completely and to get the antibiotic from the bloodstream into the sinus at high levels. Decongestants can help to open the blocked passages and to reduce the secretion of mucous, but they can also thicken the mucous and make it harder to clear out. Your doctor will try to balance these pros and cons when s/he decides whether to use decongestants. It’s likely that your doctor will choose some or all of the following kinds of medications:

• An oral antibiotic to kill the germs. Many experts now believe that treating sinusitis for as little as 7 – 10 days is adequate in most cases. Doctors used to treat for longer, but long treatment can cause germs to become resistant to antibiotics, and can be hard for patients to follow. Whatever period of time your doctor chooses, please be sure to finish the entire prescription. If you feel it is too long for your child, by all means discuss it with your doctor. Most doctors will be happy to compromise, but it’s important to make that decision as a team. Please read our Aftercare Instructions on giving Oral Medications.
• A short-acting nasal spray like oxymetazoline (Afrin® and many others). This can help open the drainage passages over the first few days. Please do not use this product for more than three days. It can cause more swelling with longer use.
• A long-acting nasal steroid spray like fluticasone (Flonase® and others) or beclomethasone (Vancenase®, Beconase® and others). These do not give any immediate relief. Over several days the tiny amount of steroid reduces the swelling in the nasal passages. Many doctors feel that using the short-acting spray 5 -10 minutes before the steroid spray for the first three days helps the steroid reach its target. Please read our Aftercare Instructions on giving Inhaled Medications.

The goal of this combination of medicines is to kill the germs that cause the sinusitis while allowing the infected material to drain more freely from the sinus. You can help this process by encouraging long hot showers and using warm compresses to the forehead or cheeks. You can run a humidifier in your child’s room at night. It’s good to encourage your child not to blow his or her nose really hard. This can push the infected material back in towards the sinus. As with most infections, it is good to keep well hydrated by drinking lots of fluids.

Most children and teens with sinusitis get better fairly quickly on medication. In some cases, the sinusitis gets worse despite treatment, or other conditions might be present. Here are some things to look out for:

• Worsening headache or sinus pain for more than 24 hours after starting treatment.
• Spreading redness or swelling of the face
• Vision problems or eye pain
• Stiff neck
• Changes in level of consciousness: too sleepy, agitated or disoriented
• Bleeding from the nose
• Fever that lasts more than 3 days after starting treatment, or fever that comes back after it’s been gone for 24 hours straight
• Any symptoms that are still present at the end of the course of treatment

Most people with sinusitis have bad breath. This is not a sign of poor hygiene, and it won’t go away no matter how much your child brushes or uses mouthwash. It will clear up as the sinusitis improves. If your teen is self-conscious about it, you might suggest that s/he mention the sinus infection to people that s/he will have close contact with. Using the excuse that "I have an infection" is usually a good way to get people to keep their distance!

Sinusitis is especially painful to people who experience changes in air pressure. This makes flying in an airplane something to be avoided if possible. It isn’t dangerous, but most people who have flown with sinusitis would prefer never to do it again. Airlines will often allow a change in ticketing with a physician’s note explaining the reason for the change. You may want to ask your doctor about this if you have a flight planned soon. If there’s no way to change the trip, you can give your child a long-acting over-the-counter oral decongestant half an hour before boarding the flight. Have your child use the short-acting nasal spray once on board before takeoff, and again when the flight crew announces the descent for landing.

Serious facial infections can begin as sinusitis, or they can cause it. You can read about these in our Aftercare Instructions on Cellulitis. People with diabetes are especially prone to serious sinus infections with unusual germs and fungi. If the doctor treating your child is unfamiliar with him or her, and s/he has diabetes, please be sure to mention that. Younger children with objects stuck in their noses can develop a nasty yellow or green discharge and very bad breath. Sometimes this looks a bit like sinusitis. If your younger child doesn’t get better on the treatment, you might want to ask your doctor to take another look in the nose.

Having a sick child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are sick are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your child’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.