Sinusitis is a general term that indicates inflammation in the sinuses. This can be due to an infection (acute sinusitis or a sinus infection) or due to long standing inflammation in the sinuses (chronic sinusitis) from allergies, poor drainage of the sinuses, or other underlying medical conditions. Sinus infections develop, in part, because the drainage pathways of the sinuses are narrow and can become obstructed easily if there is swelling of the tissue in the drainage system.
Acute sinusitis can be caused by a viral infection, a bacterial infection or a fungal infection. Symptoms of a sinus infection include nasal congestion, drainage from the nose, cough, postnasal drip, headache and facial pain, and are very similar to symptoms of a common cold. Sometimes, the adenoids can be infected. This condition is called “adenoiditis” and can also mimic a sinus infection. Often, we do not consider an illness to be a sinus infection unless the symptoms have been present for more than ten days. Most sinus infections are caused by common bacteria, but in people who have other medical problems, there can be unusual causes.
Chronic sinusitis is defined as inflammation in the sinuses that lasts three months or longer. There may be infectious organisms present, but many of the symptoms are due to the inflammation. Symptoms may be similar to those of acute sinusitis, but last much longer.
The sinuses humidify air circulating through the nasal cavity. They also produce mucous, which is has important antibacterial properties and acts as a filtration system for infectious agents and other environmental irritants. Each sinus has a specific ostium, or opening, through which mucous drains. We also believe that the sinuses help to make the head lighter and contribute to the resonance of the voice, which contributes to the way the voice sounds.
Pediatric sinusitis is a commonly encountered by primary care physicians and ENT specialists. Symptoms include nasal congestion, discolored nasal drainage, runny nose, bad breath, cough, and facial pain or pressure. Upper respiratory viral infections and allergy symptoms can mimic sinusitis; however, there are some distinguishing characteristics. Usually we do not diagnose a sinus infection unless symptoms have been present for at least ten days. Symptoms of chronic sinusitis are similar but may be less severe and longer lasting than those of a sinus infection.
Diagnosis of pediatric sinusitis may be difficult as the sinuses are not structures directly visualized. On physical exam, thick, discolored (brown or green) nasal drainage may be noted. Often sinusitis is diagnosed based on symptoms and exam findings. If you are at the Ear, Nose, and Throat office, a flexible nasopharyngoscopy might be performed to better see the drainage pathways of the sinuses or to look for other sources of infection. Because we cannot see into the sinuses directly, a CT scan might be recommended to get a picture of what is going on in the sinuses. Usually we do not recommend a CT scan unless the sinus infection is not improving normally as it should or if there are signs that structures close to the sinuses (like the eye or the brain) are becoming infected.
For symptoms that are going on for less than ten days, we usually do not recommend treatment with antibiotics. It is helpful to rinse the nose with an over-the-counter nasal saline (salt water) spray or rinse. This will wash out the excess mucous and irritants from the nose and can sometimes prevent a cold from turning into a sinus infection. Once a sinus infection (acute sinusitis) has been diagnosed, your doctor or ENT may prescribe antibiotics to treat it. Your doctor may recommend other medications like oral or nasal steroid sprays or nasal decongestants, but it is important to carefully follow the directions when administering these medications as unwanted side effects can be encountered if they are not used properly.
In chronic sinusitis, nasal saline sprays or rinses are still very helpful and are usually recommended. Nasal steroid sprays may be recommended to reduce inflammation and improve sinus drainage. Allergy medications like antihistamines or other medications may be recommended if it is suspected that allergies are a contributing to the sinus inflammation. Sometimes your doctor may prescribe a long-term course of antibiotics (21 days worth) to try to treat an infection that is not responding to a shorter course of treatment.
In patients that are unresponsive to treatment or have frequent episodes of sinusitis and adenoiditis, your doctor may recommend a CT scan or other type of imaging study. A flexible nasal endoscopy or nasopharyngoscopy provides valuable information in the evaluation of nasal issues and to see if there are structural reasons for poor sinus drainage. For patients that have failed medical treatment for sinusitis or adenoiditis, surgery may be an option.
Surgery may be recommended for sinus infections or chronic sinusitis that have failed medical treatment. In younger children, the adenoids are often a contributing factor to sinus infections or are becoming infected themselves (“adenoiditis”). In these situations, removal of the adenoids (adenoidectomy) may be recommended. This procedure will often help prevent additional infections.
Endoscopic sinus surgery is a procedure done for chronic sinusitis or for acute sinus infections that have progressed to involve the orbit or eye or the structures around the brain. The basic principle is to relieve obstruction at the natural openings of the sinuses to allow for more effective drainage. In addition, diseased tissue and polyps are removed. This procedure can be combined with adenoid removal or with correction of structural problems in the sinuses that contribute to poor drainage. Risks of endoscopic sinus surgery include damage to the eye or the muscles or structures around the eye, damage to the skull with leakage of brain fluid (CSF), and scarring within the nasal cavity. We avoid surgery in the setting of an acute infection unless the infection is worsening and spreading to other structures. Aggressive surgery is not warranted in children and typically a limited sinus surgery is all that is necessary. Even after surgery is performed, your child may need to continue allergy medications, nasal sprays or other medications. Topical antibiotics may be more effective in patients that have undergone endoscopic sinus surgery
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