If your child has a cold or flu with a green or yellow nasal discharge that lasts for more than a week, a sinus infection may be the problem.
A sinus infection is a bacterial disease of the hollow cavities at the front of the face behind the nose and eyes. In adults, common symptoms include headache, facial pain or pressure and postnasal drainage. Children with sinusitis, however, often don’t exhibit the same signs. Occasionally, sinus infections clear up on their own. However, antibiotics are usually required.
With the advent of CAT scans, which can provide strikingly clear pictures of the sinus cavities, physicians have discovered that sinus infections in children are much more common than once thought. Otolaryngologists who treat pediatric ear infections have discovered that more than half of children with ear infections severe enough to warrant insertion of drainage tubes will also have a serious sinus infection.
Diagnosing Sinus Disease in Children
If a child has had a yellow or green nasal discharge for more than a week, the physician first may ask questions to try to determine whether a single, persistent infection is at work or whether the child has had a series of back-to-back new infections. The physician may ask about the child’s day-care setting and a number of siblings as indicators to how frequently the child is exposed to new bugs. The doctor will also be curious about the child’s overall health, including allergies. He or she may peer up the child’s nostrils to look for signs of structural abnormalities or, especially in a very young child, foreign objects such as beans or small toys.
Some children who have sinus disease have little discharge from the nose. In fact, a cough may be the only sign of sinus disease in many children. In such children, only careful examination of the upper airway will reveal pus in the nasal or postnasal drainage. Persistent daytime or nighttime coughing, with or without a history of wheezing, in a child with no sign of bronchial infection should alert the examining physician that sinusitis is the likely culprit.
Enlarged adenoids can produce enough nasal obstruction to block drainage from the sinuses and lead to sinus infection. This is particularly common among four to six-year-olds, in whom adenoids already are the largest they ever will be in relation to the space that houses them.
X-Rays and CAT Scans
Given the difficulty of diagnosing sinus disease in children, imaging techniques can be particularly helpful. Research shows that CAT scans are markedly superior to plain x-rays in diagnosing sinus disease. But this fact must be weighed against the increased costs and radiation of a CAT scan, the need to sedate some children in order to perform a CAT scan and the general aversion to exposing children to x-rays of any sort.
Neither x-rays nor CAT scans are necessary if a child has four or fewer episodes of acute sinusitis each year and the diagnosis seems clear. However, if a child has more frequent episodes or if chronic sinus disease is suspected, a scan or x-ray is appropriate. In communities where CAT scanning is available at a reasonable cost-and if the child is cooperative enough to lay still during the tedious (but painless) scan-a CAT scan may be preferred. Usually, sinus x-rays are the first choice despite their lesser accuracy.
Outgrowing Sinus Disease Vulnerability
Although the natural history of sinus disease in childhood isn’t well known, certain facts seem evident. There is a marked reduction in the frequency of sinus disease from childhood to adolescence. This suggests that sinuses are less vulnerable to infection when they are larger. But how to predict which children will outgrow the problem and which won’t remains an open question.
Treatment with Antibiotics
When a sinus infection is confirmed or strongly suspected, the physician must decide whether to intervene with antibiotics based on the child’s past medical history as well as the “art” of medicine, because many of these infections may clear up spontaneously. When an antibiotic appears warranted, a broad-spectrum antibiotic is probably best. An initial treatment period of ten to 14 days is common. For suspected chronic sinus disease, a minimum of three weeks of therapy is recommended.
Surgical enlargement of the sinus outflow tracts to relieve chronic or recurrent sinusitis in carefully selected adult patients is now commonplace, but its role in childhood sinusitis remains controversial. There is a reluctance to operate on children due to: the many effective antibiotics available, the tendency of childhood sinusitis to clear up on its own as children age, the technical difficulties in operating on such small structures, the general anesthesia required and the unknown long-term effects of such surgery on facial growth and development. However, some surgeons enthusiastically endorse sinus surgery for children with proven sinus disease who have failed multiple courses of antibiotics over two to three months. Researchers haven’t yet studied whether removing enlarged adenoids prevents sinus disease, although adenoidectomy has apparently been successful in improving chronic ear infections.
If a child has more than four bouts with sinus disease in a year, a consultation with a pediatric allergist or an otolaryngologist experienced in treating pediatric sinus disease is in order. These physicians are best trained to make the most cost-effective decisions for diagnosis and long-term management of the child with suspected recurrent or chronic sinus disease.