Sinusitis: A-to-Z Guide from Diagnosis to Treatment to Prevention

Introduction to sinusitis:

That runny nose and cough just won’t go away… Perhaps your child has a sinus infection. Sinusitis is a common problem in children. Nevertheless, it is often over-diagnosed in children with green runny noses, and missed in children who really have a sinus infection!

What is sinusitis?

The sinuses are small empty caverns in the bony skull. They are lined by mucus membranes and connect with the nasal passages. Some sinuses are present at birth; others continue to grow and develop for the first 20 years of life.

Sinusitis is the name given when the lining of one or more of these sinuses is red, swollen, and tender, the opening is blocked, and the sinus is at least partially filled with fluid (mucus and/or pus).

Technically, every cold is also a case of viral sinusitis. However, when doctors use the term they are usually referring to a bacterial infection in the sinuses.

Acute bacterial sinusitis has been present for less than three or four weeks; subacute bacterial sinusitis has been present for up to about ten weeks; and chronic bacterial sinusitis has been present for about ten weeks or more. The three may have different causes and treatments.

Who gets it?

Anyone can get a sinus infection. Colds or nasal allergies are usually present first. Sinus infections are also more common when there is exposure to cigarette smoke.

Children who have ear infections, GE reflux, cystic fibrosis, immune problems, deviated nasal septa, or poorly functioning cilia are more likely to develop sinus infections. Asthma and sinus infections often go together.

In addition, swimming, breathing cold dry air, or attending day care can predispose a child to sinusitis.

Boys get more sinus infections than girls.

What are the symptoms?

Adults and adolescents with sinusitis will often have headaches or facial tenderness to make the diagnosis clear. These are much less common in younger children. Instead, the symptoms are usually similar to a prolonged cold.

The common cold usually lasts about seven days. Within one to three days of the onset, the nasal secretions usually become thicker and perhaps yellow or green. This is a normal part of the common cold and not a reason for antibiotics.

If a child has both a cough and nasal discharge that do not improve within 10 to 14 days, this may be acute bacterial sinusitis. The nasal discharge may be clear or colored. The cough is present during the day, but is often worse during naps or at bedtime.

There may be a fever, sore throat from post-nasal drip, or bad breath. About half of the children also have ear infections (caused by the same bacteria).

Occasionally a child with severe acute bacterial sinusitis will have a headache, colored nasal discharge, high fever, and facial tenderness well before the normal 10 days typically used to diagnose sinusitis.

In subacute and chronic sinusitis, the symptoms are often minimal, but include the ongoing cough and nasal discharge.

Is sinusitis contagious?

In general, sinus infections are not contagious (although there have been rare outbreaks associated with swimming together). The colds that can lead to sinus infections are quite contagious.

How long does sinusitis last?

Sinus infections often last for weeks or months without treatment.

How is sinusitis diagnosed?

The diagnosis is often made based on the history and physical examination. Sometimes x-rays or CT scans are used to support the diagnosis.

How is sinusitis treated?

Acute and subacute bacterial sinusitis is usually best treated with appropriate antibiotics at an appropriate dose for the appropriate amount of time (usually 14-21 days). The antibiotics are usually continued for at least 7 days after symptoms disappear. If symptoms worsen or do not improve, the antibiotic is usually changed early in the course.

Saline nose drops may thin the mucus and speed healing. Decongestants may help symptoms, but usually do not speed healing. Antihistamines may thicken the mucus and slow healing.

Chronic sinusitis treatment usually lasts three weeks or more. For this reason, it is wise to obtain a culture of the infected material before treatment. Sometimes the infection is caused by fungus rather than bacteria.

Most children with chronic sinusitis (and to a lesser extent, subacute sinusitis) either have allergies or an ongoing irritant exposure, such as smoke or fumes. These should be identified and addressed.

How can sinusitis be prevented?

Breastfeeding lowers the risk of sinus infections.

Preventing sinus infections is possible. It involves the same proven measures outlined for preventing colds and ear infections.

In addition, changing swimming habits may be helpful for older children (avoiding jumping, diving, or swimming underwater – unless holding the nose or using nose plugs).

Immunizations, especially to pneumococcus, Haemophilus influenzae (Hib), measles, and the flu, are particularly important for children prone to sinus infections.

Finally, identifying and properly addressing allergies and irritants is the key to reducing the frequency, duration, and severity of sinusitis.