Sinusitis, Child

Sinusitis is redness, soreness, and swelling (inflammation) of the paranasal sinuses. Paranasal sinuses are air pockets within the bones of the face (beneath the eyes, the middle of the forehead, and above the eyes). These sinuses do not fully develop until adolescence, but can still become infected. In healthy paranasal sinuses, mucus is able to drain out, and air is able to circulate through them by way of the nose. However, when the paranasal sinuses are inflamed, mucus and air can become trapped. This can allow bacteria and other germs to grow and cause infection.

ExitCare ImageSinusitis can develop quickly and last only a short time (acute) or continue over a long period (chronic). Sinusitis that lasts for more than 12 weeks is considered chronic.

CAUSES

  • Allergies.  

  • Colds.  

  • Secondhand smoke.  

  • Changes in pressure.  

  • An upper respiratory infection.  

  • Structural abnormalities, such as displacement of the cartilage that separates your child's nostrils (deviated septum), which can decrease the air flow through the nose and sinuses and affect sinus drainage.  

  • Functional abnormalities, such as when the small hairs (cilia) that line the sinuses and help remove mucus do not work properly or are not present.

SYMPTOMS

  • Face pain.

  • Upper toothache.  

  • Earache.  

  • Bad breath.  

  • Decreased sense of smell and taste.  

  • A cough that worsens when lying flat.  

  • Feeling tired (fatigue).  

  • Fever.  

  • Swelling around the eyes.  

  • Thick drainage from the nose, which often is green and may contain pus (purulent).  

  • Swelling and warmth over the affected sinuses.  

  • Cold symptoms, such as a cough and congestion, that get worse after 7 days or do not go away in 10 days.

While it is common for adults with sinusitis to complain of a headache, children younger than 6 usually do not have sinus-related headaches. The sinuses in the forehead (frontal sinuses) where headaches can occur are poorly developed in early childhood.

DIAGNOSIS

Your child's caregiver will perform a physical exam. During the exam, the caregiver may:

  • Look in your child's nose for signs of abnormal growths in the nostrils (nasal polyps).  

  • Tap over the face to check for signs of infection.  

  • View the openings of your child's sinuses (endoscopy) with a special imaging device that has a light attached (endoscope). The endoscope is inserted into the nostril.

If the caregiver suspects that your child has chronic sinusitis, one or more of the following tests may be recommended:

  • Allergy tests.  

  • Nasal culture. A sample of mucus is taken from your child's nose and screened for bacteria.  

  • Nasal cytology. A sample of mucus is taken from your child's nose and examined to determine if the sinusitis is related to an allergy.

TREATMENT

Most cases of acute sinusitis are related to a viral infection and will resolve on their own. Sometimes medicines are prescribed to help relieve symptoms (pain medicine, decongestants, nasal steroid sprays, or saline sprays).

However, for sinusitis related to a bacterial infection, your child's caregiver will prescribe antibiotic medicines. These are medicines that will help kill the bacteria causing the infection.

Rarely, sinusitis is caused by a fungal infection. In these cases, your child's caregiver will prescribe antifungal medicine.

For some cases of chronic sinusitis, surgery is needed. Generally, these are cases in which sinusitis recurs several times per year, despite other treatments.

HOME CARE INSTRUCTIONS

  • Have your child rest.  

  • Have your child drink enough fluid to keep his or her urine clear or pale yellow. Water helps thin the mucus so the sinuses can drain more easily.  

  • Have your child sit in a bathroom with the shower running for 10 minutes, 3–4 times a day, or as directed by your caregiver. Or have a humidifier in your child's room. The steam from the shower or humidifier will help lessen congestion.

  • Apply a warm, moist washcloth to your child's face 3–4 times a day, or as directed by your caregiver.

  • Your child should sleep with the head elevated, if possible.   

  • Only give your child over-the-counter or prescription medicines for pain, fever, or discomfort as directed the caregiver. Do not give aspirin to children.

  • Give your child antibiotic medicine as directed. Make sure your child finishes it even if he or she starts to feel better.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your child has increasing pain or severe headaches.  

  • Your child has nausea, vomiting, or drowsiness.  

  • Your child has swelling around the face.  

  • Your child has vision problems.  

  • Your child has a stiff neck.  

  • Your child has a seizure.  

  • Your child who is younger than 3 months develops a fever.  

  • Your child who is older than 3 months has a fever for more than 2–3 days.

MAKE SURE YOU

  • Understand these instructions.

  • Will watch your child's condition.

  • Will get help right away if your child is not doing well or gets worse.