Sinusitis and Sinus Surgery in Children

pediatric sinusitis

Sinus disease in children is different than sinusitis in adults. As with adults, sinusitis in children occurs when the tissue lining of the sinus cavities becomes swollen and inflamed. However, a child’s sinuses are not fully developed until the later teen years, and symptoms as well as underlying causes can vary greatly.

Symptoms of Sinusitis in Children

Children suffering from sinusitis may experience one or more of the following symptoms.

  • Cough
  • Sore throat
  • Bad breathe
  • Stuffy nose
  • Runny nose
  • Fever
  • Swelling around the eyes
  • Irritability
  • Cold-like symptoms
  • Nausea
  • Headache (in older children)
  • Fatigue
  • Thick yellow or green drainage

nasal airway obstruction due to chronic sinusitisCauses of Sinusitis in Children

  • Viral infections: Young children are more likely to develop infections of the sinuses, nose and ears following viral infections.
  • Allergic Rhinitis: Allergies can cause inflammation of the nasal passages preventing proper drainage and leading to sinusitis.
  • Gastroesophageal Reflux (GERD): Due to a unified airway, the irritation of reflux can result in inflammation and swelling of the nasal passages. Please see GERD image below.
  • Nasal Airway Obstructions: Obstructions such as a deviated septum or nasal polyps (growths) can prevent drainage from the sinus cavities.

Diagnosis of Sinusitis in Children

It can be difficult to diagnose sinusitis in children, especially younger children. Often similar symptoms can be caused by other illnesses and allergies. However, a thorough examination by an ear, nose and throat specialist (otolaryngologist) will usually lead to the correct diagnosis. In addition to a nasal exam and evaluation of symptoms, CT (computerized tomography) scans can be extremely helpful in diagnosing sinusitis in children. CT scans can show how developed the child’s sinuses are and where the blockages may be located. Seven-second scans can be performed successfully on children as young as 3 years old, and radiation levels are much less than with traditional CT scans of the sinuses. Factors such as medical history and problems with the immune system will also be evaluated.

Treatment of Acute and Chronic Sinusitis in Children

  • Treatment will vary depending on the severity of symptoms, the cause, and the child’s age. Treatment of allergic disease is critical in most children with recurrent sinusitis.
  • Antibiotics: Antibiotics typically work well for acute sinusitis and are used when the cause is a bacterial infection.
  • Saline drops or sprays: Saline moistens the nasal passages and helps to thin mucous.
  • Decongestants: Over-the-counter and prescription decongestants are used reduce the amount of mucous. Due to rebound congestion, these medications can only be used for a few days.
  • Antihistamines: When allergies are the underlying cause, antihistamines help control the reactions that lead to sinusitis.

With acute sinusitis, most children respond well to antibiotics, and symptoms typically improve in the first few days of treatment. When symptoms persist for at least 12 weeks, it is considered to be chronic sinusitis.  Recurrent episodes of acute sinusitis (4 to 6 per year) or chronic sinusitis may require more aggressive treatments such as sinus surgery.

Sinus Surgery for Children

When a child fails to respond to other medical therapies for allergies and sinus infections, sinus surgery may be considered. In the past, adenoids were removed (in a procedure known as adenoidectomy) prior to sinus surgery. Now, with Balloon Sinuplasty under anesthesia, the maxillary sinuses can be safely dilated without the removal of tissue, and irrigated to rinse out any infection. Because no tissue is removed, scarring is minimal to none, but the dilated opening stays dilated due to tiny fractures in the thin bone surrounding the sinus opening. This procedure is often done in conjunction with adenoidectomy and improves the success rate without increasing postoperative pain or recovery time.

 

ear-nose-throat-and-sinusGerd and Sinusitis