Sinusitis in children

What is sinusitis in children?

The sinuses are a number of air spaces found in the skull bones around the face. They normally connect up with the nasal passages, so any fluid that accumulates in the sinus can easily drain out.

These spaces, such as the maxillary sinuses (bubbly spaces in the skull bones behind the cheeks) and the ethmoid sinuses (between the eyes) are present from birth but not fully formed until a child reaches about 20.

In particular the channels that connect to the nasal passages are initially narrow and easily become blocked when the lining of the channel swells up, for example during a cold or respiratory virus infection. With immature and less effective immune systems, children are very vulnerable to such upper respiratory tract infections (throat, ears and nose). Then, once the sinus isn’t draining properly bacterial infection can easily set in.

Symptoms

As the sinuses are small, and children are less reliable in explaining what's wrong with them, sinusitis can be difficult to diagnose in this age group.

One of the strongest clues is a feverish cold that has persisted for well over a week while other symptoms have developed, including:

• Production of thick green/yellow mucus (most colds start clear)
• General moans and groans of being poorly, irritable and tired
• A post-nasal drip, where phlegm goes down the throat causing a sore throat, bad breath and vomiting
• Facial pain
• Swelling around the eyes
• Intense headache in older children

Treatment and recovery

It's unlikely that children will need an operation for sinusitis. Antibiotics are necessary to treat the bacterial infection, along with decongestants which calm the inflamed and swollen nasal membranes, helping the passages to open and the sinuses to drain again. Together these treatments help the child feel more comfortable.

Sometimes nose drops are used to thin and expel the secretions, but children often object strongly to these and many parents give up.

Surgery is usually only needed when the sinusitis becomes chronic, with symptoms persisting for months despite courses of antibiotics, or when there are frequent episodes (at least six a year) that interrupt the child's life and schooling.

The operation involves widening the drainage holes in the sinuses, so infection is less likely to be trapped. The surgeon may suggest removing the child's adenoids at the same time as these can cause similar symptoms.