Sinusitis

Dr. Parang Mehta, MD.

A cold is the most common illness in children, and most colds resolve on their own. However, a few children with what seems to be a typical cold just don't get better, and one of the reasons is sinusitis. What is sinusitis, and why is it such a big problem?

An unusually severe cold, or one that lasts very long, could be sinusitis. It can be dangerous and needs specific treatment

The sinuses are paired air filled cavities inside the bones of the skull. They are lined with mucus membranes, and communicate with the nasal cavity via ostia. When these ostia get blocked, the sinuses get infected. A short term infection is called acute sinusitis; when the infection goes on over 90 days, it is called chronic sinusitis.

Most cases of acute sinusitis follow viral colds. Sinusitis occurs after about one to two percent of colds. Sinusitis is a bacterial infection, mostly. The common causes are Streptococcus pneumoniae, Moraxella catarrhalis, and Hemophilus influenzae.

Signs and Symptoms

In general, acute sinusitis is characterised as a cold that lasts longer than normal, or is more severe than usual. With a usual viral cold, the fever usually subsides in 2-3 days, and the child starts feeling well. The cold and cough often persist for 2-3 weeks.

A cold that gets worse over time, or has high fever and other problems, is indicative of sinusitis. Indicators of sinusitis:

Diagnosing Sinusitis

The diagnosis of sinusitis is based on the history and clinical examination, followed by some laboratory and radiological investigations.

The definitive diagnosis of sinusitis needs the obtaining of infected material from the sinuses. In a procedure known as antral puncture, a thick needle is introduced into the sinus, the fluid sucked out, and tested for the presence of bacteria. However, this is painful and invasive, and is rarely done now.

X-rays of the sinuses can be helpful -- they show thickening of the lining of the sinuses in sinusitis. Sometimes, the sinuses are completely opaque because of pus.

CT Scans and MRI scans are very useful investigations. They not only diagnose sinusitis, but also give information on the anatomy and abnormalities in each patient.

However, the diagnosis of sinusitis is difficult even after the availability of this sophisticated technology. The problem is that many children without sinusitis also have abnormal pictures on X-rays and scans.

Treatment of Sinusitis

Acute sinusitis is relatively easy to treat, with antibiotics and some accessory drugs. The treatment of chronic sinusitis is often a long drawn out affair, with drugs, endoscopy, and surgery being used.

Although many cases of acute sinusitis do recover without antibiotics, it is recommended to treat sinusitis with antibiotics. Cure rates with antibiotics are much higher than without.

Other drugs are usually required. Fever medicines are needed for the first few days of treatment, to keep the fever down. Decongestants have a doubtful role in the treatment of sinusitis, but may add to the child's comfort. Antihistamines and steroids do not seem to help.

On appropriate treatment, most children with sinusitis will recover in 2-3 days. However, the treatment must be continued for 5-7 days after clinical recovery, to ensure complete cure of the infection.

Complications of Sinusitis

The complications possible with sinusitis make it a disease to be feared. Most complications involve either the eye or the brain, and can result in blindness or death. Early and complete treatment is very important to avoid these dangerous complications.

If a child with sinusitis shows any signs of eye or brain related disease, immediate hospital attendance is essential.

 

Last Revision: May 22, 2020