Sinusitis

What is sinusitis?

DEFINITION:
Inflammation and infection of the sinuses (small cavities in the facial bones).

SYMPTOMS:

• Headache
• Congestion
• Cough
• Bad breath
• Facial pain
• Fever
• Sore throat

CAUSES:
Bacteria including Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae non-typeable and less commonly, staphylococcus and anaerobes. Viruses including adenovirus, parainfluenza virus, influenza virus, and rhinovirus.

CONTAGION:
Sinusitis is not contagious. However, the upper respiratory infection, or cold that usually precedes the sinusitis is contagious through respiratory droplets.

DIAGNOSIS:
The diagnosis of sinusitis can be made either clinically (by symptoms), or by radiographic studies (x-rays). Clinically, a sinusitis can be considered if a child has had upper respiratory tract symptoms such as congestion for over ten days with no improvement. Prior to ten days, the illness would be considered viral. Radiographically, sinus x-rays or a CT scan of the sinuses can reveal a sinusitis. As all colds will produce some fluid in the sinuses, it is important that physicians read these results carefully.

TREATMENT:
Antibiotics for at least ten days. For slow responders, a two to three week course of antibiotics may be necessary. Amoxicillin is the drug of choice but there are other acceptable antibiotics. If antibiotics fail, surgical therapy including removal of the tonsils and adenoids or surgically draining the sinuses can be of some benefit. Nasal steroid sprays can also help to decrease swelling of the nasal passage and allow the sinuses to drain. Nasal neosynephrine sprays or drops (Afrin) can be used for 2-3 days to provide some immediate relief.

OUTCOME:
Excellent. Uncommon complications include abscess formation (which needs to be drained), bone infection, and very, very rarely, brain abscess or meningitis.

DISCUSSION WITH DR.B:
Sinusitis is a bacterial or viral infection of the sinuses (90% are bacterial and 10% are viral). The sinuses are small cavities in the bones of the face. They include the frontal, maxillary, ethmoidal and sphenoidal sinuses. These sinuses are very small in newborns. The frontal sinus is not fully developed until the teenage years. Sinusitis begins as a simple upper respiratory tract infection or the common cold caused by a virus.

Typically, a cold will last ten to fourteen days. However, by the tenth day there should be some improvement. If there is no improvement by the tenth day, one can say that this has become a sinus infection. It doesn’t matter how thick or thin the mucus is, or what color the mucus is to diagnose the sinus infection. Runny noses from a cold usually follow this natural course: three to four days of a clear runny nose, followed by three to four days of a green runny nose, followed by three to four days of a clear runny nose, followed by resolution of the symptoms. If the runny nose turns green and does not turn back to clear at the tenth day, it can be called sinusitis.

Other symptoms may occur as well but none will make the diagnosis definitive. These other symptoms include facial pain, cough that is worse at night, and bad breath. If there is uncertainty about the diagnosis, an x-ray of the sinuses or CT scan can make the diagnosis easier. Once the diagnosis is made, a course of antibiotics can be started. This will usually cure the illness. Sometimes a steroid nasal spray or neosynephrine drops can be used to open the nasal passages. Neosynephrine drops or spray should only be used for 2-3 days to alleviate the symptoms. Longer courses of neosynephrine can cause problems such as rhinitis medicamentosa (needing the medicine daily to keep the nasal passages open). For difficult cases, removal of the tonsils and adenoids or direct drainage of the sinuses by endoscopy may be necessary.

DR. B’s THOUGHTS:
Whenever a runny nose turns green, everyone thinks sinusitis. All runny noses turn green after three to five days. Years ago, doctors would prescribe antibiotics for this but now we know that the color of the discharge does not tell you whether it is bacterial or viral. The length of time the congestion has occurred is the best indicator of sinusitis.

People with allergies may have a runny nose for weeks, but this is not a sinus infection. A runny nose over ten days does not definitely mean sinus infection. X-rays can be helpful and some people advocate getting x-rays on all children to diagnose sinusitis. A simple cold can also cause fluid in the sinuses, so the diagnosis needs to be carefully considered. The bottom line is that there is no great way to diagnose sinusitis. Fever, congestion, headache, bad breath and fluid on an x-ray or CT scan can be symptoms of sinusitis or a cold. It takes the physician putting all the pieces together to come up with the most likely diagnosis.

 

Written by Dr. Michael Bornstein, who has over 28 years of experience as a pediatrician. 

Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.