Sinuses are air pockets on both sides of the nose; like the nose, they are also lined by Mucus skin. The Ethmoid and the Maxillary Sinus are formed in the 3rd to 4th gestational month and, accordingly, are present during the birth.
Sphenoid Sinuses are generally pneumatised by 5 years of age and the Frontal Sinuses appear at the age 7 to 8 years, but are not completely developed until late teenage years. The Sphenoid Sinus does not develop at all till teenage years.
Most of the viral infections of the upper respiratory area involve the nose and the Paranasal Sinuses. However, bacterial infections of the Paranasal Sinuses do not usually involve the nose.
Children tend to have 6-8 episodes of upper respiratory infections per year, and hence tend to have more associated Ainus problems. Episodes of inflammation of the paranasal Sinuses lasting more than 90 days i.e. 12 weeks, are called as Chronic Sinusitis. Patients have persistent residual respiratory symptoms such as a cough, runny nose or nasal obstruction.
Below are the signs and symptoms parents should watch out:
- Cold lasting more than 10 to 14 days, along with low-grade fever
- Thick Yellow-Green nasal drainage
- Facial pain
- Post-nasal drip
- Night time cough and sore throat
- Nausea and/or vomiting,
- Swelling around the eyes
- A severe headache behind or around the eyes that gets worse when bending over is a very typical sign
- Persistent bad breath along with cold symptoms is also a hint of Sinusitis. However, this could also be from a sore throat or a sign that your child is not brushing his teeth
- In very rare cases, a bacterial sinus infection may spread to the eye or the central nervous system of the brain. Look for the pain in the neck and sensitivity to light.
Antibiotics: Antibiotics may be prescribed if high-grade fever is present or acute exacerbation of chronic symptoms is there. The course of medicines may last from 10-14 days. To treat a headache or sinus pain, place a warm washcloth on your child’s face for a few minutes at a time. Pain medications such as Acetaminophen or ibuprofen may also help.
Saline nose drops: If the secretions in your child’s nose are especially thick, causing congestion, your Paediatrician may recommend that you help drain them with saline nose drops. Without your Paediatrician’s advice, do not use nose drops that contain medications because they can have side effects.
Cool-mist humidifier: Placing a cool-mist humidifier in your child’s room may help keep your child comfortable. The humidifier should be cleaned and dried every day to prevent bacteria or mould from growing in it (follow the instructions that came with the humidifier).
Hot water vaporisers: Hot water vaporizers are not advisable because they can cause injuries or burns. Steam inhalation can be used with precaution for an older child. Medicines may be needed to treat the child’s reflux symptoms.
Surgery: Surgery may be sometimes needed for Deviated Nasal Septum/ for Adenoids/ for Polyps. It is called Endoscopic Sinus Surgery.
Antihistamines may help the child’s symptoms only if an allergic component is involved. An Allergist or Immunologist may help to diagnose this.
Steroids: Initial medical management also includes a regimen of topically applied Corticosteroids. Fluticasone, Beclomethasone, Budesonide, and Mometasone are common choices. Topical Corticosteroids improve subjective patient symptoms.
Though uncommon, patients should be aware of local side effects of mucosal drying and bleeding.
Duration of a therapy is up to 3 months, and patient response is unlikely before 2 weeks of use. Systemic absorption of topical agents is minimal.
Systemic steroids in burst or taper are generally evaded due to its side effects. They can be used only if Polyps are present, as nasal sprays don’t get absorbed in that case.
Saline nasal irrigation: Saline nasal irrigation with a 2-3% solution has been found to be helpful.
Daily irrigation has been shown to significantly decrease symptoms. Relief is expected due to improved Mucous outflow and a decrease in secretions and load of inflammatory mediators.
The use of nasal decongestants for symptomatic use should be judicious. These mediators, however, should not be used for longer than 3-4 days because they are relatively short acting and can cause rebound congestion with chronic use.
The author is a Consultant Neonatologist & Paediatrician, S.L. Raheja Hospital, Mahim