Topics of interest

SINUSITIS

Q.  My child has a low grade fever and runny nose. Is this sinusitis?

A.  In children, most infections of the nose and sinuses are viral and do not require antibiotics. Sinusitis should be suspected if the "cold" has lasted more than 10-14 days,  if  there is swelling around the eyes, facial pain or high fever.  Most colds last approximately 7 days have lower temperatures and go away without treatment.

Q. How is sinusitis diagnosed?

A. Sinusitis may be suspected if the doctor sees pus draining from the sinuses, swelling around the eyes, pain over the sinuses and the doctor listens to the parent describes the illness.  X-rays are not usually helpful, especially because the changes on x-ray from sinusitis, are quite similar to the changes seen from a common cold. Sometimes CAT scans of the sinuses are performed, especially if surgical intervention is being considered.

Q. Are there other signs and symptoms of sinusitis?

A. Yes, patients may also complain about postnasal drip, sore throat, nausea or persistent cough, especially during the day.

Q. What is chronic sinusitis?

A.  Frequent recurrences of sinusitis would be considered chronic.  If this is the case, a CAT scan may be ordered to look for nasal deformities, polyps, large adenoids or infected teeth. Other causes may be looked for such as cystic fibrosis or immune deficiencies.  Underlying allergies should also be considered if there is frequent watery discharge, sneezing or throat clearing.

Q. How do you treat sinusitis?

A. Acute sinusitis is treated with 10-20 days of oral antibiotics, usually Amoxicillin unless the patient is penicillin allergic. Antihistamines and decongestants are generally not indicated.  Chronic sinusitis is generally treated with 3 to 6 weeks of oral antibiotics.  Antihistamines, decongestants and nasal steroids may be helpful, especially if there are signs and symptoms of underlying allergies.

Q. Can there be complications to sinusitis?

A.  Yes, there can be rare occurrences of brain abscess, meningitis, infection of the eye or tissue surrounding the eye, inflammation of the optic nerve and bone infections of the face.

Q. If sinusitis can lead to serious complications, how come all colds are not treated with antibiotics preventatively?

A. Most upper respiratory infections are viral and do not require antibiotics,  If we treated all of these infections with antibiotics we will breed resistance and end up having no effective antibiotics to treat bacterial infections with.  This would have disastrous consequences.  Also, treating infections with antibiotics is not without risk.  There is always the risk of allergic reactions to the antibiotic (life threatening and otherwise) , diarrhea, vomiting, bellyache, yeast infections and an overgrowth of resistant bacteria in the intestines.

Children's HealthCare