Sinusitis in Children

What are signs and symptoms of sinusitis?

Common signs and symptoms of sinusitis include:

• Fever (generally only associated with acute sinusitis)
• Yellow or green nasal discharge
• Cough
• Headache
• Facial pain or facial pressure
• Nasal congestion (snoring and mouth breathing)
• Postnasal drip (the feeling of mucus building up in the throat or dripping from the back of your nose)

How is sinusitis diagnosed?

Generally, doctors diagnose acute sinusitis based on symptoms that last longer than 10 days following a cold. No additional tests are required.

However, your doctor may recommend a CT scan to rule out complications from acute sinusitis or to diagnose chronic sinusitis. Occasionally, a magnetic resonance imaging (MRI) scan may be used. A plain X-ray of the sinuses can be helpful in diagnosing maxillary sinus disease in older children.

Before we do a CT scan for children who may have chronic sinusitis, we recommend a prolonged course (20 days) of a second-line antibiotic medicine along with nasal saline washes and a course of intranasal steroid. The CT scan will then be reviewed by a radiologist. Your otolaryngologist (ear, nose and throat doctor) will discuss the plan with you.

Why choose Children's Hospital Colorado for imaging studies?

Healthcare providers in our Radiology Department only treat children. We also have spiral CT technology, which decreases scan time and radiation dose.

What can we expect from imaging studies?

A plain X-ray of the sinuses takes a couple of seconds. A CT scan takes less than three minutes. An MRI scan takes 30 minutes and is generally tolerated by children over 7 years of age. Younger children might require sedation or anesthesia.

How is sinusitis treated?

In general, our doctors do not treat cold symptoms that have lasted fewer than 10 days with antibiotics because viruses cannot be treated with antibiotics. Also, unnecessary use of antibiotics can cause antibiotic resistance. In some cases, the doctor may treat your child with antibiotics if symptoms get worse during the first 10 days of illness.

Acute sinusitis is treated with an antibiotic. If there is significant nasal congestion, your child's doctor may also recommend a topical nasal decongestant.

How is chronic sinusitis treated?

Chronic sinusitis is more difficult to treat. Primary treatment includes:

• Antibiotics (generally at least for 20 days)
• Nasal saline washes
• Nasal steroid sprays

Children with chronic sinusitis that does not respond to antibiotics may need antral irrigation (washing out the maxillary sinuses) with targeted antibiotic therapy and adenoidectomy. An adenoidectomy is surgery to remove the adenoid. The adenoid is lymphoid tissue located behind the nose. It helps build up the body's immunity by trapping viruses that enter through the mouth. Enlarged adenoids can cause chronic sinusitis or sleep issues, and no longer provide health benefits.

In older children and children with cystic fibrosis, endoscopic sinus surgery may be recommended. Some children may develop eye or intracranial medical problems from sinusitis that can be quite serious. Hospital admission for intravenous antibiotics (given through an IV) and emergent surgical procedures may be required.

Can sinus infection symptoms be treated at home?

Sinusitis should only be diagnosed by a pediatric or ENT healthcare provider. Your child may have sinusitis if they have symptoms associated with sinusitis that continue beyond 10 days or symptoms that rapidly get worse during a short period of time. Make an appointment to find out if your child has sinusitis and get recommendations for the best treatment plan.

Home treatment may be helpful for nasal symptoms that less than 10 days or for symptoms that are not getting worse. The following may be helpful:

• Gentle nasal irrigation/suctioning for nasal secretions
• Short-term use of nasal topical decongestants (generally four days or less)
• Acetaminophen/ibuprofen for fever control

Why choose Children's Colorado for your child's sinusitis?

The Sinusitis Clinic at Children's Colorado has been operating for over 20 years. It is staffed by a pediatric otolaryngologist, an infectious diseases specialist and an allergist/immunologist. This group of specialists has an interest in this disease and expertise in this field.

• The Academy of Pediatrics Healthy Children website provides information on how to tell the difference between colds and sinus infections.