Sinusitis (Sinus Infection) in Children

00:01 Let’s switch fro noses to sinuses.

00:04 So the sinuses can get infected and this is sinusitis.

00:09 So this is an infection of the mucosal lining of any of the paranasal sinuses.

00:14 Remember that sinuses are different in children and adults.

00:18 You’re not born with all your sinuses.

00:21 Let’s go through them.

00:22 The ethmoid sinuses are those tiny ones right there on middle, those are present at birth.

00:28 The maxillary sinus will usually show up sometime in the first year of age.

00:34 And the sphenoid sinus will show up shortly thereafter.

00:37 But the frontal sinuses don’t show up typically until after 10 years of age.

00:42 So if a patient is complaining of a frontal headache, it’s probably not a sinusitis if they’re under 10.

00:49 So how do we diagnose sinusitis? Typically, what we do is we assume in acute sinusitis if a patient has had more than 10 days of nasal drainage and irritation or less than 30 days of symptoms.

01:05 That’s acute sinusitis, but it has to be more than 10 days of symptoms and it has to be sort of unrelenting.

01:11 It’s continuing on, not about to get better.

01:15 A subacute sinusitis is typically a patient with 4 to 12 weeks of symptoms and chronic sinusitis is typically more than three months of symptoms.

01:25 So what are the organisms in bacterial sinusitis? Well, strep pneumoniae, non-typeable H. flu, and Moraxella catarrhalis, which are your classic ear infection organisms, can also affect the sinuses.

01:39 But the sinuses can also have staph aureus and a variety of anaerobes.

01:44 So it’s generally a very mixed picture of an infection.

01:49 There are certain diseases that are more associated with sinusitis than others.

01:54 So patients with cystic fibrosis are often cursed with recurrent sinusitis.

01:59 Patients with Kartagener syndrome are at increased risk for sinusitis.

02:04 And certain immune deficiencies are also at risk.

02:07 Typically, humeral immune deficiency such as low IgA, low IgG or Job’s syndrome, which is hyper IgE syndrome or patients with common variable immunodeficiency which usually shows up a little bit later.

02:22 So those are the immunodeficiencies that are typically associated with sinusitis.

02:26 And these patients usually get recurrent episodes.

02:31 So what are some other risk factors for sinusitis? Well, smoke exposure certainly like these children, you’d have a risk factor, but also second hand smoke exposure is a common risk factor for sinusitis.

02:45 Also, frequent URI symptoms is a risk factor for sinusitis as is chronic allergic inflammation.

02:52 So these very allergic kids may be at more risk for sinusitis.

02:57 So how do we diagnose it? Well, they have to have nasal discharge for more than 10 days.

03:02 They need to have purulent discharge and/or high fever.

03:06 And you should have generally, facial pain and headache, but that is less common in children than it is in adults.

03:14 Sinus films are really not useful.

03:17 They’re really not useful and a CT is diagnostic, but there’s a high false positive rate in that many people who are asymptomatic will show up with sinusitis, like you can see in this patient with extensive sinus disease.

03:31 Or you might be unnecessarily irradiating the patient.

03:35 So remember, children are at increased risk for cancer with radiation exposure because they’re doing more mitosis.

03:42 So we really want to avoid radiation exposure in kids.

03:45 And so a CT of the sinuses is really not indicated.

03:49 This is a clinical diagnosis.

03:52 More than 10 days of purulent congestion and there’s your diagnosis.

03:58 What do we give them? Well, typically, because of the broad nature of the organisms that can cause the disease, you start with amoxicillin/clavulanic acid.

04:07 If they’re allergic to penicillin, you can also do clindamycin.

04:10 If there’s no improvement in 72 hours, discontinue the antibiotic and consider another cause like virus or underlying problems.

04:19 Therapy for seven days after resolution of symptoms is indicated so it’s usually up to 10-day course.

04:24 In other words, start antibiotics.

04:26 On day three, if they’re not getting better, it’s probably not bacterial sinusitis, you can stop the med.

04:33 If they are getting better, continue for a 10-day course.

04:37 There’s no evidence that nasal washers or steroid sprays or anything like that is beneficial.

04:43 Also, consider ear, nose and throat referral for endoscopy for severe or chronic or unresolved cases.

04:51 They might have problem in there like polyps or they might have an underlying disorder, which can be diagnosed by biopsy, like Kartagener syndrome.

04:59 So that’s my review of nasal problems in kids.

05:03 Thanks for your time.