Pediatric Sinusitis

W. S. Tichenor, M. D.
New York, New York

Diagnosis and treatment of pediatric sinusitis is very similar to that in adults, but it is important to remember that there are differences. Symptoms which occur more prominently in children include irritability, earache, nasal odors, cough and halitosis.

Medications used in children are very similar to those in adults, however, appropriate dosage adjustment may need to be made based on the age and weight of the child. Antibiotics which are used will often include Pediazole as one of the first line drugs along with Amoxicillin and Bactrim/Septra. Some antibiotics including the quinolones (Cipro, Floxin, Tequin, Avelox and Levaquin) may not be used in children who are still growing, however some specialists will occasionally use them. Some doctors will use a high dose of amoxicillin in some patients.

In patients who have recurrent infections, it is important to evaluate for immunodeficiency by an allergist/immunologist. Evaluation for cystic fibrosis may also need to be made, especially in situations where more unusual organisms occur or if the child has nasal polyps. Evaluation may also need to be made for allergy, gastroesophageal reflux and diseases of the cilia. Cultures from the middle meatus may be helpful in situations where there is no initial response to medications. IV antibiotics through companies such as Sinucare may also be used as in adults.

Different sinuses are often involved in children because development occurs at different points. The frontal sinus will start to develop about age 6. A discussion of that occurs elsewhere in this website. Use the search engine listed at the bottom of the page.

Exposure to environmental exacerbating agents can be a problem in children. Exposure to tobacco smoke in the home can be a major problem. Parents must be educated that they cannot just avoid smoking in the home as their clothes and hair will become contaminated. Smokers are usually unaware of the smell of tobacco smoke so are often unaware of when smoke permeates the environment. Pollutants can also be a major problem for kids.

Day care can be a major factor in some younger kids due to excessive exposure to viruses. Removal from day care for a period of time may be helpful. In older kids, exposure in school is often a problem, both from exposure to viruses, as well as due to problems with exposure to allergens. Many schools have major contamination problems with molds. In addition some schools are built on top of toxic areas and can be a major problem.

Surgery in children is typically done much less frequently than in adults, but in situations such as abscess, cellulitis of the orbit, or intracranial abscess, surgery may be necessary. It is also done more frequently in patients with cystic fibrosis. Surgery may need to be a two step procedure, in which the surgery is done the first time, and subsequently the crusting and adhesions are removed under anesthesia.

A significant number of children with chronic sinusitis may also have adenoidal or tonsillar enlargement which may require surgery in and of itself. Evaluation with a nasal endoscope is helpful under these circumstances. Eustachian tube dysfunction can also be a problem in some patients which can be evaluated at the same time.

Antral lavage (washing out the sinuses by using a needle to insert into the sinus) is generally considered an out-moded technique because the lavage is only helpful for the maxillary and not the more frequently involved ethmoid sinuses, however in kids, lavage with adenoidectomy is sometimes done to avoid sinus surgery. Occasionally antral puncture (putting a needle into the sinuses through either the mouth or the nose) is done in order to more accurately determine what the bacteria are which are causing the infection.

Interestingly, some physicians have found a relationship between ADHD and sinusitis.

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Look at the CT scans

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The contents of © 1999-2008 by Wellington S. Tichenor, M.D. Last updated March 28, 2008. Reproduction for educational, not-for-profit purposes is permitted if this source is credited and the author of this website is notified of any reproduction for other than personal use. If used on the internet, a link would be appreciated.

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