Sinusitis

SINUSITIS
A sinus infection is a bacterial infection of one of the seven sinuses that normally drain into the nose. The sinuses are air-filled spaces in the skull which are lined with mucus membranes. Normally their mucus secretions are drained through tiny openings into the nose and then swallowed with the saliva. Swelling in the nose from any cause leads to blockage of normal mucus drainage. Possible causes of such swelling are viral infection (colds), allergies, or irritation from cigarette smoke or other chemicals. When bacteria begin to grow in the pooled sinus mucus, a sinus infection results. As bacteria multiply within the sinuses, pain and pressure occur above the eyebrow, behind the eye, or over the cheekbone. Other possible symptoms include a yellow nasal discharge, postnasal drip, fever, facial swelling, and bad breath. A sinus infection may cause a chronic cough. Swallowing sinus secretion is normal and harmless but may lead to some nausea. It is important to note that symptoms of colds and sinus infection may overlap. Features that may help distinguish between a cold and sinusitis are:  A cold should resolve in 10-14 days; longer illness may be sinusitis.  Fever from a cold begins early in the course of the illness, lasts a few days, and once resolved does not return. Fevers lasting more than 5 days or retuning later in the illness may be a sign of sinusitis.  Yellow or green mucus is found in many colds and is not necessarily a sign of a sinus infection, unless it occurs with a return of fever or increased illness severity. Also, sinusitis can occur with clear mucus and does not necessarily have yellow/green discharge.
TREATMENT

 Antibiotics – Antibiotics are medicines to kill bacteria that are causing the sinus infection. Sinusitis usually improves within 48-72 hours, though sometimes symptoms may take up to five days to get better. Your child’s doctor or nurse practitioner will determine the optimal length of time for your child’s treatment. Some sinus infections take longer to resolve. Try not to forget any of the doses. If the medicine is a liquid, use a measurer to make sure that you give the right amount. Even though your child will feel better in a few days, give all the doses to prevent the infection from flaring up again. Do not save the antibiotic for the next illness because it loses its strength.  Decongestant Nose Drops or Spray – These medicines can help shrink swelling in the nose. They are used for a limited time, no more than 3-5 days, since swelling can get worse when the medicine is stopped after prolonged use (“rebound”). Examples are afrin and neosynephrine. Oral decongestants such as pseudoephedrine (Sudafed, Pediacare) can also help. Decongestants are not used under the age of 24 months and are avoided under the age of six.  Oral Antihistamines – If your child has allergies, he may take an antihistamine. Otherwise, antihistamines don’t help much. (Please refer to our handout on allergic rhinitis).  Nasal steroid sprays – These medications reduce inflammation and may help sinuses drain. Examples are Flonase, Rhinocort, and Nasonex. They are safe for use in childhood and have very few side effects. They do not work instantly but instead require a few days to see any benefit.  Nasal saline washes - These salt-balanced solutions are used to sooth and wash the nasal passages, allowing mucus to be loosened and removed.  Pain Relief Medicines – Your child can take acetaminophen (Tylenol, Tempra, etc.) or ibuprofen (Motrin, Advil) for a few days for sinus pain or for any fever over 102 degrees F (39 degrees C).  Contagiousness – Sinus infections are not contagious. Your child can return to school or day care when he is feeling better and the fever is gone.
CALL OUR OFFICE IF:

 The fever is not gone after your child has been taking the antibiotic for 48 hours.  The symptoms are not improved after 5 days.  Your child’s cheek, eyelid, or forehead becomes red or swollen.  You feel your child is getting worse. T:HPA Handouts/Sinusitis Revised 12/01, 3/05, 4/08, 3/11

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