Like adults, children can develop sinus infections. Most often, kids' infections follow on the heels of a cold, but they can also be triggered by allergies. Although the infection process is the same as in grown-ups, several factors specific to children affect the way we diagnose and treat pediatric sinusitis.
First, doctors have a harder time distinguishing between a child's sinusitis and severe cold or allergies. In an infant or a young child, the only symptom of sinusitis that parents may notice is green nasal drainage, a nighttime cough, fever, or increased irritability. Physicians, meanwhile, usually do not have the benefit of a sinus CT scan. This tool is only used for the most persistent cases because we are hesitant to expose the child's developing body to radiation.
So, faced with the never-ending supply of runny-nosed children, pediatricians must use clinical judgment to make their best assessment and treat the illness. Over-the-counter medications ,169
combining decongestants, antihistamines, and cough suppressants are helpful for both colds and sinusitis. Antibiotics are prescribed when symptoms persist and sinusitis seems probable.
Another difference is that sinus surgery is performed much less commonly in children than in adults. It's only done in the most severe cases in which antibiotics don't work and a CT scan shows definite sinus obstruction. And even in these cases, patience may pay off. Children catch fewer colds as they age and frequently outgrow their allergies, so the number of sinus infections often will drop without surgical intervention.
But when sinus surgery is performed on children, it can be just as successful as in adults. Children heal faster from surgery and are usually back to school within three to five days. Young children are often unwilling to undergo postoperative cleaning in the office under local anesthesia; such cases may require a second trip to the operating room one week after surgery for cleaning under general anesthesia.
While sinus surgery on children is rare, another type of surgery related to the sinuses is not (see the sidebar "Adenoidectomy").
Because cystic fibrosis arises in childhood and commonly causes nasal polyps, children with polyps need a test that analyzes the amount of salt in their perspiration to determine if they have
The adenoids are a lump of tissue at the back of the nose that contains cells designed to fight infection. They actually consist of the same tissue as tonsils. In some children, the adenoids grow so large that they block the nose and sinuses, causing snoring, persistent nasal discharge, and sinusitis. Swollen adenoids can also harbor bacteria, causing repeated sinus and ear infections. If the adenoid tissue remains large after repeated doses of antibiotics, surgery to remove it can usually eliminate the problem. It's a relatively brief procedure that's done on an outpatient basis.
this disorder (see the section "Genetic Causes of Sinusitis" a little later in this chapter).
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