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The term that we use for sinusitis in children is rhino sinusitis, which really means nasal
sinus disease, and that means that it starts off in the nose and goes off into the sinuses.
It is most frequent in the younger children from 3 to 8 years of age, but we see chronic
sinusitis in all age groups.
Children have more of a problem with recurrent infections for several reasons. One is they
have an amateur immune system, and particularly all babies have an amateur immune system.
The opening of the sinuses is smaller, and the amount of swelling associated with an
infection is about the same, so the openings close off more frequently, and that predisposes
them for recurrent sinus infections.
Nasal congestion, some form of *** type discharge from the nose. It’s frequently
associated with coughing. It may or may not be associated with fever. Fever is actually
fairly uncommon with chronic sinusitis or acute sinusitis.
Most of them are viral and 80 percent of them are going to clear on their own without any
antibiotics. That’s one of the reasons why pediatricians, ENT doctors, and family practice
will hold off on giving antibiotics for a good 7-9 days. Other majors that we can use
to treat sinusitis are nasal irrigations if the children will cooperate. Occasionally,
if there is a lot of inflammation or it’s a recurrent infection we will add on topical
nasal steroid sprays. These are very safe, they are not absorbed systemaically, and they
cut down on inflammation that’s on the inside of the nose.
When the children have recurrent sinus infections and they are on multiple courses of antibiotics,
somewhere around four or five in a six month period or 6-7 in a year, then we would consider
doing something else. That something else is initially an ethmoidectomy. There is now
good evidence that an ethmoidectomy will clear up 60-70 percent of the children that have
chronic sinusitis.