Describe sinusitis in children.

Sinusitis in Children

• The developmental facts govern everything — the maxillary and ethmoid sinuses are present at birth; the sphenoid pneumatises from 3 years; and the frontal sinus is absent at birth, developing from 2 years and reaching adult size after puberty
• Therefore — ethmoiditis is the sinusitis of infancy, and is why orbital cellulitis is a paediatric problem; maxillary sinusitis appears in early childhood; and frontal sinusitis does not occur in a young child, so a frontal swelling in an infant is something else
• Children have 6 to 8 viral upper respiratory infections a year, and most nasal symptoms are viral — so the central problem is deciding when it is more than a cold
• The diagnostic criteria in children: persistent symptoms beyond 10 days without improvement; severe onset with high fever above 39°C and purulent discharge for 3 or more consecutive days; or worsening after initial improvement (double sickening)
• Presentation differs from the adult — cough, especially at night, is a prominent and characteristic symptom; with nasal discharge, blockage, irritability, poor feeding and halitosis
• Facial pain and headache are uncommon in young children, and their absence does not exclude the diagnosis — which is an important difference
• The differential diagnoses that must be considered:
• Adenoid hypertrophy and adenoiditis.
• A nasal foreign body, in unilateral foul discharge
• Allergic rhinitis
• Choanal atresia, in persistent unilateral discharge from birth
• Underlying systemic disease, which must be excluded in recurrent or severe disease — cystic fibrosis (especially with nasal polyps, which in a child mean cystic fibrosis until excluded); primary ciliary dyskinesia (with situs inversus, glue ear and bronchiectasis); immunodeficiency (IgA deficiency, common variable immunodeficiency, poor pneumococcal vaccine responses); and gastro-oesophageal reflux
• Investigation IS minimal — the diagnosis is clinical; plain radiographs are of NO value; and CT is reserved for suspected complications, failure of treatment, or planned surgery, given the radiation dose to a developing child
• Investigate the child rather than the sinuses in recurrent disease — sweat chloride, immunoglobulins and vaccine responses, ciliary studies, and allergy testing
• Management — most cases resolve with symptomatic treatment: saline irrigation or drops, analgesia, and adequate fluids
• Antibiotics for those meeting the criteria above — amoxicillin or amoxicillin-clavulanate, for 10 to 14 days