NEW ORLEANS - Effective treatment of sinusitis is complicated by several factors. Identifying both the type of infection and the cause is vital to choosing the best treatment.
Differences between a viral upper respiratory tract infection and acute sinusitis can be hard to distinguish, said Evelyn A. Kluka, MD, Lousiana State University Medical Center.
"Typically, if the viral upper respiratory tract infection is present for five to 10 days and seems to be abating at that point, it's usually more consistent with an uncomplicated infection," said Kluka. "These children have nasal discharge, congestion and a cough. Fever is only present typically at the very onset."
These same symptoms may be present in acute sinusitis. The difference is that they either persist longer than 10 days or are more severe.
"In children who have daytime cough, sinusitis should be a consideration," said Kluka, who spoke at the American Academy of Otolaryngology-Head and Neck Surgery annual meeting held here. High fever and headache may be additional symptoms.
A child will have more protracted symptoms with chronic sinusitis. Nasal congestion, sore throat, anterior rhinorrhea, postnasal drip, daytime cough and headache may all be present as well as intermittent fever and "a generalized feeling of unwellness," Kluka said. "The parent might describe the child as `just not himself.'"
Response to previous antibiotic therapy is also important in differentiating between recurrent acute sinusitis and chronic sinusitis.
"Typically in recurrent acute sinusitis, the patient may become free of symptoms during therapy, and then symptoms may recur after a new viral respiratory infection," Kluka said. "On the other hand, in chronic sinusitis, symptoms might improve with antibiotic therapy, but they never completely resolve."
Etiology is key to effectively treating sinusitis. "I like to search out what could potentially cause this mucosal problem that can subsequently lead to sinusitis," Kluka said. "We need to consider what's in the child's environment that's affecting him or her."
Day care attendance, smoking and allergies may all play a role in a child's sinusitis.
"If you cannot find another cause for the child's problem, it is probably a good idea to have the patient evaluated for allergic rhinitis," Kluka said. "Parents will often complain whenever allergies are to blame that their child has a chronic runny nose, and they complain of constant cold symptoms."
Environmental controls play a prominent role in treating children with sinusitis. "You can move out some of the dust collectors that are in a child's room, such as stuffed animals," Kluka said. Cleaning ceiling fans, changing mattresses and pillows and vacuuming frequently may also help, as well as keeping pets out of the allergic child's bedroom. Smaller day care centers and a non-smoking environment are important as well.
If environmental factors cannot be controlled, there are several treatment alternatives. However, it is important to keep in mind that children react differently than adults to drugs used for sinusitis treatment.
"Expect the unexpected when you are talking about children and the administration of these drugs," Kluka said. "We always worried about drowsiness being associated with antihistamines. Parents will typically say that they hype up their children. With decongestants, you would expect them to be hyper, but some parents say that they put them to sleep."
Topical nasal steroids may help inhibit the inflammatory process. "Most of the time, they're indicated for children older than 4, but most of us who practice pediatric otolaryngology are not hesitant to use topical nasal steroids at a younger age," Kluka said.
Saline washes may keep nasal passages clear but may be difficult to use in young children.
For more information:
- Kluka EA. Pediatric sinusitis: what to consider before FESS. Session 2712-1. Presented at the American Academy of Otolaryngology-Head and Neck Surgery annual meeting. Sept. 26-29. New Orleans.
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