Sinus Disease in Children

Sinus disease (sinusitis) is a condition marked by the inflammation and swelling of the tissue lining of the sinus cavities. Healthy sinus passages are clear and filled with air, but when sinus passages become blocked because of swelling, nasal polyps, or obstructions, proper drainage is not possible. As a result, mucus builds up in the sinus cavities and can lead to infection as well as other complications.

Unlike adults, pediatric sinus disease (sinusitis) can be difficult to diagnose because symptoms of sinus disease can be caused by other problems, such as viral illness, allergy, nasal polyps, or nasal obstruction.

Acute (short-term) and Chronic (long-term) Sinus Disease in Children

Acute (short-term) Sinus Disease:

Acute sinus disease is a sudden onset of cold-like symptoms such as runny nose, nasal congestion, and facial pain that does not go away after 10 to 14 days. Acute sinusitis typically lasts 4 weeks or less.

Acute Diseases Treatments:

• Antibiotic medication is generally a very effective treatment, and children usually respond very well.
• Nasal decongestant sprays may be prescribed for short term relief of nasal congestion.
• Nasal Saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucus membrane function.
• Nasal steroid sprays work to decrease inflammation in the sinus cavities.

If your child has acute sinusitis, symptoms should improve within the first few days of treatment. Even if your child seems ‘back to normal’ right away, you should always continue antibiotic treatment as prescribed by your doctor.

Chronic (long-term) Sinus Disease:

If a child suffers from symptoms lasting more than  8-12 weeks, he/she may have chronic sinus disease. At your preliminary visit to your child’s pediatrician, he/she suspects sinus disease, your child may be referred to an ENT specialist. The ENT physician will examine his/her ears, nose, and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the office visit.

An x-ray called a CT scan may help to determine how completely your child's sinuses are developed, where any blockage has occurred, and confirm the diagnosis of sinusitis. The doctor may look for factors that make your child more likely to get sinus infection, including structural changes, allergies, and problems with the immune system.

Nasal Polyps

• Nasal polyps are soft, painless, noncancerous growths that form in the nose or sinuses, and hang down like teardrops or grapes. Nasal polyps are usually located around the area where the sinuses open into the nasal cavity.
• Nasal polyps are common and are often associated with allergies or asthma, recurrent infection allergies, or certain immune disorders. Nasal polyps may cause no symptoms, especially if they're small, and require no treatment.
• Larger nasal polyps can block normal drainage from the sinuses. When too much mucus accumulates in the sinuses, it can become infected, causing thick, discolored drainage in the nose and throat.
• Large nasal polyps can cause a decrease in the sense of smell, cause difficulty breathing through the nasal passages, and, as previously mentioned, infection and sinus disease.
• In the case of large nasal polyps, procedures are often necessary to remove the obstruction to improve sinus drainage, breathing and clear infection.

Nasal Obstruction

Nasal obstruction is a blockage of the nose and nasal cavity and can be caused by a variety of problems:

• Inferior turbinate hypertrophy: The pink lining of the nose (sponge mucosa) cover tiny bony structures called turbinates. Turbinates are very susceptible to irritation by dust and other allergens, and if they become inflamed, impede normal nasal and sinus drainage, causing congestion, infection and sinus disease.
• Foreign bodies in the nose
• Enlarged Adenoids: Small masses of tissue located behind the nose. Adenoids form part of the immune system of babies and young children. They protect the body from harmful bacteria and viruses and they fight off infection. If the adenoids themselves become infected and enlarged, sinus drainage and risk for sinus disease becomes an issue.
• Deviated Septum: The nasal passage way is divided into two different sections by a piece of cartilage known as the septum. If, because of injury or another reason, this cartilage becomes out of place, it is known to be ‘deviated’. A deviated septum greatly disrupts sinus drainage and breathing and if not repaired, can cause recurrent sinus infection.

Below are some of the distinguishing symptoms of sinus disease, nasal polyps, and nasal obstruction and may indicate sinus infection in your child:

• A cold or cold symptoms  lasting 10-14 days
• Thick, yellow-green mucus secretions
• Mucus secretions with a foul odor
• Bad breath
• Post-nasal drip, sometimes leading to coughing, gagging and vomiting
• Irritability
• Headache ( in children 6 or older)
• Swelling around the eyes
• Nausea
• Fatigue
• Difficulty breathing through nose

Endoscopic Sinus Surgery Treatment

In extreme cases where sinus disease has progressed to an advanced stage, the ENT physician may need to perform endoscopic sinus surgery in order to fully treat your child’s sinus disease.

Endoscopic sinus surgery is considered for a small percentage of children with severe or persistent symptoms of sinus disease, which do not improve by using the traditional course of treatment.

The purpose of endoscopic sinus surgery is to clear and open the sinus passages by cleaning out the area and allow for proper drainage from the nose.

The procedure of Endoscopic sinus surgery usually takes about 1-3 hours in the operating room with the child under general anesthesia. The general procedure is as follows:

• After the child is fully sedated, the ENT surgeon will use an instrument called an endoscope (a small, flexible tube with a light and a camera at the end) to view the nose and sinus passages
• The ENT surgeon will then open the natural drainage pathways of your child's sinuses by either widening the natural sinus passages or creating new ones
• The ENT surgeon will then remove any polyps, cysts, or thickened mucus membranes
• The removal of these tissues allows for culturing so that antibiotics can be directed specifically against your child's sinus infection
• Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections (recurrent sinus disease).
• Also, your doctor may advise removing adenoid tissue from behind the nose as part of the treatment for sinus disease.
• Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis (obstruction of the back of the nose), can cause many symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache.

After Endoscopic Sinus Surgery

• Your child will have intravenous (IV) fluids until time of discharge. Clear liquids for your child to drink are available in the recovery room. Most children are fussy the first few hours after this procedure. Your child may complain of a sore nose, not being able to breathe through the nose and difficulty swallowing. A pain reliever may be given for pain. An antibiotic is occasionally prescribed to prevent infection.
• The head of the bed will be raised in the recovery room to help with swelling, breathing and drainage. At home, you should have pillows or a recliner chair available to help your child stay comfortable with their head elevated above the level of the chest.
• There may be packing in the nose to prevent bleeding. The physician may remove this packing in one or two weeks or it may dissolve on its own. If the packing needs to be removed, it may be done in the physician's office for older, cooperative children, or may be done in the operation room under anesthesia. If packing is used, your child may be able to feel it in his/her nose. Your child should be told before surgery that he may feel like they have something in his nose when he wakes up. If packing is not used, swelling may cause this feeling. Your child should know that they will not be allowed to forcefully blow his nose for a week or two.
• If a septoplasty (correcting a deviated septum) is performed, then splints will be placed inside the nose at the end of the operation. These will be removed at the physician's office in one to two weeks and may cause some discomfort while they are in place.
• At first, there may be some drainage from the nose. You may see a small piece of gauze taped under your child's nose, called a drip pad. This is usually only necessary for the first day, if at all. Drainage from the nose will likely be tinged with blood. Your child may cough or spit up some pink or brown mucus.
• Your child may begin normal play after several days, but may need to stay home from school until the discomfort improves. Your child's physician may recommend the use of nasal ointment, salt water spray, or nasal steroid spray after surgery. If this is the case, please follow instructions carefully.

When to Call the Doctor after Endoscopic Sinus Surgery

After surgery, monitor your child for symptoms that may indicate a need for you to contact your child's physician:

• Signs of dehydration, include dry mouth, sunken look around eyes, decreased amount of urine, no tears when crying and skin that forms and holds the shape of a tent when pinched
• Bright red bleeding from the nose or mouth
• Double or impaired vision
• A persistent leak of clear fluid from the nose
• Wheezing or a cough that sounds croupy (barky)
• If your child's temperature rises greater than 100.5 degrees Fahrenheit orally
• Vomiting (or if the vomiting becomes severe)

Follow-Up after Endoscopic Sinus Surgery

A visit with your child's physician will be scheduled for one to two weeks after surgery to make sure that the nose is healing properly. Consult your child's physician if you have any questions.

Dr. Gamble is a ear, nose, throat, and sinus surgeon in Plano and Dallas. If you would like to schedule an appointment with our office, please call our Plano office at 972-378-0633 or Dallas office at 214-239-1641. You may also conveniently submit an online appointment request and our office will contact you within 1-2 business days to schedule an appointment.