Sinus infections are bacterial infections of the sinus cavities along the nasal passages. They are usually complications of viral upper respiratory infections (colds). A typical cold will cause nasal congestion for 7-10 days; if the congestion remains thick and lasts longer than 12-14 days, then a sinus infection has probably developed. Note that the color of the mucous does not matter; green-yellow mucous is common with a normal cold. Sinus infections tend to be over-diagnosed and over-treated; however, they are real infections and need to be treated when present. Sinus infections tend to be under-diagnosed in children with asthma and allergies.
Description
- Thick congestion, with congestion lasting longer than 10-12 days.
- Difficulty breathing through nose.
- Headache or facial pain.
- Sore throat, especially in the morning.
- Upper teeth may ache.
- Bad breath.
- Cough, especially at night, or a chronic cough.
- Post-nasal drainage.
Cause
The upper respiratory passages become infected with a virus, or are swollen for other reasons such as allergies. The swelling causes the opening of the sinuses to become blocked. Sometimes polyps or other causes may obstruct the opening of the sinuses. Fluid builds up in the sinus cavities and then becomes infected with bacteria that live in the nasal passages.
Diagnosis
The only reliable way to diagnose a sinus infection is by x-ray or CT scan of the sinuses. Of course, we don’t do this for routine cases, so we depend mostly on the duration of the symptoms, looking for congestion lasting longer than 10 days, and if associated symptoms are also present. Sometimes a child may have 2 viral colds in a row and this may seem like a sinus infection. However, usually the congestion is gone for 2-3 days and then a clear runny nose starts all over again. Allergies can also cause chronic congestion and mimic a sinus infection; however, allergies usually cause runny nose for weeks, not congestion.
Complications
- Sinusitis can become a chronic infection lasting weeks or months.
- The infection can sometimes spread to the tissues around the eye or behind the eye. (This requires immediate medical attention).
- Because of the location of some of the sinus cavities, the infection can sometimes spread to the bones of the face or to the tissues around the brain or the brain itself. Thankfully, this is rare.
Treatment
- The main treatment is getting the sinuses to drain. This is done by saline nasal washes, humidifier, warm drinks, plenty of fluids. This is the main treatment for a sinus infection. These are also the things that will help your child to feel better.
- Decongestants can be used in children 6 years old and up.
- Acetaminophen or ibuprofen can be used for headache, sinus pain or sore throat.
- Hard candy can be used for sore throat in children 4 and up. Sore throat strips and lozenges can be used as well.
- Avoid diphenhydramine (Benadryl) and similar antihistamines, which make mucous thicker and can worsen the sinus infection.
- Nasal steroids are sometimes prescribed to decrease the swelling of the nasal passages and help the sinuses to drain.
- Antibiotic, though recent studies show that many sinus infections will resolve with the treatment above and antibiotic not necessary, still used and recommended in most cases, especially the younger the child is.
Prevention
- Avoiding colds and situations that lead to colds such as daycare can lessen the chance of developing a sinus infection.
- Handwashing can also help to prevent colds.
- Avoid exposure to tobacco smoke, which damages the lining of the respiratory tract and weakens the immune system.
- Treat allergies if your child has them.
Return to school or daycare
Sinus infections are not contagious. As long as your child is drinking well, does not have a fever and is not having pain that interferes with activities, she can return to school or daycare. Fever usually indicates that your child should stay home for extra fluids and rest.
When to call
Seek medical care immediately if your child develops:
- Facial swelling and pain.
- Redness and swelling around the eyes.
- Severe headache and/or stiff neck.
- Eye pain or swelling, a change in vision, or difficulty moving the eyes.
- Confusion and/or abnormal behavior.
Call your doctor if:
- Congestion is not improving after 1 week.
- Your child’s symptoms worsen.
For more information
Choosing Wisely: Antibiotics for Respiratory Illness in Children
References
Wald, E.R., Applegate, K.E., Bordley, C., et al. (2013). Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years. Pediatrics 132, e262–e280. doi: 10.1542/peds.2013-1071
DeMuri, G.P., and Wald, E.R. (2012). Acute Bacterial Sinusitis in Children. New England Journal of Medicine 367, 1128–1134. doi: 10.1056/NEJMcp1106638
