Sinusitis (Sinus Infections)
1. What Is A Sinus?
The term "sinus" refers to an air-filled cavity in the facial bones. There are four different sinus areas: the maxillary sinuses (behind the cheeks), the frontal sinuses (above the eyes), the ethmoid sinuses (between the eyes), and the sphenoid sinuses (behind the eyes).
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2. What Is Sinusitis?
Sinusitis is an infection of the lining of the sinus. It is due to a blockage of the natural drainage passages; this blockage may be the result of chronic allergic irritation of the nasal tissue, viral infection ("common cold") and nasal injury or repeated sinus infection. If the thin mucus that the sinus normally produces cannot drain out of the sinus, it will allow bacteria to grow; this is an infected sinus. This infected sinus is what produces the symptoms of sinusitis.

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3. What Is Chronic Sinusitis?
Swelling of the lining of the sinus drainage passage is the most common cause of blockage. Once the drainage passage is blocked, infection in the sinus may cause the passage to stay swollen shut. Therefore, the infected mucus cannot leave the sinus. This is known as chronic sinusitis if it lasts for more than 10-12 weeks. The initial lining swelling is usually due to either a viral infection (a cold) or allergic rhinitis.

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4. Can Children Get Sinus Infections?
Sinusitis is now recognized and diagnosed with increasing frequency in the pediatric population. It is usually associated with upper respiratory illnesses suck as colds and flu. The incidence rises significantly in the fall and winter. Aleergy also plays a role, particularly in chronic sinusitis. Children with weak immune systems and asthmatics are likely sinusitis victims. The chance for resistant bacteria as a cause of sinusitis increases as the wide spread use of stronger antibiotics increases.
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5. What Are The Symptoms Of Sinusitis?
1) Thick nasal drainage, usually white or green

2) Nasal congestion

3) Sensation of post-nasal drip

4) Chronic cough

5) Chronic sore throat

6) Facial pain and/or pressure

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6. Should My Child Have Sinus X-rays?
The diagnosis of both acute and chronic sinusitis is made primarily on clinical information gathered from the history and physical exam. X-rays of the sinuses may be helpful, however, sinus x-rays in children under the age of 3 can be inaccurate in up to 2/3 of the cases. In children older than 3, the x-rays are wrong 1/3 of the time. The most accurate way to evaluate the sinuses with x-ray involves the CAT scan. A CAT scan can give an accurate and detailed picture of which sinus cavities are involved with infection. Plain x-rays and CAT scans provide little radiation exposure to the child; however, all x-rays in children should be kept to a minimum and used judiciously.
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7. Medical Treatment Of Sinusitis
1) Antibiotics - these are to kill the bacteria in the sinus; may require a total of 4 to 6 weeks for complete resolution of infection.

2) Decongestants - these decrease congestion and swelling of the sinus lining.

3) Nasal steroid spray - works directly in the nose to decrease the congestion and swelling.

4) Guaifenesin - thins the secretion to help relieve congestion.
Antihistimines (Benadryl, Chlortrimeton, Tavist) are not helpful in
sinusitis as they thicken secretions and aggravate the congestion problem. The prognosis for improvement and resolution of acute and chronic sinusitis is very good when appropriate therapy is given. Sinus surgery is indicated only in those cases that fail to respond to medical therapy and have significant and persistent sinus disease demonstrated by CAT scan.
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