The sinuses are hollow air-filled sacs lined by mucous membrane. The ethmoid and maxillary sinuses are present at birth. The frontal sinus develops during the 2 nd year and the sphenoid sinus develops during the 3 rd year.
What are the sinuses? (cont’d)
Sinuses have small orifices (ostia) which open into recesses (meati) of the nasal cavities.
Meati are covered by turbinates (conchae).
Turbinates consist of bony shelves surrounded by erectile soft tissue.
There are 3 turbinates and 3 meati in each nasal cavity (superior, middle, and inferior).
Considerations for Pediatrics
At birth, the ethmoid, sphenoid and maxillary sinuses are tiny and cause problems in infants and toddlers.
Frontal sinuses develop between 4-7 years of age, causing problems in school aged children and adolescents.
Inflammation of paranasal sinuses
What is sinusitis?
An acute inflammatory process involving one or more of the paranasal sinuses.
A complication of 5%-10% of URIs in children.
Persistence of URI symptoms >10 days without improvement.
Maxillary and ethmoid sinuses are most frequently involved.
How Does Sinusitis Develop ?
Usually follows rhinitis, which may be viral or allergic.
May also result from abrupt pressure changes (air planes, diving) or dental extractions or infections.
Inflammation and edema of mucous membranes lining the sinuses cause obstruction.
This provides for an opportunistic bacterial invasion.
With inflammation, the mucosal lining of the sinuses produce mucoid drainage. Bacteria invade and pus accumulates inside the sinus cavities.
Postnasal drainage causes obstruction of nasal passages and an inflamed throat.
If the sinus orifices are blocked by swollen mucosal lining, the pus cannot enter the nose and builds up pressure inside the sinus cavities.
Allergies, nasal deformities, cystic fibrosis, nasal polyps, and HIV infection.
High pollen counts
Day care attendance
Smoking in the home
Reinfection from siblings
Acute or Chronic Sinusitis ?
Acute Sinusitis – respiratory symptoms last longer than 10 days but less than 30 days.
Sub acute sinusitis – respiratory symptoms persist longer than 30 days without improvement.
Chronic sinusitis – respiratory symptoms last longer than 120 days.
Etiology of Sinusitis
70% of bacterial sinusitis is caused by:
Other causative organisms are:
Complications of Sinusitis
Orbital cellulitis or abscess
Intractable wheezing in children with asthma
Cavernous sinus thrombosis
Subjective Symptoms of Sinusitis
History of URI or allergic rhinitis
History of pressure change
Pressure, pain, or tenderness over sinuses
Increased pain in the morning, subsiding in the afternoon
Persistent nasal discharge, often purulent
Cough, worsens at night
Mouthing breathing, snoring
History of previous episodes of sinusitis
Sore throat, bad breath
Clinical Presentations of Sinusitis
Nasal mucosa is reddened or swollen
Percussion or palpation tenderness over a sinus
Nasal discharge, thick, sometimes yellow or green
Postnasal discharge in posterior pharynx
Swelling of turbinates
Boggy pale turbinates
Pale, Boggy Turbinates
Imaging studies, such as sinus radiographs, ultrasonograms, or CT scanning – indicated if child is unresponsive to 48 hours of antibiotics and if the child has a toxic appearance, chronic or recurrent sinusitis, and chronic asthma.
Laboratory studies, such as culture of sinus puncture aspirates.
Carcinoma of sinus
Structural defects (septum deviation)
Nasal foreign body
Pharmacological Plan of Care
Amoxicillin:90mg BID for 10 days or
Azithromycin 12mg for 5 days (penicillin allergy).
Paracetamol 15mg every 6 hrs
Salt water gargle.
Pharmacological Plan of Care
Adults:Paracetamol 500mg Tid 5 days
Amoxycillin 500mg BID 10 days
Ofloxacin 400mg BID for 10 days
Salt water gargle
Avoid allergy triggers,antihistamine or nasal corticosteroids
Eat fruits & vegetables,
Wash hands and maintain hygiene.
Avoid smoke and pollution hydration
Follow Up Guidelines
Instruct parent to call in 48 hours if condition of child has not improved.
Instruct parent to bring child in for a recheck in 2 weeks.
Guidelines for Referral
Child with complications or signs of invasive infection.