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Sinusitis in children: symptoms and treatment. Sinusitis in children: symptoms, diagnosis, treatment

The symptoms of sinusitis are known to almost every adult. With a prolonged runny nose, accompanied by nasal congestion, fever, headache and pain directly in the maxillary sinuses, men and women know that they should immediately go to the hospital and undergo appropriate treatment. With young patients things are more complicated. Sinusitis, which occurs quite often due to the imperfection of the immune system in children, manifests itself with nonspecific symptoms, which, moreover, children are not always able to describe. It is important for parents to recognize the disease as early as possible in order to provide timely treatment to the child and avoid worsening his condition.

Causes of inflammation of the maxillary sinuses in children

Inflammation of the maxillary (maxillary) sinuses can occur in people of any age. According to medical statistics, sinusitis is diagnosed in children even more often than in adults. There are a number of explanations for this.

Most often, inflammation of the maxillary sinuses has a viral or bacterial etiology. Children under 12-14 years of age are most susceptible to ARVI and other viral and bacterial infections. Firstly, due to the age-related characteristics of the immune system. Secondly, because they are constantly in an aggressive environment - kindergartens and schools, where they constantly come into contact with carriers of one or another microflora. Bacteria or viruses that provoke respiratory diseases, in particular sinusitis, spread through the nasal passages into the maxillary sinuses, where the inflammatory process occurs. In this case, it is necessary to treat the disease-cause and the sinusitis itself.
The same imperfection of the child’s immune system explains their susceptibility to allergic reactions. Sinusitis in young children can be of allergic origin. Therefore, after the inflammation has been treated, it is necessary to determine what exactly the baby is allergic to and carry out sensitization.
The baby may be a carrier of opportunistic microflora. If his body is attacked by a virus, all the body’s defenses are directed to repel it. Against the background of weakened immunity, bacteria begin to multiply, and sinusitis develops. To prevent the disease from recurring after it has been cured, you need to do a bacterial culture and determine which bacteria is causing it. An analysis of the sensitivity of bacteria to antibiotics, carried out simultaneously with bacterial culture, significantly facilitates treatment.
Sinusitis in children 3-12 years old can occur due to adenoids. Inflamed and enlarged, they prevent full nasal breathing and create a warm and moist environment in the nasal cavity. This is ideal for the growth of bacteria, including in the maxillary sinuses.

Sinusitis in a child under one year, and sometimes up to three years, is diagnosed very rarely. The fact is that at that age the maxillary sinuses are physiologically immature, and there is little room for the development of infection.

Inflammation of the maxillary sinuses of odontogenic origin is also quite rare in children under 10-12 years of age due to the underdevelopment of dental roots. Teenagers are recommended to undergo timely dental sanitation and treatment so that problems with them do not lead to sinusitis.

Signs that will help identify sinusitis in a child in time

Symptoms of sinusitis in children are nonspecific, often similar to the symptoms of acute respiratory viral infection, accompanied by rhinitis. But the treatment of inflammation of the maxillary sinuses is completely different, and often includes antibacterial therapy and surgical techniques.

In order to promptly recognize the disease, parents should monitor the child and, if the following signs are detected, immediately describe them to the doctor.

Based on the symptoms described by the parents or the baby himself, a clinical blood test, and the results of an ultrasound examination of the maxillary sinuses, the doctor makes a final diagnosis and determines treatment tactics. If the little patient’s condition is moderate, he is treated at home. In parallel with antibiotics, vasoconstrictors, anti-inflammatory drugs, and drugs to relieve symptoms of sinusitis, traditional methods can be used. Usually, the child recovers completely within 10-14 days. He will need a restorative regime for another month.

Any infections in a child are more severe than in an adult. In this article we will talk about the features of sinusitis in childhood.

When do sinuses form in children with sinusitis?

Normally, a 2-3 year old child does not have paranasal sinuses. They are not formed enough. And the inflammatory process in them occurs very rarely. The maxillary sinuses are fully formed by 5–6 years. This age is typical for the first attacks of sinusitis. A little later, the child develops the remaining sinuses: frontal, ethmoid, and sphenoid.

A huge role in the development of sinusitis in a child adenoids play.

Let us recall that in the area of the nasopharynx, from 1.5 to 2 years of age, lymphoid tissue is formed, which protects us from infections. With frequent colds, it begins to increase in volume, grow and block important ducts and openings. In addition, adenoids cause hearing loss.

In a 5-year-old child who often suffers from viral infections, the adenoids are a source of constant infection and can block the entrance to the maxillary sinus, provoking frequent attacks of maxillary sinusitis. Worsening sinus drainage- this is the main reason for the stagnation of thick exudate in them and subsequent suppuration.

So, let's summarize:

sinusitis in children occurs at the age of 5–6 years when the child’s facial sinuses are fully formed;
Children 2–3 years old may develop diseases similar to sinusitis. This happens against a background of weakened immunity, long-term chronic inflammation in the nasal cavity, severe concomitant pathology (leukemia);
Overgrowth of adenoids is a factor provoking sinusitis in children.

Symptoms of sinusitis in children

In a 5-year-old child, a typical attack of sinusitis begins after a severe viral infection. Typically, catarrhal symptoms last 5–7 days, after which a visible improvement occurs, and then when the sinus is blocked and fluid accumulates in its cavity, the patient notices the return of the disease. Children usually react severely to the first symptoms of the disease. Children's health deteriorates, motor activity decreases, and a temperature reaction inevitably appears. They become capricious, require more attention, and eat poorly. Mothers always know when their child’s illness began. Therefore, if after a long runny nose the baby feels unwell again, immediately consult an ENT doctor so as not to miss sinusitis .

What complaints do children have with sinusitis?

A 5-year-old child can already clearly talk about his health. Ask if he is bothered by pain in the facial area. Typically, sinusitis hurts in the projection of the sinuses, pain radiates to the teeth, upper jaw, cheekbones and orbit. There is a strong pain attack when the points located on both sides of the wings of the nose are compressed. The child may also suffer from headaches.

Further, sinusitis, especially purulent, often manifests itself as redness on the face. The skin is hyperemic, swollen, and painful when touched. The swelling spreads to the entire cheek and reaches the orbits. This symptom indicates a severe course of the disease.

And of course about sinusitis indicated by yellow, green and purulent nasal discharge. They appear when you tilt your head. When moving, the patient feels the fluid rolling. When the outlet is blocked, dull, arching pain appears in the sinus area.

In addition, children always react violently to sinusitis. They experience a rise in temperature (38 and above). Fever is difficult to control with conventional antipyretics.

Treatment of sinusitis in children

Therapy children with sinusitis includes the following items:

ensuring adequate hydration of the mucous membrane;
elimination of blockage of the sinus outlet;
destruction of the infectious agent;
creating a beneficial psycho-emotional climate.

To restore the protective forces of the immune system, the nasal mucosa must be adequately moisturized. Maintain the humidity in the room at 50 - 70%, ventilate the room often. Buy a humidifier if you can't create the ideal microclimate on your own. In addition, additional intranasal humidification can be used to reduce the viscosity of mucus. A saline solution, saline solution or sterilized packaged sea water is suitable for this; do such inhalations as often as possible. It becomes easier for the child to breathe, swelling goes away, and drainage improves.

Decongestants are used to restore sinus drainage in children. Considering the age at which sinusitis most often appears, use vasoconstrictor drops and long-acting sprays. These include oxymetazoline (Nozakar, Nazivin). Also suitable for safe treatment is the substance phenylephrine hydrochloride (NazolKids, Adrianol). They reduce swelling of the mucous membrane of the excretory ducts and restore natural drainage of the sinuses. In some cases, it is necessary to additionally use local hormones, which also relieve inflammation and swelling, but do not cause rebound syndrome with long-term use. In this case, Nasonex, Avamys, Fliconase drops are prescribed.

Hormones reduce local immunity, so they are prescribed in combination with an antibacterial drug.

Bacterial sinusitis in children

At bacterial sinusitis antibiotics are prescribed. In childhood, preference is given to soluble forms. In severe cases, therapy takes place in a hospital, and the medicine is given by injection. In other cases, they try to avoid injections. For sinusitis, a systemic antibiotic is needed; no local forms are effective. They do not accumulate in tissues and practically do not enter the sinus. The use of such drugs is even dangerous due to the risk of the emergence of forms of bacteria resistant to the antibiotic. For internal use in children, penicillins (amoxiclav, augmentin), cephalosporins (cefaclor, cefixime), macrolides (azithromycin, clarithromycin) are suitable.

The baby’s rapid recovery depends on his psychological state. During illness, be gentle with your child. Try to fulfill his wishes. Hug and feel sorry for the baby.

In children, sinusitis in most cases begins as a result of complications of the flu or cold. The danger of this disease is that at first it is difficult to distinguish it from a runny nose. When treating ARVI at home, parents do not recognize the first symptoms of sinusitis and consult a doctor only after more serious symptoms appear. In this case, defeating the disease is much more difficult.

How to distinguish a common runny nose from sinusitis?

How can you independently determine and promptly recognize sinusitis in your child?

It is very easy to distinguish unilateral sinusitis from a runny nose - the baby will complain of congestion on one side. With a runny nose, breathing will be difficult through both nostrils.
Lightly press your thumbs onto the spots on the inner corners of your eyes and in the center of your cheeks. If it is sinusitis, the baby will feel pain.
The child feels pain in the area of the inflamed sinus (cheekbones and forehead). This pain or unpleasant, pressing sensation goes away a little after blowing your nose.

Methods for diagnosing the disease in children

How is sinusitis diagnosed in children?

Doctors use the method to determine the presence of sinusitis in children anterior rhinoscopy. It is performed using regular or special nasopharyngeal dilators and speculums. To determine the type of virus or bacteria that caused the disease, the ENT takes mucus samples and tests them in the laboratory.
They will also help you find out the disease and the root cause. blood tests.
Method radiography of the paranasal sinuses used to determine the complexity of the disease.

Characteristic features of the disease

How does sinusitis usually manifest in children?

The first signs of sinusitis in children are pain in the forehead and nose, and nasal congestion.
The temperature in acute cases is high.
The baby feels discomfort in brightly lit rooms, his eyes begin to spontaneously water, and photophobia appears.
A clear symptom is a decreased sense of smell.
General weakness and loss of appetite are a sign of many diseases, sinusitis is no exception.
With sinusitis, the voice sounds nasal, the child seems to be talking through his nose.
With the development of sinusitis, the child’s temperature may rise to fever or, conversely, stay within 37.8 degrees (this is typical for the chronic form).
Discharge from the nose acquires a distinct and very unpleasant odor; it can be purulent and even bloody. You may notice redness and swelling in the area of the maxillary sinuses and near the eyes; when pressing on these areas, the baby will feel pain.

You should also pay attention to the appearance of the child when he wakes up in the morning. One of the obvious signs of sinusitis is facial swelling, which becomes less noticeable after a few hours.

Signs of types of sinusitis in children

Depending on the form of sinusitis, special symptoms may appear that are characteristic only of a certain type of disease.

Unilateral sinusitis is an inflammation of the mucous membrane of one of the maxillary sinuses. Depending on which side is affected, pain occurs on the right or left of the nose. Unpleasant sensations can arise and spread to the ear, eye or cheek when chewing or pressing on a tooth.
Bilateral sinusitis is much more severe. Nasal congestion with bilateral sinusitis in a child may not even be particularly worrying, since stagnation of mucus in both maxillary sinuses causes weakness, severe headaches, a sharp increase in temperature and even fever.
Spicy Sinusitis in a child occurs suddenly, usually after the flu, a cold with a runny nose, measles, scarlet fever and other infectious diseases. In addition to nasal congestion, fever and general weakness, characteristic of all types of sinusitis, the child complains of a headache that extends to the gums or forehead area.
Chronic Sinusitis symptoms are similar to the acute course of the disease. Special symptoms of chronic sinusitis in children are weakening or complete loss of smell. There is no serious increase in temperature or obvious pain. The child may complain of an unpleasant odor from the mouth or nose, which you will definitely feel. Find out about children too. Nasal discharge in chronic sinusitis is scanty, but breathing is difficult. Another sign of a chronic form of the disease is hoarseness of the child’s voice.
Purulent Sinusitis can be recognized by its smell, which is difficult to confuse with others. Pain and fever are also present. With purulent sinusitis in children, nasal discharge will be viscous, with pus and even blood. All symptoms of acute and chronic sinusitis can appear, but they are much more pronounced.

Let's figure out whether there is sinusitis without a runny nose.

If the illness is not accompanied by a runny nose

Nasal congestion, which is not accompanied by mucus discharge, may be one of the symptoms of sinusitis.

This is not easy to determine, but attentive parents will definitely notice other symptoms of sinusitis without a runny nose:

For several days, the child’s temperature remains around 37.8 degrees.
Nasal congestion does not go away for more than a week.
Painful or simply unpleasant sensations in the head, ears or jaw, which intensify during chewing and talking or when the child lies down.
The child may develop bad breath.
The baby becomes lethargic and gets tired quickly.
Unpleasant sensations in the nose area, which become stronger in the evening.

Without examination by a doctor, you will not be able to independently determine whether your child has sinusitis. But, these symptoms should serve as a signal to immediately go to the hospital.

Read about why your nose still gets stuffy without a runny nose.

The main methods of treatment for symptoms of sinusitis in children

Parents should not make a diagnosis and decide on treatment methods on their own. Sinusitis is a very serious disease, which without proper treatment can lead to very bad consequences.
The disease is treated comprehensively.

Specialized drugs to eliminate the cause of the disease and generally strengthen the baby’s body.
The hospital carries out physiotherapy procedures of a local nature.
Also apply nasal rinsing with the addition of medications, this procedure flushes out the mucus along with germs and normalizes the mucous membranes.
If the cause of sinusitis is an attack of bacteria, use antibacterial drugs. If the cause of the disease is fungal in nature, antibiotics will only worsen the situation; completely different drugs are needed.
Decision on surgical intervention The doctor accepts it only in very difficult cases. It consists of puncture of the maxillary sinuses, removal of pus and administration of medications. It is rare, but it happens that the main cause of sinusitis is curvature or abnormal development of the nasal passages. In this case, you can get rid of sinusitis only through surgery.

To learn how to recognize sinusitis in yourself, watch the video below.

In childhood, acute sinusitis ranks second among inflammatory processes of the ENT organs. Sinusitis is diagnosed in children starting from 1 year of age. Parents should know the peculiarities of the course of the disease in order to consult a doctor in time. After all, many young mothers associate nasal congestion in their child and the presence of mucous discharge with a common runny nose due to a viral infection. And the lack of timely treatment can lead to serious consequences. In this article we will look at the main symptoms of sinusitis in children, methods of diagnosis and treatment.

Causes

The main pathogens are streptococci, pneumococci, E. coli, influenza virus and their combinations. The most favorable conditions are created during acute viral infection, since viruses suppress the work of epithelial cells, disrupt the production of immunoglobulins, and reduce the content of lymphocytes and macrophages - the body’s protective cells. And the “bare” layers of the nasal mucosa are the optimal factor for the proliferation of coccal flora.

The source of infection in the body is also often an inflamed pharyngeal tonsil. Acute sinusitis occurs in most cases as a complication of rhinitis or adenoiditis.

Experts divide acute sinusitis depending on the source of infection into:

rhinogenic;
hematogenous;
odontogenic.

According to the form of the inflammatory process, they are distinguished:

Catarrhal sinusitis.
Purulent sinusitis.
Hemorrhagic sinusitis.
Necrotizing sinusitis.

Pathogenesis

Why can sinusitis develop as a result of banal rhinitis? This occurs due to dysfunction of the mucous membrane, blocking drainage and aeration of the sinus.

Occlusion of the natural openings connecting the nasal cavity with the maxillary sinus occurs due to swelling of the mucous membrane, in the presence of thick exudate, hyperproduction of mucus containing a high concentration of mucoid. All this ultimately leads to disruption of ventilation, a decrease in the partial pressure of oxygen, an increase in carbon dioxide content, and suppression of the function of the ciliated epithelium. This creates favorable conditions for the development of anaerobic infection.

Acute sinusitis is most often diagnosed in children. This is due to the anatomical structure of the sinus. Due to the low location of the outlet openings, slight swelling of the nasal mucosa may impair its drainage, which leads to congestion.

Clinic

With sinusitis, there is a clear deterioration in the general condition. Acute sinusitis occurs with fever, weakness, and loss of appetite (a complete refusal to eat is also possible). Children become capricious and irritable. Locally, it is possible to detect impaired nasal breathing and nasal congestion (usually bilateral). With the catarrhal form of inflammation, nasal discharge is insignificant.

Purulent, necrotic, hemorrhagic sinusitis in a 3-year-old child is severe. There are pronounced general and local manifestations of the disease. Mucous, mucopurulent discharge appears, sometimes. Children 5 years old can also report having a severe headache. In children 3 years old, it is not always possible to identify subjective signs. This complicates the diagnostic process a little.

During a clinical examination, the otolaryngologist diagnoses swelling of the cheek, swelling of the eyelid, and signs of conjunctivitis. On palpation, the area that corresponds to the outer wall of the maxillary sinus is painful. Breathing through the corresponding half of the nose is difficult.

Diagnostics

To confirm whether a child has sinusitis, otolaryngologists perform an additional examination - anterior rhinoscopy. With inflammation of the maxillary sinus, it is possible to identify:

Hyperemic, swollen nasal mucosa.
Mucous, mucopurulent discharge under the middle concha. With severe edema due to compression of the outlet, pathological exudate is often absent.

Since the presence of discharge in the area of the middle nasal meatus may also indicate acute ethmoiditis, frontal sinusitis (in children over 5 years old), radiography is indicated for a more accurate diagnosis.

Treatment

How to treat acute sinusitis? When acute sinusitis is combined with viral rhinitis, therapeutic measures are carried out in accordance with protocols for the treatment of respiratory infections. Primary is indicated in the presence of at least one of the following symptoms:

Soreness in the sinus area.
Presence of purulent discharge.
The appearance of signs of intraorbital and intracranial complications.

Interesting fact: when symptoms of the disease are detected in France, treatment is carried out from the very first days. Whereas in America, drug therapy is prescribed while maintaining the characteristic clinical picture for up to 10 days or even more (in the case of a bacterial infection).

Antibacterial drugs are used from the group of semisynthetic penicillins and cephalosporins. Amoxicillin is considered the most effective drug against penicillin-resistant pneumococci.

Amoxicillin clavulanate (Augmentin) is active against Haemophilus influenzae and Moraxella. A good alternative to Augmentin are medications such as Sumamed, Clarithromycin.

If sinusitis is detected in a 3-year-old child with characteristic symptoms, physiotherapeutic treatment is carried out only if there is an outflow of exudate. In case of severe disease, hospitalization is indicated. includes:

Antibacterial agents, the purpose of which is to eliminate pathogens, prevent chronicity of the process, and prevent severe complications.
Antihistamines are used to eliminate sensitization in the body.
General restorative measures: bed rest, taking multivitamin complexes, eating protein foods, drinking plenty of fluids.

Vasoconstrictor drops (Nazivin, Sanorin) and aerosols (Miramistin) are prescribed locally. It is better to use turundas previously soaked in the same solutions. If conservative treatment is ineffective or there is purulent discharge, sinus puncture is indicated. Next, a Teflon drainage is installed, which improves the outflow of exudate and creates the necessary conditions for washing the sinus. The effectiveness of using the Yamik sinus catheter in children is still being studied.

Surgical intervention is performed regardless of the child’s age if intracranial or orbital complications are suspected.

If nasal congestion has been observed for more than 7 days, while your baby has a fever, is capricious, eats poorly, or has trouble sleeping, do not waste time, consult a doctor immediately. These may be the first symptoms of sinusitis.

Sinusitis or inflammation of the paramandibular sinuses, one of the types of sinusitis that most often occurs in children. This disease occurs against the background of a complicated, prolonged runny nose when a viral or bacterial infection spreads to the cavity of the sinuses located on both sides of the nostrils.

If sinusitis in a child is not treated, serious complications may arise in the form of adenoiditis, otitis and the spread of inflammation to bone tissue, then we will talk about a chronic disease.

Inflammation of the sinus mucosa can develop when a viral or bacterial infection enters the sinus along with liquid mucus during improper blowing of the nose or rinsing the nose. The inability of a 5-year-old child to blow his nose, sniffle his nose and suck in snot contributes to the penetration of infection into the maxillary sinus, which leads to the spread of infection. In the limited space of the sinus, the infection multiplies quickly and contributes to inflammation of the mucous membrane.

Often the anastomosis connecting the sinuses with the nasal cavity is blocked, and then a liquid infiltrate forms inside; with a viral and allergic etiology of the runny nose, it can be transparent, with the addition and development of pathogenic microflora, the discharge from the sinuses acquires a yellow tint, often with admixtures of pus.

Factors that contribute to the development of sinusitis in a child are usually:

Colds accompanied by a runny nose.
Decreased immunity.
Allergic rhinitis with severe rhinorrhea.
Deviation of the nasal septum in a child.
Adenoids in the nose.

Improper treatment of a runny nose in a 5-year-old child can also lead to complications in the form of sinusitis.

Symptoms

As a rule, sinusitis does not occur in young children, under 3 years of age, since sinuses - cavities in the facial bones are absent at birth and develop during the first 3 - 4 years.

You can determine that a 5-year-old child has sinusitis by the following symptoms:

Difficulty in nasal breathing, especially at night and in the morning.
Decreased sense of smell, sometimes loss of appetite.
Headache.
Swelling of the cheek near the nostril.
Pain radiating to the jaw or eye socket, which intensifies when tilting the head.
Discharge from one nostril with unilateral sinusitis.

If a child has one or more symptoms indicating sinusitis, a rhinoscopy should be performed and X-rays taken in three planes to confirm the diagnosis and determine the localization of the inflammatory process. Timely detection and treatment of the disease increases the chances of quickly getting rid of the disease without complications.

Medicines

Treatment of sinusitis in children should be comprehensive and involves the use of medications from various groups:

Vasoconstrictor drugs

Treatment of a runny nose and sinusitis accompanied by the symptom of nasal congestion is carried out using agents that act on the vessels of the mucous membrane. In this case, the swelling is relieved and the child receives short-term relief. Children 5 years old can use Vibrocil, Xylometazoline, Otrivin baby, Nazivin baby. You can treat a child with such drugs for no longer than 5 days, while adhering to the recommended dosage.

Mucolytics

This group of drugs has a thinning property, which facilitates easy removal of mucus during drainage. Treatment of sinusitis in children may be accompanied by taking one of such drugs as Fluimicil, Fluditek, ACC.

Corticosteroids

Used for very severe inflammation of the mucous layer of the sinuses, which is not eliminated by other groups of drugs.

Antipyretics

Used to relieve symptoms of fever and pain. Treatment with drugs such as Panadol, Paracetamol, Nurofen, Bofen, Efferalgan is justified only at temperatures exceeding the reading of 38 degrees or with symptoms of pain.

Antiseptics

Sinusitis of viral etiology can sooner or later be complicated by the addition of bacteria or other pathogenic microorganisms that quickly develop in a humid environment with decreased immunity. Therefore, to sanitize the nasal cavity for preventive purposes, antiseptic solutions of Decasan or Miramistin are used as rinses or inhalations with a nebulizer. Thus, it is possible to treat bacterial sinusitis in a child in combination with taking antibiotics in the form of a suspension.

Antibiotics

Most often, the treatment of sinusitis is not complete without the use of antibiotics, both local and systematic. Doctors often prescribe such treatment for children even without confirming the presence of pathogenic microflora in the contents of the sinuses, believing that sooner or later bacteria will join viruses. Such treatment is not correct, since the use of antibiotics without a reason increases the body’s resistance to their influence, and in the future a stronger drug will be required.

When treated with antibiotics, there is a possibility of allergic reactions, so antihistamines are prescribed not only to treat the child, but also in combination with antibiotic therapy.

Procedures

Drug treatment will be more effective when combined with physiotherapy, which can be carried out in a physiotherapist's office or, if necessary, at home.

Cuckoo

The most common procedure is to rinse the sinuses using the cuckoo method. Due to the intricacies of such drainage (during rinsing, you need to throw back your head and say peek-a-boo), it is not performed on children aged 3 to 4 years, since it is difficult for children to explain the procedure. But for a 5-year-old child, treating sinusitis in this way will not be scary at all and even interesting.

Warming up

In the early stages, sinusitis can be treated with heating, which relieves inflammation and increases blood circulation in the sinus area. In a physiotherapist's office, a blue lamp is used for this; at home, you can use a boiled egg.