RHINOSINUSITIS IN CHILDREN

Monitor: Dr. Thong Menglong

Presented by: Kin molika
ENT residency year 1
Date:
CONTENT

 Definition
 Symptoms
 Etiologiy
 Physical examination
 Treatment Options
 Differential diagnosis
 Prevention
 Complication
DEFINITION

 Rhinosinusitis in children is an inflammation of the sinuses around the nose and forehead. The symptoms may
include:
 Mucus coming out of the nose.
 Pressure, pain, or swelling around the eyes and nose.
SYMPTOMS

o Children with rhinosinusitis may experience:

 Cold symptoms lasting more than 10 to 14 days
 Low- or high-grade fever
 Thick yellow-green nasal drainage for at least three consecutive days
 Post-nasal drip, sometimes accompanied by sore throat, cough, bad breath, nausea, and/or vomiting
 Headache, typically seen in children aged six or older
 Irritability or fatigue
 Swelling around the eyes
ETIOLOGIY

 Rhinosinusitis in children can have various causes. Here are some common factors that contribute to this
condition:
 Viral Infections:
 Most cases of pediatric rhinosinusitis are caused by viruses. These viruses can lead to inflammation of the nasal passages and sinuses.
 Common cold viruses, such as rhinovirus, adenovirus, and influenza virus, are often implicated.

 Bacterial Infections:
 Bacterial sinusitis is less common in children but can occur.
 Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are some of the bacteria associated with sinus
infections.
ETIOLOGY

 Allergies:
 Children with allergic rhinitis (hay fever) are more prone to developing rhinosinusitis.
 Allergens like pollen, dust mites, and pet dander can trigger inflammation in the nasal passages and sinuses.

 Anatomical Factors:
 Abnormalities in the nasal passages or sinuses, such as a deviated septum, nasal polyps, or enlarged adenoids, can obstruct
proper drainage and ventilation.
 These structural issues may contribute to recurrent or chronic sinusitis.
ETIOLOGY

 Environmental Factors:
 Exposure to smoke, pollutants, or other irritants can lead to inflammation.
 Dry indoor air can also affect the nasal mucosa.

 Immunodeficiency:
 Children with weakened immune systems are more susceptible to infections, including sinusitis.

 Other Factors:
 Cystic fibrosis, ciliary dyskinesia, and primary ciliary dyskinesia are rare conditions associated with chronic sinusitis in
children.
PHYSICAL EXAMINATION
 Rhinosinusitis is an inflammation of the nasal passages and sinuses. When evaluating children for rhinosinusitis,
clinicians perform a physical examination to identify relevant signs and symptoms. Here are common findings
during the examination:
 Pain and Tenderness: The clinician palpates the involved sinuses to check for pain and tenderness. Specifically:
 Frontal Sinuses: Tenderness in the forehead.
 Maxillary Sinuses: Tenderness in the upper jaw.
 Ethmoid Sinuses: Tenderness around the eyes and eyelids.

 Nasal Discharge: Purulent (thick, yellow-green) nasal discharge may be observed in the nose or posterior
pharynx.
 Nasal Examination:
 Using a speculum or otoscope, the clinician may find:
 Purulent Nasal Discharge
 Mucosal Edema
 Narrowing of the Middle Meatus
TREATMENT OPTIONS

 Symptomatic Treatment: Most of the time, children are diagnosed with viral sinusitis, which typically improves
with symptomatic treatment. This includes measures such as rest, hydration, and using saline nasal rinses to
relieve congestion. Antibiotics are generally not needed for viral sinusitis unless there are severe symptoms or
complications
 Bacterial Sinusitis: In severe cases, bacterial sinusitis may require antibiotics. However, medical therapy is usually effective.
 Surgery: Rarely, when medical treatment fails, surgery can be considered as a safe and effective option for treating sinus
disease in children. Keep in mind that a child’s sinuses are not fully developed until late in their teen years.
 Preventive Measures:
 Saline Rinses: Regular saline rinses can help maintain sinus health.
 Nasal Steroid Sprays: These can reduce inflammation.
 Adenoid Removal: Some children may benefit from adenoid removal to manage symptoms.
 Endoscopic Sinus Surgery: Older children with specific conditions may require this procedure.
DIFFERENTIAL DIAGNOSIS

 Viral Rhinosinusitis: Most cases of acute rhinosinusitis result from viral infections associated with the common
cold. This type, more accurately termed viral rhinosinusitis, typically resolves without treatment within 7 to 10
days. Antibiotics are not necessary for uncomplicated viral rhinosinusitis
 Acute Bacterial Rhinosinusitis (ABRS): ABRS occurs due to bacterial infection and may also resolve without
treatment. However, antibiotics can expedite recovery. Distinguishing between viral and bacterial rhinosinusitis is
crucial to avoid unnecessary antibiotic use. Here are some clinical features of ABRS in children:
 Duration: Symptoms lasting beyond 10 days or worsening after initial improvement suggest ABRS.
 Severe Symptoms: Severe symptoms include high fever, purulent nasal discharge, and facial pain or swelling.
 Worsening Course: Symptoms initially improving but then worsening after 5 to 7 days.
 Double Sickening: Initial improvement followed by recurrence of fever and worsening symptoms.
 Tooth Pain: Unexplained tooth pain, especially in the upper molars.
 Physical Examination: Tenderness over the sinuses, especially the maxillary sinuses.
PREVENTION

 Hygiene and Handwashing:

 Teach your child proper handwashing techniques. Regular handwashing helps prevent the spread of viruses and bacteria that
can cause sinus infections.
 Avoid Irritants:
 Smoke: Keep your child away from cigarette smoke and other environmental irritants.
 Allergens: Identify and manage any allergens that might trigger sinus symptoms. Common allergens include pollen, dust
mites, pet dander, and mold.
 Stay Hydrated:
 Encourage your child to drink plenty of water. Proper hydration helps maintain healthy mucous membranes in the nasal
passages.
PREVENTION

 Nasal Irrigation:
 For older children, consider using saline nasal sprays or rinses. These can help keep the nasal passages moist and clear.

 Avoid Overuse of Nasal Decongestants:

 Overusing nasal decongestant sprays can lead to rebound congestion and worsen sinus symptoms. Use them only as directed
by a healthcare professional.
 Vaccinations:
 Ensure your child is up-to-date with vaccinations, including the flu vaccine. Influenza and other respiratory infections can
contribute to sinusitis.
 Healthy Diet:
 A balanced diet rich in vitamins and minerals supports overall immune health. Encourage fruits, vegetables, and whole grains.

 Regular Medical Check-ups:

 Regular visits to the pediatrician allow for early detection and management of any underlying conditions that may predispose
your child to sinusitis.
COMPLICATION

 The main complications of sinusitis in children include:

 Persistent Headache: Especially if it is progressive or prolonged1.
 Vomiting: Particularly if it develops several days after the onset of upper respiratory infection (URI) symptoms1.
 Worsening Symptoms: Despite appropriate treatment1.
 Additionally, children with compromised immune systems, such as those with cancer, type 1 diabetes, and type 2 diabetes, can also
develop invasive fungal sinusitis.