Treating Rhinosinusitis in Children

Most children with acute rhinosinusitis respond very well to antibiotic therapy. Nasal decongestants or topical nose sprays may also be prescribed for short-term relief of stuffiness. See Medications for more information.

Nasal saline (saltwater) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function. If your child has acute rhinosinusitis, symptoms should improve within the first few days. Even if your child improves dramatically within the first week of treatment, it is important to continue therapy until all the antibiotics have been taken. Your doctor may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.

If your child suffers from one or more symptoms of rhinosinusitis for at least 12 weeks, he or she may have chronic rhinosinusitis. Chronic rhinosinusitisor recurrent episodes of acute rhinosinusitis numbering more than four to six per year are indications that you should seek specialty consultation.

Once the diagnosis of rhinosinusitis has been made, children are successfully treated with antibiotic therapy in most cases. If medical therapy fails, surgical therapy can be used as a safe and effective method of treating sinus disease in children. First, other abnormalities such as CF, Kartagener’s Syndrome, and other immunodeficiencies must be eliminated. Other contributing problems such as reflux and sleep apnea must be considered. If the child still surpasses the misery index, then surgical intervention may be recommended.

We generally try to address all the possible problems while the child is under anesthesia. If the child has ear problems, we will typically clean the ears with the microscope and place Xomed antibiotic impregnated T-tubes. We actually cannulate the maxillary (or cheek) sinuses to suction out fluid for evaluation. The sinuses are then rinsed out with an antibiotic or saline solution. Radiofrequency technology is utilized to reduce the turbinate tissue in the nose to facilitate breathing and sinus drainage. Tonsils and adenoids are removed with the latest coblation technology. The child can then be skin tested or blood can be drawn for allergy testing while under anesthesia.

Most children will do well with this level of surgical intervention. Allergies can also be dealt with more intelligently following testing. We have a large experience with pediatric sinus surgery, and have even operated on many neonates for congenital nasal abnormalities. However, only a small percentage of children with severe or persistent rhinosinusitis require endoscopic sinus surgery.

Posted by: on