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Sinus infections are common and especially in smaller children.  The runny nose and congestion can be from allergies or viral colds.  We also see infants and older children noses react to particles in the air.  If we put pepper in our noses, we all react.  Not because it is and allergy but because it is an irritant. Your house air conditioner has a filter and you replace it.  The nose is the filter for our lung.  It warms, humidifies, and cleans the air.  But we cannot replace our nose so we produce mucous to cleanse it.  It is getting rid of stuff out of our body we don't need.  You should see the babies in West Texas with the dust.  They are congested and snorty all the time.

The bacteria love to grow in the mucous so it then becomes yellow and green.  That means there are more bacteria in the buggers that live on the surface of your nasal passageway but not necessarily in your body causing an infection .... yet.  It can go into a sinus infection with crying and/or fever and then it needs to be treated.  If they are just having green mucous but acting normal, then watch it and not over due antibiotics.  The bacteria will just come back into the clear mucous.  The infection can move up what is called the tear duct into the eye and cause green mucous in the eye but the white of the eyeball is white.  That is not Pink Eye but what Grandma called "cold in the eye."  If they are fussy or fever, then the sinus or ear is infected.  There is a high probability of an ear infection occurring if there is green mucous in the nose and eyes.  Treating the nose with antihistamines, steroid nasal sprays, or rinsing out the nose with saline can help.  Vaporizers usually do not help and the moister can cause more mucous in some babies.  If the runny nose is not getting infected and the child is not bothered by it, then don't give medications that are not needed.  My favorite question is who is this bothering?  The child or the mother?  Treating the nose with help the sinus infection but does not prevent ear infections in children below 2 years old.

Dr. Knapp

 

 

SINUSITIS

Sinuses are air-filled sacs within the bones of the face. There are six major sinuses plus a group of six or eight tiny air sacs between the eyes and the nose. The space behind the eyebrow is called the frontal sinus. The area behind the cheekbones is the maxillary sinus, and the area behind the eye is the sphenoid sinus. The small groups of sinuses between the eye and nose are termed ethmoid air sacs.

Structure

The sinuses themselves are lined with the same tissue as is found inside the nose. This tissue is comprised of two types of cells. About 10% are goblet cells which make and secrete mucus, and the other 90% are ciliated cells. These cilia are microscopic hairs which beat in an orchestrated manner to move the mucus toward the back of the throat. Similarly, the hair cells inside the sinuses move the mucus up and out of the sinus into the nasal passage where this mucus mixes with the mucus from the nose. This area in the back of the nose where the mucus passes is where the adenoids reside. It is the function of the adenoids to sample the mucus and look for infection. Cells within the adenoids manufacture antibodies to protect the body against invasion if they detect infection. This flow of mucus is continuous and normally the nasal and sinus lining will produce about two quarts of fluid per day.

Blockage

The small opening from the sinus into the nose can be easily blocked by swelling or by infection. Once it is blocked, the mucus within the sinus has nowhere to go and pressure builds up. At some point, symptoms will be perceived due to the increased pressure. As long as the sinus remains sterile, there is no accompanying infection. However, nasal mucus is rarely sterile, and there often is secondary infection. As the sinus fills with fluid, bacteria trapped in this moist, warm environment find it an excellent place to grow. The bacteria begin to multiply and cause infection. The body reacts by sending more fluid and white blood cells into the sinus to fight the infection. Occasionally, pressure is so intense that it is desirable to insert a needle into the sinus and drain the infection. Generally, with newer and more potent antibiotics, these drainage procedures are rarely needed.

Causes of Sinusitis

  • Common Cold and Allergy can irritate the lining in the sinuses leading to sinusitis.
    Anatomic Abnormality and/or Polyps in the nose can cause poor drainage from the sinuses leading to sinusitis.

Sensations

Sinus infections or inflammation in each of these sinuses can cause pain, tenderness or headache. You are also likely to have a "stuffed-up" feeling in the face. Surprisingly though, you can have good air flow through the nose itself while at the same time having blocked sinuses. Blockage of the frontal sinus causes pain in the forehead that worsens when you bend forward. Blockage of the maxillary sinus often gives pain in the cheek or in the upper teeth, worsened if you drink hot or cold beverages. If the sphenoid sinus is blocked, symptoms are often transferred to the ear or the area behind the ear. Occasionally, you feel pain on the top of the head or get a feeling that the eyes are being pushed out from behind. Blockage of the ethmoid sinus causes pain and tenderness alongside the nose.

Often there is nasal drainage which is clear or yellowish. It is possible to have longstanding inflammation or blockage of a sinus and low-grade symptoms. This can then gradually or suddenly worsen and develop into significant symptoms. Even when the symptoms fade, the inflammation may persist and then flare up again days or weeks later.

Treatment

The infection need to be dealt with, and inflammation needs to be reduced. Generally, this involves the use of nasal cortisone. Oral decongestants are sometimes used, however, they can cause the mucus to become too thick to move efficiently. Systemic cortisone may need to be used in severe situations.

Since sinustis is generally produced by a bacteria, infection can be cured with antibiotics. It is often desirable to culture the fluid to determine which bacteria are causing the infection. For an effective culture, a sample should be obtained by inserting a needle into the sinus and aspirating (withdrawing) the infected fluid. A simple culture from the nose is often not the same bacteria as is in the sinuses. If the condition warrants, a CT scan of the sinuses may be taken to see whether the sinuses contain air or fluid which would indicate infection.

There are some things which your doctor may prescribe to help with the pain, pressure and infection related to sinusitis:

  • . Bactroban ointment as a lubricant or as part of the nasal washes.
    . Cortisone nasal sprays.
    . Decongestants
    . Oral steroids
    . Antibiotics

Antibiotic choices are often based on knowledge of what types of bacteria are most likely to cause the infection. The antibiotic will generally have a broad spectrum, which means that it covers most of the bacteria likely to cause infection. While many sinus infections are caused by viruses, a bacteria may contaminate the sinus and cause a secondary infection. It is important to take antibiotics long after the symptoms have cleared due to the "stagnant pond" theory. Often three or even four weeks of antibiotics are appropriate. Nasal cortisone also needs to be used long after the symptoms have cleared.

Allergy

It is not necessary that you be allergic to have chronic sinusitis, although about half of the people with sinus infection have underlying allergies. In these situations, treatment of the underlying allergy is designed to cause a gradual and general improvement. Treatment of the infection itself is undertaken at the time the symptoms are present. Your doctor will want to perform skin testing to determine whether there is an allergy present or not. Blood testing may also need to be done. If you have symptoms suggestive of sinusitis, your doctor may recommend that a CT scan of the sinuses be taken if this test has not recently been obtained. Sinuses may be abnormal even though the symptoms have cleared.

Summary

In summary then, (1) Sinusitis is a bacterial infection of the sinuses and the facial bone; (2) Colds and allergies can clog the drainage from the sinuses and lead to sinusitis; and, (3) Antibiotics are used to cure the infection and need to be continued long after symptoms have cleared.