Sinusitis in a child

Sinusitis is an inflammation of the mucous membrane of the paranasal sinuses.

Synonyms: sinusitis, ethmoiditis, frontal sinusitis, sphenoiditis, hemisinusitis, pansinusitis.

ICD-10 code

• J01.0 Acute maxillary sinusitis.
• J01.2 Acute ethmoid sinusitis.
• J01.1 Acute frontal sinusitis.
• J01.3 Acute sphenoidal sinusitis.
• J01.4 Acute pansinusitis.
• J01.8 Other acute sinusitis.
• J01.9 Acute sinusitis, unspecified.
• J32.0 Chronic maxillary sinusitis.
• J32.1 Chronic frontal sinusitis.
• J32.2 Chronic ethmoid sinusitis.
• J32.3 Chronic sphenoidal sinusitis.
• J32.4 Chronic pansinusitis.
• J32.8 Other chronic sinusitis.
• J32.9 Chronic sinusitis, unspecified.

Causes and pathogenesis of sinusitis

In acute catarrhal inflammation, the mucous membrane thickens tens of times, up to filling the entire lumen of the sinus. Serous impregnation and sharp edema of the mucous membrane, cellular infiltration, dilated vessels, accumulation of exudate with the formation of extravasates are characteristic. Acute purulent inflammation is characterized by purulent deposits on the surface of the mucous membrane, hemorrhages, hemorrhages (in flu), pronounced round-cell infiltration. Periostitis and osteomyelitis processes are possible, up to sequestration.

What causes sinusitis?

Symptoms of sinusitis

The clinical course and symptoms of acute sinusitis are very similar. Usually, during recovery from ARVI and flu, a temperature reaction appears again, weakness, health deteriorates, symptoms of intoxication increase, reactive edema of the eyes and cheeks, profuse purulent discharge from the nose, pain in the sinus area appears (especially in young children). If the outflow is difficult, one-sided toothache, a feeling of pressure in the eye area can be observed. Headache is often without a specific localization. At the same time, nasal congestion, mucous or purulent discharge and, in connection with this, respiratory hypoxia appear. Significant swelling of the mucous membrane of the nasal cavity leads to a violation of the patency of the nasolacrimal canal and the appearance of lacrimation. It should be noted that in early childhood, all symptoms of sinusitis can be weakly expressed. With different localization of sinusitis, some features are noted.

Symptoms of sinusitis

Classification

According to the course, the following are distinguished: mild, moderate, severe; uncomplicated and complicated (rhinogenic and intracranial) forms.

By duration: acute (up to 1 month), subacute (up to 1.5-3 months), recurrent and chronic (over 3 months).

By localization: unilateral and bilateral, monosinusitis, polysinusitis, hemisinusitis and pansinusitis; ethmoiditis, sinusitis, frontal sinusitis, sphenoiditis.

By the nature of inflammation: catarrhal, serous, purulent, hemorrhagic, necrotic (osteomyelitis).

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Diagnosis of sinusitis

Until recently, direct examination of the paranasal sinus cavity was impossible; only with the development of modern endoscopy did observation become possible by inserting the finest endoscopes into the sinus. That is why simple accessible methods of assessing the condition of the nasal cavity and nasopharynx using external examination, palpation, anterior, middle and posterior rhinoscopy are becoming important.

Diagnosis of sinusitis

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Treatment of sinusitis

Since acute sinusitis is an infectious disease, it is natural that the attention of doctors is primarily focused on antibacterial treatment. However, the inflammatory process in the paranasal sinuses occurs in unusual conditions of a closed cavity, impaired drainage, deterioration of the ciliated epithelium function, and sinus aeration. Unfortunately, pediatricians do not take all this into account in most cases.

That is why we will focus on local treatment, which in a significant number of cases provides a positive effect without the use of antibiotics.

The primary objective is to improve drainage from the sinuses, which is achieved by using vasoconstrictors - decongestants. They eliminate swelling of the nasal mucosa, improving the outflow through natural openings. At the moment, there is a wide range of vasoconstrictors, slightly different in the mechanism of action. The main drugs are widely known: naphazoline (naphthyzinum, sanorin), galazolin, oxymetazoline (Nazivin) in children's doses. Nazivin has an additional advantage - prolonged action (up to 12 hours). It is preferable to use aerosol forms, since the spray is evenly distributed over the mucous membrane of the nasal cavity, this creates a longer and more pronounced therapeutic effect. At the stage of severe rhinorrhea, especially with a purulent nature of the discharge, you should not use oil-based decongestants, since they slightly reduce the function of the ciliated epithelium, worsening the outflow of sinus contents into the nasal cavity. Pay attention to the technique of introducing the drug into the nasal cavity. The child's head should be slightly tilted back and turned to the painful side. If the drug is administered by a doctor under rhinoscopy control, it is better to simply lubricate the area of the middle nasal passage - the semilunar fissure - with a vasoconstrictor.

Treatment of sinusitis

Forecast

With early diagnosis and timely treatment, the outcome is usually favorable.

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