Sinusitis in a child

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

Synonyms: sinusitis, etmoiditis, frontitis, 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 pancinusitis.
• J01.8 Another acute sinusitis.
• J01.9 Acute sinusitis, unspecified.
• J32.0 Chronic maxillary sinusitis.
• J32.1 Chronic frontal sinusitis.
• J32.2 Chronic, ethmoidal sinusitis.
• J32.3 Chronic sphenoidal sinusitis.
• J32.4 Chronic pancinusitis.
• J32.8 Other chronic sinusitis.
• J32.9 Chronic sinusitis, unspecified.

Infections and pathogenesis of sinusitis

In acute catarrhal inflammation, the mucous membrane thickens dozens of times, up to the filling of the entire lumen of the sinus. Characteristic serous impregnation and a sharp mucosal edema, cellular infiltration, dilated vessels, accumulation of exudate with the formation of extravasates. For acute purulent inflammation is characterized by purulent overlays on the surface of the mucous membrane, hemorrhage, hemorrhage (with influenza), severe circular cell infiltration. Possible processes of periostitis and osteomyelitis, up to sequestration.

What causes sinusitis?

Symptoms of sinusitis

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

Symptoms of sinusitis

Classification

With the flow, there are: light, medium, heavy; uncomplicated and complicated (rhinogenic and intracranial) forms.

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

Localization: unilateral and bilateral, monosynusitis, polysynusitis, hemisinusitis and pansinusitis; etmoiditis, sinusitis, frontalitis, sphenoiditis.

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

[1], [2], [3], [4], [5], [6], [7]

Diagnosis of sinusitis

Until recently, a direct examination of the cavity of the paranasal sinuses was impossible, only with the development of modern endoscopy it became possible to observe the insertion of the finest endoscopes into the sinuses. This is why simple, affordable ways of assessing the nasal cavity and nasopharynx by external examination, palpation, anterior, middle and posterior rhinoscopy become important.

Diagnosis of sinusitis

[8], [9], [10], [11],

Treatment of sinusitis

Because acute sinusitis is an infectious disease, it is natural that the attention of physicians is primarily drawn to antibacterial treatment. However, the inflammatory process in the paranasal sinuses occurs in unusual conditions of a closed cavity, disturbed drainage, impaired function of the ciliated epithelium, aeration of the sinus. All this, unfortunately, in most cases, pediatricians do not take into account.

That is why, we will stop on local treatment, in a significant part of cases providing a positive effect and without the use of antibiotics.

The paramount task is to improve drainage from the sinuses, this is achieved using vasoconstrictive drugs - decongestants. They eliminate the edema of the nasal mucosa, improving the outflow through natural openings. At the moment, there is a wide choice of vasoconstrictors, slightly different in the mechanism of action. The main drugs are widely known: naphazoline (naphthyzine, sanorin), galazoline, 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. In the stage of pronounced rhinorrhea, especially when the discharge is purulent, it is not necessary to use oil-based anticoestingants, since they slightly decrease the function of the ciliated epithelium, worsening the outflow of sinus contents into the nasal cavity. Attention is also paid to the technique of introducing the drug into the nasal cavity. The head of the child should be slightly thrown back and turned to the sore side. If the drug is administered by a doctor under the control of a rhinoscopy, it is better to simply lubricate the area of the middle nasal passage with a vasoconstrictor - a semilunar gap.

Treatment of sinusitis

Forecast

With early diagnosis and timely treatment, as a rule, it is favorable.

[12], [13], [14], [15]