Children’s sinuses are not yet well developed, the sinus mucosa is delicate and fragile, rich in vascular lymph, coupled with their own immune deficiency, sensitive to external stimuli, infectious factors, allergens and other reasons, the incidence of sinusitis remains high.
However, in the clinic, we found that many parents are often unaware of their children’s sinusitis, some think it is a small problem and indifferent, but some are the wrong doctor, the wrong medicine, so that the condition is prolonged, and even spread, causing complications such as otitis media, pharyngitis, lower respiratory tract infections, and even affect the growth and development of children.
Nasal congestion, runny nose, head and facial swelling, and decreased sense of smell are the four major symptoms of sinusitis in adults, but for children, the symptoms of sinusitis may not be typical and are not easily distinguishable from colds and nasal allergies, and sometimes they even show only respiratory or digestive tract symptoms.
Children, being young, may not be able to describe it well or simply do not know how to express it. To detect the telltale signs of sinusitis, we have to rely on the parents’ discernment. When asked how to detect sinusitis in children early, like in nasal congestion, the child may not be able to say, but will show a heavy nasal sound, poor breathing, resulting in restless sleep and open mouth breathing. These are not difficult to detect through careful observation.
Generally, history analysis, together with rhinoscopic examination revealing a large amount of purulent secretions in the middle nasal tract and olfactory fissure, together with CT scan if necessary, will lead to a clear diagnosis.
The possibility of sinusitis should be considered when a child presents with the following abnormalities.
1. frequent runny nose, especially in large amounts and purulent in nature.
2. frequent sputum, purulent and even bad breath, with nausea, vomiting or loss of appetite
3, frequent nosebleeds or nasal congestion.
4.Frequent dizziness and headache, aggravated by coughing or blowing the nose.
5, pressure pain in the cheek near the side of the nose.
6, chronic cough, coughing phlegm, heavier at night and in the morning.
In fact, for children with sinusitis, the results are still good as long as they are detected early and treated regularly.” However, parents and a few inexperienced doctors, misconceptions and practices about treatment often become a roadblock to treatment.
Four major misconceptions that delay treatment
Misconception 1: Misuse of antibiotics, actually trying to generate revenue. Baby just has a small sinusitis, the doctor gave a month of antibiotics, want to generate revenue?
Antibiotics play a pivotal role in the treatment of sinusitis. The antibiotics used for acute and chronic sinusitis are different due to different causes. Shi Jianbo said that for acute sinusitis (symptoms lasting no more than 12 weeks), second or third generation cephalosporin antibiotics, amoxicillin plus clavulanic acid are generally preferred, while for chronic sinusitis (symptoms lasting more than 12 weeks), clarithromycin is recommended.
Sinusitis medications do take quite a long time to administer. For example, acute sinusitis requires about 2 weeks or 3 to 5 days of continued medication after the purulent nasal discharge subsides; chronic sinusitis requires more than 12 weeks of medication. Many parents are unaware of this and suspect that the doctor’s motives are impure, so they refuse to use the medication or use it intermittently, resulting in inflammation that is difficult to cure.
Misconception 2: Hormones are fiercer than tigers. It is said that hormones have adverse effects when used in excess, but the doctor even let his daughter spray her nose for at least two months!
The application of topical glucocorticosteroids (such as endosulfan, co-corticosteroids, and ryanodine, etc.) is crucial to the treatment of sinusitis. However, some parents have a deep-rooted negative impression of hormones and refuse to accept long-term medication.
In fact, the amount of steroid hormones absorbed locally is very small when used in the nasal cavity; moreover, the high receptor affinity and low bioavailability of these hormones have even more minimal effects on the human body. Therefore, even in chronic sinusitis, which requires medication for more than 12 weeks, there is no need to be overly concerned. “But we do not advocate oral or intravenous, nasal hormone injections.” Shi Jianbo stressed.
Misconception 3: Use vasoconstrictors for nasal congestion. When my son first started using nasal drops, the effect was not bad, but then the more I used it, the worse it got, and now the nasal congestion is more powerful than before.
The use of low concentration vasoconstrictors, such as nasal drip (the main component is naphthazoline hydrochloride), ephedrine, etc., can indeed contract the nasal mucosa blood vessels, reduce mucus secretion, thus playing a role in reducing nasal congestion, nasal passage.
”But the medication generally should not exceed 7 days, otherwise, excessive vasoconstriction may lead to secondary expansion of mucosal vessels, ‘rebound congestion’, nasal turbinates but more swollen, nasal ventilation worse, but also may make the destruction of nasal cilia off, resulting in drug rhinitis, affecting the defense function of the nasal cavity. ” Shi Jianbo said so.
Misconception 4: Replacement therapy is very powerful.
Not only patients, but also doctors even have some treatment misconceptions. Shi Jianbo told us: “At present, there are still hospitals to carry out negative pressure replacement therapy, the principle is to use negative pressure to suck out the purulent secretions in the sinuses, and then the antibiotics and other drugs into the instillation. However, the disadvantage is that while the negative pressure sucks out the sinus secretions, it may also bring the purulent secretions in the nasal cavity into the sinuses, thus causing secondary infection. Therefore, the therapy is not really advisable.”
Acute sinusitis, conservative treatment mainly
In general, for acute sinusitis, conservative treatment is the mainstay. Oral antibiotics and mucus promoters (such as Genoton) can be given, vasoconstrictors are used appropriately, and antihistamines (such as loratadine, etc.) are added for those with allergic factors, together with morning and evening saline (see link for preparation method) to rinse the nasal cavity or local hot compresses with towels. With the above medications, most children can obtain more satisfactory treatment results.
Saline preparation method
Physiological saline, i.e. 0.9% sodium chloride solution, can be prepared directly with injectable saline or with 500 ml of warm water at 37-40 degrees Celsius to 4.5 grams of special nasal rinse salt powder. Special salt powder and rinse are available at pharmacies.
Chronic sinusitis, three-step treatment
For chronic sinusitis, a three-step treatment is advocated.
Phase I: Systemic medication (see conservative treatment of acute sinusitis).
Stage 2: Adjunctive surgical treatment. If the symptoms of sinusitis persist after standardized medication, the adenoids in children must be routinely examined and can be removed opportunistically if they are found to interfere with nasal ventilation and drainage.
Stage 3: Minimally invasive nasal endoscopic surgery. After adequate medication and pre-treatment are not effective, and it is confirmed that nasal polyps and hooked hypertrophy do exist to obstruct nasal ventilation and sinus drainage, minimally invasive nasal endoscopic surgery can be performed opportunistically, with the principles of small, delicate and minimally invasive. It is generally believed that minimally invasive nasal endoscopic surgery in children over 10 years of age will not affect their maxillofacial development.