As you are more familiar with sinusitis in children, you may want to start with a multiple choice question
The following options are symptoms of sinusitis in children (multiple choice).
A nasal congestion
B runny nose
C Cough
D Hearing loss
E Behavioral changes
In ENT clinics, we often encounter children with recurrent cough that has been prolonged for more than 1-3 months, with a mild to severe cough lasting from a few minutes to half an hour, with sputum and a foreign body sensation in the throat, most of them have no runny nose, some show aspiration of the nose, some show throat clearing and throat itching. He was referred to the ENT department after conservative treatment in pediatrics was not effective. On examination, he saw a congested pharynx, mucosal lymphoid follicle hyperplasia or cobblestone sign or pavement-like changes in the posterior pharyngeal wall, congested and enlarged tonsils, and pus flowing down the nasopharynx from the posterior pharyngeal wall. Sinus CT shows mucosal thickening, soft tissue hyperdensity shadow or fluid flattening.
When it comes to this, it comes to mind – sinusitis in children
Sinusitis in children is a common disease in otolaryngology, mostly manifested as nasal blockage, runny nose, headache, etc. It is not easily distinguished from general upper respiratory tract infection, but if it does not ease after a week of cold and yellow pus is constantly present, sinusitis needs to be considered. In children, because they cannot blow their noses, the snot can also flow into the mouth through the back of the nasal cavity and cause coughing when there is more snot. Some children show symptoms of gastrointestinal disorders such as nausea and poor appetite due to the swallowing of purulent nasal secretions. Since many children have a combination of adenoid hypertrophy and other diseases, they are also more prone to upper respiratory tract infections, so sinusitis is prone to recurrent attacks.
It should be noted that some children with sinusitis have cough as the main or even the only clinical manifestation, and some parents do not pay enough attention to the symptoms of nasal congestion and runny nose, but are more sensitive to cough, fever, headache and other manifestations, so many children with sinusitis repeatedly visit the pediatric department, which is easily ignored by clinicians, so that children do not receive timely and effective treatment and delay their condition.
Treatment of sinusitis in children: conservative treatment is the main focus. The use of antibiotics, anti-allergy, local glucocorticoids and decongestants, mucosal promoters and other drugs to achieve anti-inflammatory, reduce nasal mucosal edema, promote the drainage of sinus secretions, improve the function of the nasal cavity sinus mucosa. In combination with clinical practice, most children are supplemented with sinus replacement and nasal irrigation therapy, and maxillary sinus puncture and irrigation are performed in older children. In addition, rest and nutritious, easily digestible food should be given; if there is a combination of complications, they should be treated at the same time. After the above treatment, the cough improved significantly and gradually disappeared.
As you may remember, when the living conditions in rural areas were poor some years ago, there were many children who hung up their oil bottles (dragging snot) every day, and their sleeves were all oily and shiny, and the typical performance of runny nose easily made people think of pediatric rhinitis sinusitis. However, the anatomy and physiology, pathogenesis and pathological features of sinusitis in children are not the same as those in adults, and some of the symptoms are not typical, some of them only show cough, which is easy to misdiagnose and mistreat.
The postnasal drip syndrome comes to mind when we talk about it
Postnasal drip syndrome is a syndrome in which secretions flow backward into the postnasal and pharyngeal areas or even backward into the vocal cords or trachea due to nasal diseases, or inflammatory secretions in the nose of patients with allergic rhinitis can flow through the postnasal orifice and pharynx or be inhaled into the lungs, resulting in a cough as the main manifestation.
The main reason is that physicians lack knowledge of postnasal drip syndrome and only pay attention to the tonsils, pharynx and lung manifestations, and diagnose interstitial pneumonia when they see thick and deep texture on chest radiographs, ignoring the patient’s medical history and other signs. In fact, postnasal drip syndrome is the most common cause of chronic cough, and patients with chronic cough can be given specific empirical treatment for postnasal drip syndrome until the cause is determined and the disease is diagnosed based on the outcome.
The typical clinical manifestations of patients with postnasal drip syndrome are.
A. Paroxysmal or persistent cough, mainly during the day and less frequently after sleep;
Most patients have postnasal discharge, oral mucus, itching in the throat, foreign body sensation or the feeling of “paste sticking to the throat”, and frequent throat clearing. Simply put, the backflow of nasal secretions causes discomfort in the throat, which naturally leads to a reflexive cough;
Third, there are symptoms such as nasal itching, nasal congestion, runny nose and sneezing;
4. Some patients also have hoarseness, and even speech can trigger coughing;
V. A history of rhinitis, sinusitis, nasal polyps or chronic laryngitis.
When it comes to this, you will also think of – adenoiditis
The nasal symptoms of adenoiditis: hypertrophic adenoids and mucopurulent secretions can block the posterior nostrils and attach to the throat wall, stimulating the pharynx and causing coughing, secretions can also accumulate in the nasal cavity, and it is not easy to blow out, so it is often combined with rhinitis and sinusitis and symptoms of nasal congestion, runny nose, and open-mouth breathing, speech with an occlusive nasal sound and snoring during sleep.
Sinusitis and adenoiditis in children can often cause pharyngotonsillitis and otitis media, which can lead to hearing impairment, cognitive and learning loss, as well as recurrent lower respiratory tract infections and pediatric snoring, which can seriously affect the quality of life of children and their families.
Therefore, when diagnosing chronic cough in pediatric patients clinically, it is important to take a detailed medical history, physical examination, and appropriate ancillary tests to avoid misdiagnosis.