Sinus Disease / Abnormalities

The nose

The nose is the organ of smell located in the middle of the face. The internal part of the nose lies above the roof of the mouth. The nose consists of:

  • External meatus – triangular-shaped projection in the center of the face
  • External nostrils – two chambers divided by the septum
  • Septum – made up primarily of cartilage and bone and covered by mucous membranes. The cartilage also gives shape and support to the outer part of the nose.
  • Nasal passages – passages that are lined with mucous membranes and tiny hairs (cilia) that help to filter the air.
  • Sinuses – four pairs of air-filled cavities, also lined with mucous membranes.

The sinuses

The sinuses are cavities, or air-filled pockets, near the nasal passage. As in the nasal passage, the sinuses are lined with mucous membranes. There are different types of sinuses:

  • Ethmoid sinus – located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.
  • Maxillary sinus – located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues to grow.
  • Frontal sinus – located inside the face, in the area of the forehead. This sinus does not develop until around 7 years of age.

Sinusitis

Sinusitis is an infection of the sinuses near the nose. These infections usually occur after a cold or after an allergic inflammation. There are three types of sinusitis:

  • Acute sinusitis – occurs quickly and improves with the appropriate treatment
  • Subacute sinusitis – does not improve with treatment initially, and lasts less than three months
  • Chronic sinusitis – occurs with repeated acute infections or with previous infections that were inadequately treated. The symptoms last longer than three months.

What causes it?

Sometimes, a sinus infection happens after an upper respiratory infection (URI) or common cold. The URI causes inflammation of the nasal passages that can block the opening of the paranasal sinuses. When the flow of secretions from the sinuses is blocked, bacteria may begin to grow. This leads to a sinus infection, or sinusitis. Allergies can also lead to sinusitis because of the swelling of the nasal tissue and increased production of mucus. Other possible conditions that can block the normal flow of secretions out of the sinuses and can lead to sinusitis include the following:

  • Abnormalities in the structure of the nose
  • Enlarged adenoids
  • Diving and swimming
  • Infections from a tooth
  • Trauma to the nose
  • Foreign objects stuck in the nose
  • Cleft palate

The most common bacteria that cause sinusitis include the following:

  • Streptococcus pneumonia
  • Haemophilus influenzae
  • Moraxella catarrhalis

Symptoms

The symptoms of sinusitis depend greatly on the age of the child. The following are the most common symptoms of sinusitis. However, each child may experience symptoms differently. Symptoms may include:

  • In younger children: A runny nose that lasts longer than seven to 10 days; discharge is usually thick green or yellow, but can be clear; nighttime cough; occasional daytime cough; swelling around the eyes; usually no headaches younger than 5 years of age
  • In older children and adults: A runny nose or cold symptoms lasting longer than seven to 10 days; a drip in the throat from the nose; headaches; facial discomfort; bad breath; cough; fever; sore throat; swelling around the eyes, often worse in the morning.

The symptoms of sinusitis may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.

The diagnosis

In addition to a complete medical history and physical examination, diagnostic procedures for sinusitis may include the following:

  • Cultures from the nose or sinus fluid – laboratory tests that involve the growing of bacteria or other microorganisms to aid in diagnosis.
  • Sinus x-rays – diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. (X-rays are not typically used, but may help assist in the diagnosis.)
  • Computerized tomography (Also called CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called “slices”), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • Blood tests

Treatment

Specific treatment for sinusitis will be determined by your child’s physician based on:

  • Your child’s age, overall health, and medical history
  • Extent of the infection
  • Your child’s tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the infection
  • Your opinion or preference

Treatment of sinusitis may include the following:

  • Antibiotics, as determined by your child’s physician (antibiotics are usually given for 10 to 14 days, and sometimes longer)
  • Acetaminophen (for pain or discomfort)
  • Use of a cool mist humidifier in your child’s room
  • Nasal drops

Decongestants and antihistamines may not help the symptoms of sinusitis.

Allergic rhinitis

Rhinitis is a reaction that occurs in the nose when airborne allergens trigger the release of histamine. Histamine causes itching, swelling and mucus production in the fragile linings of nasal passages, sinuses, and eyelids.

There is usually a family history of allergy problems.

Types of allergic rhinitis

The two categories of allergic rhinitis include:

  • Seasonal – occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after four years of age.
  • Perennial – occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.

What causes it?

The most common allergens that cause allergic rhinitis include the following:

  • Pollen
  • Dust mites
  • Mold
  • Animal dander

Symptoms

The following are the most common symptoms of allergic rhinitis. However, each child may experience symptoms differently. Symptoms may include:

  • Sneezing
  • Stuffiness
  • Runny nose
  • Itchy nose, throat, eyes, and ears
  • Nosebleeds
  • “Allergic salute” is when a child rubs his/her hand upward across the bridge of the nose while sniffing. This may cause a line or crease to form across the bridge of the nose.

Children with perennial allergic rhinitis may also have the following associated problems:

  • Recurrent ear and sinus infections
  • Snoring
  • Mouth breathing
  • Fatigue
  • Poor performance in school

The symptoms of allergic rhinitis may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.

The diagnosis

Typically, the diagnosis is made by your child’s physician based on a thorough medical history and physical examination. In addition to the above symptoms, your child’s physician may find, upon physical examination, dark circles under the eyes, creases under the eyes, and swollen pale tissue inside the nose. The diagnosis is confirmed by allergy skin tests.

Treatment

Specific treatment for allergic rhinitis will be determined by your child’s physician based on:

  • Your child’s age, overall health, and medical history
  • Extent of the reaction
  • Your child’s tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the reaction
  • Your opinion or preference

Treatment options may include:

  • Avoidance of the allergens that are causing the problem is the best treatment.
  • Over-the-counter antihistamines antihistamines help to decrease the effects of histamine, and decrease the symptoms of itching, sneezing, or runny nose. An example of an antihistamine is diphenhydramine (Benadryl®). Some antihistamines may cause drowsiness. Consult your child’s physician to determine the proper dosage.
  • Nonsedating antihistamines work like antihistamines but without the side effect of drowsiness. Nonsedating antihistamines may include loratadine (Claritin®) or fexofenadine (Allegra®). Consult your child’s physician to determine the proper dosage.
  • Anti-inflammatory nasal sprays help to decrease the swelling in the nose. An example is cromolyn (Nasalcrom®). Consult your child’s physician to determine the proper dosage.
  • Corticosteroid nasal sprays also help to decrease the swelling in the nose. Corticosteroid nasal sprays work best when used before the symptoms start. Consult your child’s physician to determine the proper dosage.
  • Decongestants help by making the blood vessels in the nose smaller, thus, decreasing stuffiness. Decongestants can be purchased either over-the-counter or by prescription. Consult your child’s physician to determine the proper.

If your child does not respond to avoidance or to the above medications, your child’s allergist then may recommend allergy shots or immunotherapy based on the findings. Immunotherapy usually involves a three- to five-year course of repeated injections of specific allergens to decrease the reaction to these allergens when your child comes into contact with them. Consult your child’s physician for more information.

Prevention

Preventive measures for avoiding allergic rhinitis include:

  • Environmental controls, such as air conditioning, during pollen season
  • Avoiding areas where there is heavy dust, mites, molds
  • Avoiding pets

The link between allergic rhinitis and asthma:

Controlling asthma may mean controlling allergic rhinitis in some patients, according to allergy and asthma experts. Allergic rhinitis affects up to 26 percent of Americans. The majority of asthma patients have rhinitis, and patients with rhinitis have a much higher prevalence of asthma than those who do not have rhinitis.

The link between asthma and allergic rhinitis was discussed at an annual meeting of the American College of Allergy, Asthma and Immunology. Newly released guidelines from the World Health Organization (WHO) recognize the link between allergic rhinitis and asthma. Although the link is not fully understood, one theory asserts that rhinitis makes it difficult to breathe through the nose, which hampers the normal function of the nose. Breathing through the mouth does not warm the air, or filter or humidify it before it enters the lungs, which can make asthma worse.

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