Sinusitis in children: symptoms and treatment Komarovsky

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Doctor Komarovsky about sinusitis

The diagnosis of “sinusitis” sounds ominous for most mothers and fathers. The attitude that sinusitis is a very dangerous disease, and treating it is incredibly difficult and dangerous, is firmly ingrained in the parental mind.

Table of contents:

Is this so, says authoritative children's doctor, author of books on children's health and TV presenter Evgeniy Komarovsky.

What it is?

People have a rather vague concept of sinusitis. It is often mistakenly attributed to all sorts of problems with nasal breathing, which, in fact, are allergic rhinitis or a type of sinusitis. Sinusitis is also a type of sinusitis, but with it only the maxillary sinuses (paranasal sinuses) are affected (inflamed). These sinuses are located on both sides of the nose in the maxillary bone. Due to mucus accumulated in the sinuses, a blockage of the narrow channel that connects them to the nose can occur, and the inflammatory process of the membrane begins.

Sinusitis can be viral, allergic and bacterial, unilateral and bilateral. According to the duration of the disease - acute and chronic. By type of pathology - purulent (exudative), necrotic (with death of the sinus mucosa), productive (associated with the growth of polyps), atrophic (with atrophy of the mucosa).

The maxillary sinuses in newborns are very small, they grow with the child, and reach normal size only by the age of 4-5. It is for this physiological reason that sinusitis does not occur in children under 3-4 years of age.

Causes

There is a widespread belief that sinusitis is the cause of untreated or improperly treated ARVI, influenza and a number of other respiratory infections that are accompanied by a runny nose. Dr. Komarovsky has his own opinion on this, different from the standard one.

He claims that viruses that cause ARVI also cause sinusitis, in other words, if a child inhales a viral agent, the foreign organism will enter not only the nasopharynx, but also the maxillary sinuses, which are anatomically located immediately behind it and together constitute a single respiratory “ complex".

Thus, if a child begins to have liquid discharge from the nose, then he has not only acute viral rhinitis, but also acute viral sinusitis. Komarovsky considers this statement to be true for 100% of children with ARVI. And parents need to understand that this is completely normal.

The situation becomes abnormal if the inflammatory process in the maxillary sinuses persists after the main signs of the viral infection have passed. Typically, a child’s body copes with the virus in 5-7 days. If the disease has generally subsided, but the symptoms of sinusitis remain, doctors talk about bacterial sinusitis. In the acute period, a viral illness led to a large secretion of mucus that accumulated in the sinuses. And bacteria began to actively multiply in it. This leads to the formation of pus. According to Evgeniy Komarovsky, the probability of a bacterial complication of ordinary viral sinusitis during ARVI is about 2-3%.

Symptoms

It is quite simple to understand that a child has sinusitis, says Evgeniy Komarovsky. This disease has quite classic and specific signs and symptoms:

  • Nasal congestion;
  • Impaired sense of smell up to complete inability to recognize and smell;
  • The presence of pain in the area of ​​the maxillary sinuses is mandatory (with obligatory intensification when tilting the head forward);
  • Weakness, feeling of being “broken”;
  • Increase in body temperature to 37.5-38.0 degrees;
  • Headache;
  • A clear feeling of “pressure”, fullness in the area of ​​the maxillary sinuses;
  • Enlargement of the cheek on the affected side, facial asymmetry (visually noticeable).

If we are talking about chronic sinusitis (more than three weeks), the symptoms will not be as pronounced, and it will be much more difficult to recognize it.

The protracted and chronic form of the disease is characterized by persistent nasal congestion, nasal discharge is thick and does not respond to conventional treatment, and redness of the mucous membrane of the eyes is possible in the morning after a night's sleep.

In chronic illness, body temperature does not rise.

Allergic sinusitis also has a chronic course and is quite difficult to treat with medication. It has almost all the characteristic symptoms, with the exception of yellow-green nasal discharge.

Diagnostics

If you suspect sinusitis, parents should consult an otolaryngologist. The specialist will give a referral for diagnostic tests. Usually the disease is clearly visible on an x-ray of the sinuses as a darkening, the picture is complemented by a blood test with a modified formula. Komarovsky reminds that an x-ray will show not only bacterial, but also viral sinusitis, and the ENT specialist will simply be obliged to prescribe antibiotics to the child when making such a diagnosis based on the image.

Therefore, if there is no pain and signs of a bacterial infection, Evgeniy Komarovsky advises not to take the child for an x-ray. By the way, this research method is not used anywhere in the world as the main method for diagnosing sinusitis.

Treatment according to Komarovsky

Acute viral sinusitis in a child, according to Evgeniy Komarovsky, does not require special treatment. In most cases, in both adults and children, it passes when the immune system completely “deals” with the foreign agent that entered the respiratory system and caused ARVI.

During these 3-7 days, it is important to let your child drink as much fluid as possible to avoid the mucus in the sinuses from drying out and becoming clogged. You can and should irrigate the nasal cavity with saline solutions by instilling or spraying them into the nose.

In the room you need to create conditions favorable for recovery: air humidity 50-70%, air temperature 18-20%, the air must be clean.

A complication in the form of bacterial sinusitis requires medication and treatment. Antibiotics are used to neutralize bacterial activity, and decongestants, rinses and drops are used to reduce swelling. The child should also be allowed to drink more, he should breathe air that is “correct” in terms of humidity and temperature. The average course of taking antibiotics in the treatment of this disease, according to Komarovsky, is days.

There is no point in giving a child antibiotics earlier while the sinusitis is acute and viral.

Antibacterial drugs are ineffective against viruses, and certainly do not reduce the risk of bacterial complications. Moreover, the risk of getting purulent discharge, on the contrary, increases.

There is another danger in taking prophylactic antibiotics for acute sinusitis. While the child takes them, bacteria begin to multiply in the maxillary sinuses, which, due to drug support, are very resistant to antibiotics. Purulent sinusitis will still begin, but it will be very difficult to treat.

The allergic form of the disease is treated not even with medications, but by searching for and eliminating the antigen that causes the child’s allergy. If the allergist was unable to find the “culprit” for swelling of the maxillary sinuses using special samples and tests, then parents need to avoid contact with any allergens as much as possible - pollen, house dust, household chemicals, especially chlorine-based ones, and also actively humidify the air in the apartment . In severe cases of the disease, the doctor may prescribe antihistamines.

About “punctures”

Such a radical method as a puncture in the inside of the nose with a needle penetrating the sinus and pumping out accumulated pus and mucus from it may be an adequate prescription for a completely adequate doctor, says Komarovsky. Popular myths and legends that say that someone who has made a puncture once will do it again and again do not stand up to criticism and cannot be explained in any way by medicine.

In most developed countries with equally developed medicine, the procedure for puncturing the maxillary sinus is often used not only as a therapeutic procedure, but as a diagnostic procedure, the purpose of which is to take a little of the contents of the sinus and find out which microbe caused this condition.

This does not mean that piercing is a measure that can be recommended to everyone. Komarovsky emphasizes that there are strict indications for the procedure:

  • The nature of the inflammatory process is unknown, diagnostics did not answer this question;
  • Antibiotics do not work, inflammation does not decrease;
  • Acute pain and high fever, treatment failure.

About folk remedies

On the Internet you can find many folk recipes for the treatment of sinusitis. Moreover, even if the mother does not go on the Internet to look for a panacea, then a neighbor, grandmother, or friend will most likely helpfully suggest another “effective method”. Evgeny Komarovsky urges parents to refrain from treating sinusitis with folk remedies.

The viral form of the disease cannot be treated either with medications or folk remedies. But it is simply dangerous to treat bacterial infections by instilling onion juice and compresses with honey. The doctor warns that any heating of purulent sinusitis, any warming compresses contribute to even more severe inflammation, since bacteria multiply many times faster in a warm environment.

Komarovsky also considers common advice to breathe over hot milk or herbal decoctions during this disease to be quite dangerous. The fact is that the effectiveness of inhaling steam for inflammation of the maxillary sinuses is minimal, and the risk of getting burns to the respiratory tract is very high.

Adviсe

One of the effective ways to prevent sinusitis is vocal training. While singing, breathing becomes more intense.

If the house does not have an air humidifier, Komarovsky recommends that parents put water in basins so that it evaporates freely, and equip heating radiators with special valves to regulate the heating intensity in winter.

With sinusitis, if there is no temperature, the child can easily live a normal life - go to the pool, take a walk, even in winter, attend school or kindergarten, play sports.

Dr. Komarovsky will tell you more about sinusitis in the video below.

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Source: http://www.o-krohe.ru/komarovskij/gajmorit/

Symptoms of sinusitis in children and methods of treating the disease

Children with a cold are often diagnosed with sinusitis, an inflammatory process that occurs in one or more paranasal sinuses (sinuses). Parents are very worried about the baby: it is not clear what lies behind the name of this disease, how dangerous it is. You can relieve anxiety by understanding its nature and causes. Then it will become clear how to alleviate the child’s condition and quickly cure his nose.

Sinusitis is a very common disease, affecting about a quarter of children worldwide.

Reasons for the development of sinusitis

Inflammation of the paranasal sinus occurs due to a combination of two reasons:

  1. There are pathogens (viruses or bacteria) in the nasal cavity.
  2. Natural ventilation has been disrupted.

It is not difficult to pick up pathogens from an infected person. Even if the child is at home all the time, the risk of getting sinusitis does not decrease. Adults constantly communicate with someone, and their interlocutors will not always say that they are sick. Therefore, the infection is brought home, and all household members receive it. But if everything is in order with the ventilation of the nasal sinuses, then the body copes with the infection. Otherwise, inflammation begins.

Ventilation can be disrupted for several reasons:

  • anatomical feature - narrow anastomoses (passages connecting the sinuses with the nasal cavity);
  • crooked nasal septum;
  • blockage of the anastomosis with mucus during a runny nose;
  • swelling of the mucous membrane;
  • nasal polyps;
  • proliferation of the pharyngeal tonsil (adenoids).

“My daughter complained of pain near her nose for several days. She looked tired and her temperature began to rise. I took her to the ear, nose and throat. The doctor examined the daughter. It turned out that there was a small part from a toy deep in the nose. She closed the anastomosis, completely isolating the maxillary sinus. This caused bacteria to multiply."

Buttons, beads, food, and insects that get into the nasal passage can cause inflammation.

Sinusitis develops more often in children than in adults. This is due to the size of the lumen of the nasal passages. The narrower it is, the easier the blockage occurs.

Symptoms of sinusitis in a child

Sinusitis usually develops not as an independent disease, but as a consequence of an untreated acute respiratory viral infection or a complication of influenza. Therefore, keep an eye on your child who has a cold. And if you have at least 2-3 of the following signs, contact your doctor for additional examination:

    • persistent runny nose;
    • labored breathing;
    • alternating nasal congestion (either the right or left nostril does not breathe);
    • copious discharge of sputum (sometimes with purulent content) in the morning;
    • dry throat during the day;
    • heaviness and pain around the nose or in the bridge of the nose (increased if you lean forward);
    • pain spreading to the cheeks, cheekbones, teeth and eyes;
    • headache;
    • increased facial sensitivity;
    • the child does not smell;
    • eyelids and cheeks swell;
    • increased body temperature;
    • general malaise, manifested in rapid fatigue, memory loss and increased irritability.

Typically, the cause of sinusitis is a viral infection.

When children have sinusitis, the light hurts their eyes, so they try to stay in dark places in the room or cover themselves with their hands and squint. In this case, lacrimation is observed. A sick child has difficulty falling asleep and refuses to eat.

“Alina is 4 years old. At first she caught a cold, then the symptoms subsided. But after a few days they intensified. New ones appeared: the daughter began to complain of pain near her nose, her face seemed swollen. Then Alina stopped smelling smells that she didn’t like before. I turned to the pediatrician, and my assumption was confirmed - sinusitis began.”

Classification - forms of the disease

There are many sinuses, or cavities, in the cranial bone. Below is a list of them indicating the number of sinuses of this type. In parentheses is the name of the inflammation that affected only these sinuses.

  • Lattice - 2 (ethmoiditis). Children are born with these sinuses, so the disease can develop even in newborns.
  • Maxillary sinusitis - 2 (sinusitis). Dr. Komarovsky assures that it cannot begin earlier than 3-4 years, because in newborns these sinuses are in an underdeveloped state. However, their full formation ends only by the age of 7 years.
  • Frontal - 2 (frontitis). Sinuses develop by age 5.
  • Wedge-shaped - 1 (sphenoiditis). From the age of 10.

There are two main forms of the disease. Their symptoms are slightly different from each other:

    • Acute sinusitis. Accompanied by copious discharge of mucus and/or pus, nasal congestion. The sense of smell decreases or disappears completely. The pain and heaviness of the paranasal areas of the face intensify when bending over. The temperature is elevated, and a blood test reveals an increase in ESR and leukocytes. The temperature rises to 38 degrees and above.

In the acute form of the disease, the inflammatory process begins suddenly.

  • Chronic sinusitis. It is characterized by purulent discharge flowing down the nasopharynx or coming out of the nose. They are the ones that cause coughing. The child's mouth smells unpleasant. He has a headache and blood rushes to his face, making it red. Nose is stuffed. Body temperature may remain normal; rarely the thermometer scale shows 37-37.5°C. And the blood test will be the same as for a healthy child.

The duration of the acute course of the disease is up to 3 months. And if it returns several times during the year, then they speak of acute recurrent sinusitis.

Sometimes they talk about allergic sinusitis. This name only indicates the cause that led to the development of the disease. Her symptoms remain the same. The fact is that with an allergic rhinitis, the mucous membrane swells. This leads to narrowing of the anastomosis. Ventilation of the sinuses is impaired, and this contributes to the proliferation of pathogenic microflora. Inflammation begins.

Purulent sinusitis can be either acute or chronic. It is characterized by pus in nasal discharge. The causative agents in this case are bacteria (Haemophilus influenzae, pneumococcus or Moraxella).

As a rule, the diagnosis is confirmed by x-ray examination.

Treatment tactics

Treat sinusitis once the diagnosis is confirmed. It is diagnosed by a doctor based on a survey of the mother and child, as well as after examining an x-ray. However, Komarovsky believes that x-rays are useless in this case, because inflammation in the form of a darkened area will look the same with sinusitis as with a runny nose.

Depending on the form and severity of the disease, medicine offers:

  • Symptomatic treatment of sinusitis (refusal of walking, inhalation, plenty of warm drinks, taking anti-inflammatory and antipyretic drugs as indicated).
  • Irrigation-elimination therapy (rinsing the nasal passages and sinuses, using vasoconstrictors).

Vasoconstrictor nasal drops will ease the child’s condition.

  • Antibacterial therapy. The method is effective only for purulent sinusitis, which is caused by bacteria. In other forms of the disease, antibiotics will only do harm.
  • Surgical treatment (puncture). This is an extreme measure if other methods have not given a positive result, and the drainage of pus naturally is impossible.

Inhalations help with this:

  • Traditional medicine suggests breathing over a bowl of hot water or freshly boiled potatoes.
  • Decoctions of sage, chamomile, eucalyptus or oregano help greatly. Instead, you can use hot water with the addition of a few drops of essential oil of these herbs.
  • When inhaling with a nebulizer, mucolytic, anti-inflammatory, antiseptic and antibacterial agents are used.
  • Cold inhalations are popular in folk medicine: it is useful to breathe over finely chopped onions or horseradish.

To rinse the paranasal sinuses, use:

  • saline solution;
  • Aqua Maris;
  • Marimer;
  • Fluimarin.

Washing is an effective and simple way to cleanse the mucous membrane of pathogenic microorganisms.

Suitable vasoconstrictor drugs:

Among antibiotics, pediatricians recommend drugs with the active ingredient amoxicillin. These are Amoxiclav, Amosin or Hiconcil in the form of a suspension or Flemoxin Solutab in tablets. And if sinusitis is allergic in nature, then antibacterial medications will not help. Here you will need antihistamines: Zyrtec, Cetrin, Zodak or Dezal.

Zyrtec will help with allergic sinusitis.

Complications and consequences

The disease is dangerous because it easily becomes chronic. This happens if the wrong treatment is chosen or it is not carried out. Sometimes parents feel sorry for the child and do not rinse the nose, do not give medicine at all, or do it irregularly.

It recurs several times a year and increases the incidence of acute respiratory viral infections, and also causes damage to internal organs (kidneys, liver, lungs and heart).

When is it justified to call a doctor?

If your child is sick, visit your pediatrician as soon as possible. If the temperature rises to 38 degrees, bring it down with Paracetamol or Nurofen in the form of a suspension. If it continues to rise, call a doctor at home.

Prevention

Sinusitis cannot be cured forever. It can return when conditions favorable for the development of the disease are formed: the presence of a pathogen and impaired ventilation. Therefore, carry out prevention:

    • Isolate your baby from sick people.
    • Avoid contact with the allergen.
    • Maintain high air humidity in the nursery (about 60-70%).

It is advisable that the humidity in the children's room is about 60%.

  • Ventilate the room twice a day.
  • Walk with your child for an hour a day.
  • Treat runny nose, ARVI and other diseases in a timely manner.

“Five-year-old Kirill’s sinusitis has just been cured. After antibiotics and other chemicals, I decided to protect my son: I didn’t let him go for walks and didn’t open the window, I was afraid that he would get blown out and he’d get sick again. But after a few days the symptoms returned. The doctor said that after recovery it was necessary to lead a normal lifestyle, and not isolate from the world. Without walking, the sinuses were poorly ventilated.”

Sinusitis rarely starts on its own. It is preceded by ARVI or runny nose. Therefore, do not hope that they will go away on their own: be sure to show your child to the doctor. He will choose the right treatment. Then the cold will not remain untreated, and complications in the form of inflamed sinuses will bypass you.

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Source: http://www.o-my-baby.ru/zdorovie/bolezni/sinusit.htm

Sinusitis: symptoms and treatment in children. How to recognize?

Sinusitis in children is quite common. This disease is quite dangerous, since it can quickly become chronic and cause the development of a huge number of complications that are dangerous not only to health, but also to life.

Therefore, it is very important for parents to understand when they should pay special attention to a runny nose and show the baby to the doctor. This, as well as how the pathology is diagnosed and treated, will be discussed below.

What is sinusitis in a child: causes of development

Sinusitis is traditionally called inflammation of the mucous membrane of the first or several paranasal sinuses (sinuses), localized on both sides and in the area of ​​the bridge of the nose. The main cause of its occurrence is acute respiratory infections caused by viruses or bacteria.

However, sometimes pathogenic fungal flora can also lead to the development of pathology. Against the background of impaired outflow of mucus containing pathogenic microorganisms, if recommendations for nasal care during rhinitis are not followed, inflammation from the nasal mucosa spreads to the paranasal sinuses, which leads to the development of the disease.

Somewhat less frequently, the following are prerequisites for the development of sinusitis:

  • deviated nasal septum;
  • hypertrophy (increase in size) of shells;
  • ridges and spines of the nasal septum;
  • allergic rhinitis;
  • polyps and tumors of any other nature;
  • teeth affected by caries and, in particular, their roots.

These factors often lead not only to the occurrence of sinusitis in children, but also to disruption of the development of the paranasal sinuses. As a result of this, their shape, size and even the diameters of the anastomosis and passages are distorted.

Classification of sinusitis: forms of the disease. Differences

There are several categories by which types of disease are distinguished. According to the localization of the process, they are distinguished:

  • sinusitis - damage to the maxillary sinus;
  • frontal sinuses - damage to the frontal sinuses;
  • ethmoiditis is an inflammatory process affecting the cells of the ethmoid labyrinth;
  • sphenoiditis is a rarely self-developing inflammatory process in the sphenoid sinus, located deep behind the nose;
  • pansinusitis – simultaneous damage to all paranasal sinuses.

If only one of the paired sinuses is affected, a diagnosis of unilateral sinusitis is made. If both are affected, it is bilateral.

Depending on the duration of the pathology, they speak of an acute or chronic form. The latter is diagnosed only if symptoms persist for more than 3 months.

According to the nature of the inflammatory process, they are distinguished:

  • catarrhal (observed mainly in viral infections);
  • purulent (typical of infection with bacterial flora).

Children under 3 years of age rarely suffer from the disease. In older children, acute sinusitis is most often diagnosed.

Symptoms of sinusitis in a child. How to recognize?

In acute sinusitis, not only the paranasal sinuses are affected, but the entire body as a whole. Therefore, the signs of pathology are quite multifaceted and are manifested by the occurrence of disturbances in the functioning of many organs.

Thus, if sinusitis occurs in a child, the symptoms will be as follows:

  • fever, fatigue;
  • headaches and a feeling of fullness in the affected sinuses, aggravated by bending the head forward and pressing on the tissue over the affected sinuses;
  • constant or periodic difficulty in nasal breathing, and usually the baby can breathe normally in the morning, but in the evening his condition worsens;
  • rhinorrhea;
  • deterioration of sense of smell;
  • swelling of the soft tissues of the face in the projection of the inflamed sinus.

The most specific sign of the disease in the acute period is headache, pain observed against the background of a runny nose. Usually it is diffuse in nature, but in the presence of a unilateral process it can be localized precisely on the side of the affected sinus.

In this case, sometimes a cough may also be present with sinusitis in a child, although it is not characteristic of the disease itself. Cough is a frequent companion to acute respiratory infections and other similar diseases that can precede the development of sinusitis or occur against its background.

Sometimes a cough appears in response to mucus flowing down the back wall of the nasopharynx, which is often observed in the morning or when the cells of the back of the ethmoid labyrinth or sphenoid sinus are inflamed.

Chronic sinusitis manifests itself in a similar way. But its main feature is a certain frequency of occurrence of signs of pathology, for example, exacerbations are often observed in autumn and spring, when climatic conditions are most conducive to the active reproduction of viruses.

When should you call a doctor?

The reason for calling a specialist is always an increase in temperature, and in the acute form of the pathology it can reach 39 °C or higher. In any case, it is extremely difficult to cure the disease on your own and is dangerous due to the development of life-threatening complications.

Moreover, the sooner competent therapy is started, the faster the recovery will occur. Therefore, you should consult a doctor when the first symptoms of the disease appear.

Diagnostic measures: which doctor should I contact?

Traditionally, sinusitis is treated by an otolaryngologist or ENT specialist. However, in the absence of such a specialist in the local clinic, which is often the case in small villages, you can contact a pediatrician.

To diagnose the disease, patients are prescribed:

  • general blood and urine analysis;
  • rhinoscopy – endoscopic examination of the nasal passages and surrounding structures;
  • X-ray;
  • CT;
  • MRI.

In severe cases, when the therapy does not produce results, a microbiological examination of the contents of the affected sinuses is prescribed to accurately determine the type of pathogen and its susceptibility to various antibiotics.

Sinusitis in a child: treatment. Step by step

Treatment of sinusitis in a child begins only after the cause of its development has been accurately established and eliminated, since its effectiveness directly depends on this.

If it lies in the presence of a diseased tooth, then one of the first stages of treatment is the elimination of caries, and in case of severe destruction, removal.

Otherwise, even complete therapy in full compliance with the doctor’s instructions will not bear the expected fruits or the pathology will soon recur.

Once the cause is eliminated, patients are prescribed drugs with antibacterial activity to destroy pathogenic bacterial microflora.

It is also necessary to prescribe medications for sinusitis, which help accelerate the evacuation of mucus from the sinuses and restore their normal drainage and aeration.

For this purpose the following are appointed:

  1. saline solutions for irrigation, that is, washing the nose (Marimer, Aqualor, Physiomer, Humer, Aquamaris, saline, etc.);
  2. vasoconstrictor drops (Nazivin, Nazik, Noxprey, Rinazolin, Galazolin, Vibrocil, Rinofluimucil, etc.);
  3. corticosteroids (Nasonex, Beconase, Flixonase, Avamis, etc.);
  4. NSAIDs (Paracetamol, Panadol, Nurofen, Ibuprofen);
  5. homeopathic remedies (Sinupret, Cinnabsin, etc.).

In severe situations, patients are recommended to undergo a “cuckoo test”. This procedure, carried out in an ENT office, involves professionally flushing the paranasal sinuses from mucus accumulated in them by injecting a solution into one nostril and suctioning it through the other using a vacuum.

In the presence of sinusitis, much less often frontal sinusitis, with the release of purulent secretion and insufficient effectiveness of drug therapy, parents of patients are offered to perform a puncture (puncture) of the affected sinus, followed by washing it with solutions of antibiotics and antiseptics.

But this technique is practiced only in extreme cases, when conservative measures cannot cope with the disease.

Hospitalization is required only in severe situations when complications may develop.

Antibiotics for sinusitis in children

For mild catarrhal forms, drugs for local use, that is, sprays, can be used:

In more severe cases, oral forms of antibiotics are prescribed, for example, Cefix, Cefodox, Amoxicillin, Sumamed, Ciprofloxacin, Floracid, etc.

Patients are also often prescribed antiseptic drops, such as Protargol or Collargol.

How to treat sinusitis in children: Dr. Komarovsky

In many of his books and videos, the popular children's doctor E. O. Komarovsky talked about the symptoms and treatment of sinusitis, etc.

First of all, he insists that the doctor should decide how to treat sinusitis in a child, strictly on an individual basis and based on data from a number of laboratory and instrumental examinations.

He sets one of the primary tasks for the patient’s parents to create and maintain conditions in the apartment that are ideal for normal breathing. That is, the air temperature is no more than 18–20 °C and humidity is 45–60%.

It is important to regularly ventilate the nursery and carry out wet cleaning in it.

Otherwise, the doctor also adheres to the importance of timely prescribing antibiotics and, if necessary, using medications to eliminate symptoms that prevent the child from living a normal life.

Folk remedies at home

It is impossible to cure sinusitis in a child, especially bacterial sinusitis, using folk remedies alone. This practice can only lead to the development of dangerous complications and the process becoming chronic.

However, as a complement to traditional drug treatment, nebulizer inhalation can be used using:

  • infusion of chamomile or calendula flowers;
  • infusion of plantain leaves;
  • fir essential oil;
  • tea tree essential oil, etc.

Warming the nose, which is popular among people, using boiled chicken eggs, potatoes or bags of cereal can only be used with the permission of a doctor after the end of the acute period of the disease, provided there is no purulent discharge.

They are applied on top of cotton fabric on the sides of the bridge of the nose above the affected sinuses.

You should not give your child any mixtures based on onion, garlic or aloe juice, as they can burn the mucous membrane and cause a deterioration in the baby’s condition.

It is not recommended to use honey or beets for these purposes, since the sugars they contain will become an excellent breeding ground for pathogenic microflora.

It is better to take immunomodulatory agents internally, such as rosehip decoction, tea or milk with honey.

Complications and consequences

If treatment for the disease is started in time, it usually goes away without leaving a trace. But in the absence of timely, competent therapy, the development of:

Prevention

Since in most cases, sinusitis is a consequence of untreated rhinitis, the main prevention of its development is timely, competent treatment of all acute respiratory infections, in particular:

  • regular nose blowing;
  • washing with saline solutions;
  • the use of medications indicated in each individual case.

To avoid the occurrence of an odontogenic form of the disease, you should be regularly examined by a dentist and, if necessary, immediately treat teeth affected by caries or remove them. An important aspect of prevention is the elimination of anatomical defects of the nasal cavity.

Related video: ENT consultation

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Specialty: Otorhinolaryngologist Work experience: 12 years

Specialty: Otorhinolaryngologist Work experience: 8 years

Source: http://nasmorkam.net/sinusit-u-detej-lechenie/

How to treat acute sinusitis in children?

Sinusitis in children is a common disease, which, according to statistics, is registered in 20% of children. Often, parents do not consult a doctor in a timely manner, since the characteristic symptoms of the pathology (runny nose, fever) resemble a common cold. The insidiousness of sinusitis is that in the absence of timely treatment, the disease can lead to serious consequences that threaten not only the health, but also the life of the child.

Symptoms and treatment of sinusitis in children is an important topic that is worth considering in more detail. Parents need to know what signs they should pay attention to and how to distinguish manifestations of sinusitis from ordinary ailments, so as not to trigger the disease and provide timely assistance to the child.

Sinusitis in children - features of the disease

Sinusitis is an inflammation of the paranasal sinuses (sinuses). A newborn baby has only 2 pairs of sinuses - ethmoid sinuses. located in the bridge of the nose and maxillary (maxillary), which are located inside the cheeks. The remaining paranasal sinuses (frontal and sphenoid) are formed only by the age of 7.

The baby’s immune system is still imperfect, which explains the spread of sinusitis at a young age. The natural purpose of the paranasal sinuses is to retain and filter air, so as not to allow external infection into the body. Two pairs of sinuses do not always cope with a powerful attack of viruses and bacteria, and the underdeveloped structure and small size of the sinuses cannot resist the development of inflammation.

The inflammatory process can affect any of the air-bearing nasal cavities. The proliferation of pathogenic microflora causes irritation and swelling of the mucous membrane, which leads to stagnation and accumulation of mucus in the paranasal sinuses. Thus, favorable conditions are created for the further proliferation of harmful bacteria and the development of purulent processes that can provoke serious complications. The paranasal sinuses are located in close proximity to large vessels, the brain, and the eyes. In advanced cases, a breakthrough of purulent contents to vital organs and the development of situations that pose a threat to the child’s life are possible.

Classification

The infectious and inflammatory process in the paranasal sinuses can be acute or chronic, of a bacterial, allergic, viral or fungal nature. Depending on the nature of the inflammatory process, sinusitis can be catarrhal (when the disease is viral) or purulent (when the causative agent is bacterial microflora).

There are several categories of sinusitis based on location:

  • frontal sinusitis - inflammation covers the frontal sinuses;
  • sinusitis or maxillary sinusitis in children;
  • ethmoiditis - the inflammatory process affects the mucous membrane of the ethmoid labyrinth;
  • sphenoiditis (rare in children) – the sphenoid sinus, located deep inside the nose, is affected.

Another form of the disease, pansinusitis, develops with simultaneous inflammatory damage to all paranasal sinuses. If only one side of the paired sinus is affected, they speak of a unilateral course of the inflammatory process; if there is inflammation of two sections at once, they speak of bilateral sinusitis.

Since the paranasal sinuses are not developed in children, sinusitis in a 2-year-old child is practically asymptomatic. In older children, the ethmoid and maxillary sinuses are already practically formed, so sinusitis in a child 3 years of age and older already manifests itself with characteristic symptoms associated with the development of the inflammatory process in the air cavities.

Causes

The main causes of sinusitis in childhood are imperfections of the immune system and infectious agents that penetrate the paranasal sinuses. Most often, the pathology develops as a complication after a respiratory or cold illness (acute respiratory infection, ARVI, influenza, scarlet fever). Sometimes the provoking factor is an allergic reaction or hay fever (seasonal allergy to the flowering of certain plants).

Among other reasons that provoke the development of sinusitis, doctors name:

  • congenital anomalies of the structure of the nose;
  • deviated nasal septum;
  • nasal injury;
  • polyp growth;
  • adenoids;
  • caries, gingivitis and other dental problems;

Children develop sinusitis much more often than adults. In addition to weak immunity and other predisposing factors, imperfections in the anatomical structure of the sinuses play a major role. In a child, the sinuses are connected to the nasal cavity by too narrow anastomoses. As the inflammatory process develops, they quickly become clogged, mucous secretions begin to accumulate in the sinuses, and pathogenic microflora multiply in them at an accelerated pace. The main danger of sinusitis is the suppuration of accumulated secretions, the penetration of infection into the blood and damage to vital organs and tissues.

Symptoms of sinusitis in children

In children under 3 years of age, the paranasal sinuses are not sufficiently developed, so sinusitis is practically asymptomatic, and the cause of its development is viral infections or inflamed adenoids, from which pathogenic microorganisms penetrate the sinuses.

Acute sinusitis in older children is manifested by the following symptoms:

  • persistent runny nose that lasts more than 2 weeks;
  • clear nasal discharge becomes thick as the inflammatory process develops, acquires a purulent character and a yellow-green color;
  • the child develops a nasal voice;
  • the sense of smell decreases or completely disappears;
  • there is difficulty in nasal breathing;
  • pain occurs in the area of ​​the affected sinuses, which gradually increases and is especially severe in the evening;
  • when purulent discharge appears in the child, the temperature rises, general symptoms of intoxication of the body occur (headache, weakness, loss of appetite, sleep disturbances);
  • An unpleasant, putrid odor appears from the mouth.

Painful sensations in the area of ​​inflamed sinuses are a characteristic sign of sinusitis. The pain is throbbing, pressing in nature, and intensifies when pressing fingers on the face, near the wings of the nose or on the eyeballs, when bending forward, while coughing or sneezing. In this case, painful sensations can radiate to the temple, upper jaw or ear, or cover the entire head. Another constant sign of sinusitis is photophobia, lacrimation, redness and swelling of the eyes, which is especially severe in the morning.

Chronic sinusitis in children manifests itself with less pronounced symptoms; it is characterized by alternating remissions with periods of exacerbation. Most often, relapses of the disease are observed in the cold season and occur against the background of hypothermia or colds.

If characteristic symptoms appear, parents need to show the child to an otolaryngologist as soon as possible. Only a specialist will be able to make a correct diagnosis and explain how and how to treat sinusitis in a child.

Treatment methods

Treatment of sinusitis in a child should be comprehensive. The doctor prescribes a treatment regimen after confirming the diagnosis. For this purpose, the otolaryngologist interviews the child’s parents, identifies the main complaints and symptoms, and performs rhinoscopy, that is, examines the nasal passages using the endoscopic method. If necessary, in order to clarify the diagnosis, an X-ray examination or computed tomography (CT) is prescribed.

The main goal of therapy is as follows:

  • restoration of nasal breathing;
  • freeing the paranasal sinuses from accumulated secretions and pus;
  • destruction of infectious agents;
  • relief of the inflammatory process;
  • maintaining immunity and increasing the body's resistance to infections.

Antibiotics

Purulent sinusitis in a child is treated with antibiotics. Antibacterial therapy in this case is the main method of treatment, since only in this way can pathogens be destroyed and dangerous complications avoided. Ideally, such drugs should be prescribed after a bacteriological test to determine the sensitivity of the pathogen to the antibiotic.

But the results of this analysis need to wait several days. Therefore, in acute sinusitis, with high fever, copious purulent discharge and pronounced intoxication of the body, the doctor immediately prescribes drugs with a wide spectrum of antimicrobial action. In such cases, any delay in treatment can lead to the development of serious complications.

The main antibiotics for sinusitis in children are drugs from the group of penicillins, macrolides or cephalosporins:

Antibiotics for children are usually prescribed in the form of a syrup or suspension, which have a pleasant taste, are better absorbed and, unlike tablets or powders, do not cause disgust in children. The dosage of drugs and the course of treatment are determined by the doctor; parents must strictly follow all recommendations.

Dr. Komarovsky speaks of sinusitis in children as an insidious infection, since complications develop much faster in children than in adults. But at the same time, the doctor says that in many cases the use of antibiotics is not justified, since the reason for prescribing potent drugs should be not just prolonged rhinitis, but a runny nose, accompanied by painful sensations in the paranasal sinuses and other characteristic symptoms of sinusitis.

Much depends on the type of infectious agents. Antibacterial therapy is effective only when the causative agents of the infection are pathogenic bacteria (Aureus or hemolytic Staphylococcus, pneumococcus). If the disease is caused by a viral or fungal infection, antibiotics will not help; in this case, you should select a different treatment regimen based on antifungal and antiseptic agents.

Irrigation therapy

To cleanse the nose of mucous secretions, natural products based on sea water are best suited - Aqualor baby, Aquamaris, Quix. They are absolutely safe, have no contraindications, effectively clear the nasal passages, eliminate swelling of the mucous membrane and restore free breathing.

In order to speed up the discharge of mucus, the baby is prescribed nasal drops with a vasoconstrictor effect - Naphthyzin, Sanorin, Galazolin, Otrivin. They help cope with swelling and nasal congestion. Vasoconstrictors in children are allowed to be used only as prescribed by a doctor and for no more than 5 days in a row, as they quickly become addictive and the likelihood of developing side effects increases.

Antiseptics have good anti-inflammatory properties - Protargol drops, Collargol, solutions of Furacilin, Chlorhexidine. Treatment is supplemented with combined agents - these are drops, solutions or sprays with anti-inflammatory, antiallergic, antiseptic effects (Polydex, Isofra).

In the acute period, antipyretics (Paracetamol, Efferalgan) are used to alleviate the condition; it is recommended to give the baby more fluid to accelerate the introduction of toxins from the body (tea with honey, lemon, jam, fruit drinks, compotes or juices). For sinusitis caused by allergies, antihistamines (Claritin, Suprastin, Zodak) are additionally prescribed.

Physiotherapeutic procedures

Such procedures can be prescribed only in the absence of purulent complications. UHF, ultrasound or laser therapy sessions help stop the inflammatory process. Electrophoresis is used for better penetration of medicinal substances into the paranasal sinuses; treatment is supplemented with darsonvalization or tube-quartz methods.

Sinus puncture

This is a painful method, which is used only in severe cases, in the absence of results from conservative treatment and the development of a purulent process. During the procedure, the surgeon pierces the affected sinus, removes pus, rinses the cavities with an antiseptic solution and inserts drainage catheters, through which medications (antibiotic solutions and anti-inflammatory drugs) are then injected into the sinus daily.

Treatment of sinusitis in children at home

You can use folk recipes in the treatment of sinusitis in a child only in consultation with your doctor. Incorrectly performed rinsing can complicate the course of the disease, and the use of herbal remedies and herbal decoctions can provoke an allergic reaction and complicate the course of the pathological process. The warming procedure also needs to be approached with extreme caution, since in case of purulent complications, heat will contribute to the further spread of infection, which can lead to serious health consequences.

Inhalations

In the absence of allergies, you can do inhalations based on decoctions of chamomile, sage, and calendula. Medicinal herbs will provide the necessary antiseptic and anti-inflammatory effect, accelerate the discharge of mucus, and eliminate nasal congestion. Before the procedure, the herbal mixture is poured with water, brought to a boil, then cooled slightly. The child must breathe in the medicinal steam, but before doing this, his temperature must be checked. The steam should not be too hot, otherwise the baby may get burned.

If you are allergic to herbs, you can do potato inhalations. To do this, boil several tubers, mash them, and then breathe in the steam.

Nasal rinsing

The child’s nose can be washed with saline solution (1 teaspoon of salt per 200 ml of boiled water), mineral water, herbal decoctions (if there are no allergies). Be sure to consult your doctor - he will explain how to properly rinse your nose. Then just follow his recommendations. To rinse the nose in children, it is better to use a syringe without a needle or a small syringe, cleaning the nasal passages one at a time.

Breathing exercises

At home, you can do therapeutic exercises using the Strelnikova method, or master acupressure, which helps remove mucus from the paranasal sinuses. Simple manipulations will help restore free breathing, avoid complications and relapses of the disease.

Reviews about the treatment

This spring, my daughter caught a bad cold, her runny nose did not go away for a long time, and then she began to complain of pain in the bridge of her nose, under her eyes, and her temperature rose. After an examination, a diagnosis of sinusitis was made. First, we took antibiotics prescribed by the doctor, washed our nose with antiseptics, and instilled anti-inflammatory and vasoconstrictor drops.

Improvement was evident already on the 2nd day of treatment. But the doctor warned that the course of antibiotics must be completed to the end, otherwise complications and relapse of the disease are possible. I was afraid that I would have to do a puncture; I heard that this was a very painful procedure, and the child was already weak during the illness. But everything worked out, the antibiotics did their job, defeated the infection and prevented purulent complications. Now my daughter has recovered, we are trying to monitor her health and strengthen her to avoid a recurrence of the disease.

A year ago, my son was treated for sinusitis. He had an infection in his frontal sinuses, had severe headaches, runny nose, and fever. First we took the antibiotic Amoxicillin and did nasal rinses, but there was no improvement. Then the doctor adjusted the treatment regimen and prescribed other tablets - a strong antibiotic Cefixime, nasal drops with an anti-inflammatory effect. Soon my son felt better and stopped taking the pills.

But it turned out that it was impossible to interrupt the treatment, since a week later the symptoms returned, unbearable bursting pain and purulent discharge from the nose appeared. As a result, I had to get my sinuses pierced.

The procedure is painful, but it was done with local anesthesia. They removed the pus, cleaned everything, and washed the cavities with antiseptics. After that, every day we went to the treatment room for treatment, during which antibiotic solutions were injected into the sinus. Now everything is over, the son feels well, only a small scar at the puncture site remains as a memory.

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Before using medications, consult your doctor!

Source: http://glavvrach.com/sinusit-u-detey/

Sinusitis

A. Pathogenesis. Sinusitis is an inflammation of the mucous membrane of the paranasal sinuses caused by a bacterial or viral infection, physical or chemical trauma, or an allergic reaction. It can be acute, subacute or chronic and occur with damage to one or more sinuses. Predisposing factors include polyps and other nasal tumors, deviated nasal septum, chronic swelling of the nasal mucosa with allergic and vasomotor rhinitis, immunodeficiency, cystic fibrosis, Down syndrome, cleft palate, primary ciliary dyskinesia. Sinusitis often develops in patients with bronchial asthma and worsens during asthma attacks.

1. Acute sinusitis is usually manifested by congestion and purulent discharge from the nose, fever, malaise, and pain on palpation in the projection of the affected paranasal sinus. Differential diagnosis is carried out with dental diseases, migraine, trigeminal neuralgia, orbital phlegmon, Quincke's edema, insect bites, giant cell arteritis, neoplasms of the paranasal sinuses. Rhinoscopy reveals hyperemic and edematous mucosa, enlarged, often covered with purulent discharge of the nasal turbinates.

2. With chronic sinusitis, general symptoms are rarely observed, pain in the projection of the affected sinuses is insignificant. Characterized by constant swelling of the nasal mucosa, viscous discharge from the nose, drainage of discharge down the back wall of the pharynx, bad breath, cough, especially when lying down, decreased sense of smell and taste.

1. X-ray of the paranasal sinuses reveals thickening of the mucous membrane (more than 8 mm in adults, more than 4-6 mm in children), darkening and horizontal fluid levels. In the presence of radiological signs of sinusitis, the results of culture of punctate paranasal sinuses are usually positive. The maxillary sinuses are most often affected. It is better to examine them in the occipitomental projection. The frontal sinuses and the ethmoidal labyrinth are clearly visible in the anterior direct projection. X-ray of the skull in a lateral projection allows you to examine the sphenoid sinus (sphenoiditis is observed quite rarely) and the nasopharynx to assess the diameter of the pharynx and the size of the adenoids. It should be noted that in children the paranasal sinuses are usually unevenly developed. The formation of the maxillary sinuses is completed by the age of 3, the frontal sinuses by the age of 5. The absence of one or both frontal sinuses is observed in less than 5% of adults. X-rays of the paranasal sinuses are performed if physical examination reveals signs of sinusitis. Because sinus culture results are often false-positive or false-negative, they cannot be used as a basis for radiography.

2. CT scan of the paranasal sinuses allows a better assessment of their condition than radiography. CT is indicated if physical examination reveals signs of sinusitis, and radiography does not confirm the diagnosis. CT is also used to diagnose lesions of the maxillary and frontal sinuses and the ethmoidal labyrinth.

3. General blood test. In acute sinusitis, leukocytosis and increased ESR are usually observed. ESR can also be increased in chronic sinusitis.

4. Sowing punctate of the paranasal sinuses. Normally, there are no microbes in the puncture of the paranasal sinuses. The most common pathogens of acute sinusitis in children are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, in adults - Haemophilus influenzae, Streptococcus pneumoniae, anaerobic bacteria (12% of patients) and viruses. Chronic sinusitis in both children and adults is most often caused by anaerobic bacteria, usually Bacteroides spp. and Peptostreptococcus spp. , along with anaerobic bacteria, aerobic bacteria are often detected, in particular Staphylococcus aureus, alpha-hemolytic streptococci and Haemophilus spp. In 25% of patients with chronic sinusitis requiring surgical treatment, culture results are negative. The microflora of the nasal cavity and paranasal sinuses varies greatly, so the diagnostic value of cultures of nasal discharge for sinusitis is low.

5. Ultrasound. It has been shown that for sinusitis in adults, ultrasound of the paranasal sinuses is more informative than in younger children. Further studies will allow a more accurate assessment of the role of ultrasound in the diagnosis of sinusitis.

6. Diaphanoscopy. For sinusitis, this study is not very informative and cannot replace radiography of the paranasal sinuses.

1. Drug treatment. To reduce swelling of the nasal mucosa and improve the outflow from the paranasal sinuses, vasoconstrictors are prescribed for topical use. It should be remembered that they cannot be prescribed for more than 3-5 days. Alpha-agonists for systemic use are also effective. For concomitant allergic diseases, they are used in combination with H1 blockers . Topical corticosteroids are also effective. They restore the outflow from the paranasal sinuses, as they reduce swelling of the mucous membrane and the severity of allergic reactions. Antimicrobial agents are selected individually, taking into account the patient’s age, duration of the disease, sensitivity of the pathogen, and epidemiological situation. For acute sinusitis, antimicrobial agents are usually prescribed for 3 weeks, and for chronic sinusitis - for 6-8 weeks. If sinusitis occurs against the background of allergic rhinitis, be sure to treat the underlying disease.

2. Surgical treatment. If drug treatment for acute sinusitis does not lead to the restoration of outflow from the paranasal sinuses, the nasal cavity is rinsed and the frontal or maxillary sinuses are punctured. Puncture of the paranasal sinuses reduces pressure in them and allows you to obtain material for culture. If these measures are ineffective and complications develop - osteomyelitis, meningitis, cavernous sinus thrombosis, encephalitis - more active surgical intervention is indicated.

Source: G. Lawlor Jr., T. Fisher, D. Adelman “Clinical immunology and allergology” (translated from English), Moscow, “Praktika”, 2000

published 08/16/:58

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