From the point of view of development, the sinuses have different periods of pneumatization (filling the sinus cavities with air), as follows:
- Ethmoid sinuses they are located between the eyes and the nose and develop from birth until the age of 2 years of the small child
- Maxillary sinuses located under the eyes, in the jaw bones, are the largest of the paranasal sinuses and associate 2 growth stages – the first from birth to 3 years, then from 7 to 12 years
- Frontal sinuses they are located above the eyes, in the frontal bone, they begin to develop only after the age of 2 years
- Sphenoidal sinuses they are located behind the ethmoid sinuses, in the sphenoid bone, they become pneumatized only after the age of 10.
These physiognomic characteristics of the child are the main reason why up to 2 years old you can talk about ethmoiditis, after 5 years about sphenoiditis, and sinusitis in the true sense of the word, can be considered as a diagnosis only after the age of 7-8 years .
Currently, it is estimated that the incidence of sinusitis in children is approximately 10% in the pediatric population aged up to 3 years. Approximately 7.5% of upper respiratory tract infections present a complicated evolution of an acute bacterial sinusitis.
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Causes of sinusitis in young children
In most situations, pediatric sinusitis is caused by a viral infection of the respiratory tract superior with rhinoviruses, coronaviruses or Influenzae virus which presents a self-limited evolution of up to 10 days. Inflammation of the respiratory mucosa associated with viral infections causes hyperemia, watery secretions and their stasis, which favors deficient ventilation of the sinuses and the appearance of bacterial superinfection. Second, there is a decrease in pressure at the level of the affected sinuses, aggravated by incorrect blowing of the nose, which mobilizes the secretions from the respiratory mucosa in the sinus cavities.
Bacterial pathogens involved in the occurrence of pediatric sinusitis are frequently represented by:
- Streptococcus pneumoniae
- Haemophillus influenzae
- Moraxella catarrhalis
- Streptococcus pyogenes
- Staphylococcus ears
- Anaerobic bacteria.
Allergies in children
In approximately 80% of cases, pediatric sinusitis manifests itself against the background of atopic terrain, the incidence of allergies in the pediatric population being between 15 and 20%. More than half of the cases of sinusitis, especially the chronic forms that show an evolution longer than 12 weeks or the recurrent ones, are associated with bronchial asthma. Allergies favors the appearance of sinusitis either through an inflammatory mechanism or through the direct effect of allergens on the cells of the respiratory mucosa.
Nasal polyps
Adenoid vegetations are structures located at the level of the nasopharynx with a function similar to the palatine tonsils that can contribute to the appearance of pediatric sinusitis due to their function as a bacterial reservoir. Bacterial cultures of pharyngeal secretions carried out in the case of children with sinusitis that associate adenoid vegetations confirm the bacterial etiology of the pathologies, studies affirming the fact that between 70-80% of patients who have benefited from adenoidectomy have significantly reduced sinus symptoms after the surgical intervention to remove nasal polyps.
Cystic fibrosis
Cystic fibrosis is a recessive genetic pathology with a long evolution that has a strong impact on the quality of life and is usually associated with:
- Recurrent respiratory infections
- Hypertrophy of adenoid vegetations
- Sinusitis, along with systemic pathologies represented by poor nutritional status, intestinal obstructions and pancreatic insufficiency.
The structural peculiarities of the respiratory mucosa associated with nasal septum deviation, craniofacial anomalies, dental infections, nasal trauma, intranasal foreign bodies and palatoschisis (cleft palate), represent other causes that can generate the appearance of sinusitis in children.
Learn about the causes and treatment of acute sinusitis in adults
Risk factors for children’s sinusitis
The main risk factors that predispose to the occurrence of pediatric sinusitis are represented by:
- Recurrent viral infections
- Cold or dry air
- Atmospheric pollutants
- Cigarette smoke
- Incorrect blowing of the nose
- Certain conditions (ciliary dyskinesia or Kartagener syndrome – genetic pathology manifested by reduced airway clearance, gastroesophageal reflux)
- Medicinal treatments that affect the functioning of the immune system.
- In the case of infants, sinusitis can be favored by using teats or feeding with a bottle in the supine position (lying on seven).
Sinusitis in children symptoms
The main manifestations that make up the evolving clinical picture of pediatric sinusitis are:
- Persistent cough that occurs especially during the night after placing the child in the supine position (occurs as a result of the leakage of respiratory secretions at the level of the posterior pharynx)
- Nasal congestion and mucopurulent secretions in the case of bacterial sinusitis, watery, in viral etiologies
- High fever syndrome
- Edema periorbital.
The symptomatology can present different degrees of severity, and in the case INFANTSthese manifestations can be accompanied by:
- State of increased irritability
- Refusal of food
- Oropharyngeal erythema
- Altered general condition.
In older childrenthe clinical symptoms are more specific, associating:
- Pain or feeling of pressure at the level of the frontal sinuses accentuated during forward bending movements
- DISORDERS
- halitosis
- Hyposmia (decreased sense of smell)
- Anosmia (lack of smell).
Diagnosis of sinusitis in children
The diagnosis of sinusitis in a child is established by the pediatric ENT doctor with the help of information about the patient’s medical history and those related to the patient’s clinical manifestations, provided by the parents, the detailed clinical examination and imaging and laboratory investigations.
The imaging investigations that can be recommended by the specialist doctor to establish the diagnosis of sinusitis in the child can include radiological examination of the sinuses and sinus computer tomography.
Laboratory analyzes for the diagnosis of pediatric sinusitis require the collection of respiratory secretions for bacteriological examination or through molecular biology techniques to establish the etiological agent involved in the appearance of the pathology.
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Treatment of sinusitis in children
The treatment of pediatric sinusitis is etiological and addresses the cause that determined the appearance of the disease and symptomatically to reduce the patient’s discomfort.
- Etiological pharmacological treatment it is represented by antibiotic therapy administered according to the results obtained after carrying out the cultures of the nasal secretions and the antibiogram and is carried out in accordance with the indications of the attending physician.
- Symptomatic drug therapy it involves the administration of mucolytics to fluidize secretions and improve their clearance (easier elimination of secretions), nasal decongestants, anti-inflammatories, antihistamines, local vasoconstrictors and steroids in the form of nasal sprays to reduce inflammation of the sinus mucosa and antialgesics to reduce pain discomfort.
- Treatment surgical has the purpose of eliminating secretions that stagnate in the sinuses and is instituted in patients with an unsatisfactory response to antibiotic therapy (administered correctly and completely) and in the presence of the unfavorable evolution of sinusitis, which associates an increased risk of local and systemic complications through bacterial dissemination.
The surgical intervention is performed under general anesthesia by the otorhinolaryngologist or the oromaxillofacial surgeon and may involve resection of middle nasal turbinate hypertrophy, correction of deviated nasal septum, removal of adenoid vegetations and removal of intranasal foreign bodies.
The method of surgical approach used to treat sinusitis in children depends on the extent of the inflammatory process and the causes that determined the appearance of the pathology. Minimally invasive endoscopic treatment (sinus endoscopy) being preferred to the classic approach in the case of children.
Untreated sinusitis in children
Untreated, sinusitis can cause a series of local and systemic complications represented by:
- Orbital complications – preseptal or periorbital cellulitis, orbital abscess, vision loss, optic neuritis
- Intracranial complications – meningitis, epidural abscess, subdural epiema/abscess, venous sinus thrombosis, epidural hematoma, oculomotor nerve paralysis and trigeminal neuralgia
- Local complications – mucocele, facial vein thrombophlebitis, premaxillary abscess, osteomyelitis
- Systemic complications – septicemia, pneumonia, stroke.
Prevention methods of sinusitis in children includ:
- Frequent and correct washing of the child’s hands because he has a tendency to put his fingers to his nose, a fact that favors the colonization of the respiratory mucosa with different types of pathogens involved in the occurrence of sinusitis
- Compliance with the vaccination schedule against seasonal viral infections (flu vaccine) and bacterial ones (pneumococcal vaccine)
- Avoiding crowds and contact with family members who have respiratory ailments
- Avoiding exposure to cigarette smoke
- Maintaining a warm and humid air inside the house and the bedroom.
References:
2023-12-19 23:10:07
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