My son is cold. It started with sneezing and a blocked nose. But it takes more than a week, and it does not improve. He coughs for the day and at bedtime. The mucus is thick. Also today he has some fever. Will you have sinusitis?

The Colds are infections of the upper respiratory tract, i.e., nose and throat caused by viruses; they are very frequent. Occasionally, up to 6-8% of cases are complicated by acute sinusitis; double in children going to daycare.

How is sinusitis produced?

Sinusitis is the infection of the sinuses that surround the nasal passages. The breasts are air cavities inside the bones of the face and skull. They are located: on both sides of the nose; on the forehead, just above the eyebrows; and between the eyes (Image).

The sinuses are covered with a membrane that produces mucus. Its mission is to humidify and trap the dust and germs of the air we breathe. This mucosa has villi (cilia) that move. Thus, they help to eliminate mucus from inside the breasts towards the nose through communication holes.

When we have a cold, the membrane becomes inflamed and produces more mucus, thicker. The exit orifice of the breasts decreases in size. And, at the same time, the cilia work worse. As a result of all this accumulates mucus in the sinuses giving rise to an environment conducive to the development of a bacterial infection that causes acute sinusitis.

The maxillary sinuses (located on both sides of the nose) are not formed until two years of age, the frontal (above the eyebrows) at 5-6 years. In other words, there can be no sinusitis before these ages.

When do I suspect my child has sinusitis?

The cold is characterized by nasal congestion and runny nose (mucus) with or without a sore throat. The mucus is initially clear and fluid and becomes thick and full of color. Little later, coughing appears. There may be fever a couple of days. Typically, symptoms begin to subside between five and seven days.

We will think of sinusitis in any of the following cases:

  • A persistent cold: rhinorrhea and cough that lasts more than 10 or 14 days and that seems more serious than usual; or that after 5 to 7 days instead of going better, it gets worse.

  • Sometimes, these symptoms are accompanied by fever, purulent mucus, pain, and malaise.

  • In older children and adolescents there may be a headache and pain in the face when squeezing the forehead, cheekbones and inner corner of the eye.

  • There are chronic forms: mucus of months of evolution, with a night cough and when getting up. In these cases, you have to suspect basic allergic rhinitis.

Is the diagnosis made with a breast x-ray?

No. The diagnosis is made by the symptoms. It is not necessary to make an x-ray. Only in special cases due to chronicity or seriousness can it be useful; but in these, a computerized axial tomography (CT) will be more useful.

That I have to do?

Sinusitis is usually mild in most cases and resolves spontaneously.

Go to the pediatrician if your child has: high fever and purulent mucus in the nose; or prolonged low-grade fever, annoying cough, or a headache.

It is not common, but the infection can spread around the eyes and lead to a complication called periorbital cellulitis. It manifests as swelling or redness around the eyelids, without discharge and fever. If these symptoms appear, go to the pediatrician urgently.

How is sinusitis treated?

  • Most cases are mild, and symptoms are treated. They will improve discomfort or pain with acetaminophen or ibuprofen. The use of antibiotic is reserved for when there are: fever, poor general condition, alteration of appetite, sleep or activity; or if there is no improvement in one or two weeks.

  • The antibiotic of choice is amoxicillin or amoxicillin with clavulanic acid, for 10 to 14 days.

  • Medications such as nasal decongestants or antihistamines that are sold without a prescription are not recommended . Especially in children under five years. They are not recommended because they are not effective in the improvement of symptoms and cure of this disease; and because in young children can have undesirable side effects.

  • If allergic rhinitis is suspected, it will be confirmed with skin tests or a blood test; and this rhinitis will have to be treated and controlled.

  • Diseases of the immune system and malformations or alterations in the nose, such as polyps are rare. But they cause more serious chronic sinusitis that will be controlled and treated specifically by your pediatrician and the Torino.

What factors intervene in sinusitis? Can they be prevented?

  • The washing frequently hands, especially in nurseries and in winter, reduce the spread of colds; in this way, the chance of having sinusitis will be less.
  • Avoid exposure to tobacco smoke at home
  • If you have allergic rhinitis: avoid triggers such as mites and pollens, and treat it with the proper medication.

Cold or Sinusitis?

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