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Anatomy
Paranasal Sinuses
Anatomy
Lateral View of Sinuses
The sinuses are hollow air-filled sacs lined by mucous membrane. The ethmoid and maxillary sinuses are present at birth. The frontal sinus develops during the 2nd year and the sphenoid sinus develops during the 3rd year.
Sinusitis
Inflammation of paranasal sinuses
What is sinusitis?
An acute inflammatory process involving one or more of the paranasal sinuses. A complication of 5%-10% of URIs in children. Persistence of URI symptoms >10 days without improvement. Maxillary and ethmoid sinuses are most frequently involved.
Development (contd)
With inflammation, the mucosal lining of the sinuses produce mucoid drainage. Bacteria invade and pus accumulates inside the sinus cavities. Postnasal drainage causes obstruction of nasal passages and an inflamed throat. If the sinus orifices are blocked by swollen mucosal lining, the pus cannot enter the nose and builds up pressure inside the sinus cavities.
Predisposing Factors
Allergies, nasal deformities, cystic fibrosis, nasal polyps, and HIV infection. Cold weather High pollen counts Day care attendance Smoking in the home Reinfection from siblings
Etiology of Sinusitis
70% of bacterial sinusitis is caused by: Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Other causative organisms are: Staphylococcus aureus Streptococcus pyogenes, Gram-negative bacilli Respiratory viruses
Complications of Sinusitis
Orbital cellulitis or abscess Meningitis Brain abscess Intractable wheezing in children with asthma Cavernous sinus thrombosis Subdural empyema
Diagnostic Tests
Imaging studies, such as sinus radiographs, ultrasonograms, or CT scanning indicated if child is unresponsive to 48 hours of antibiotics and if the child has a toxic appearance, chronic or recurrent sinusitis, and chronic asthma. Laboratory studies, such as culture of sinus puncture aspirates.
Differential Diagnoses
Allergic rhinitis Non-allergic rhinitis Infectious rhinitis Drug-induced rhinitis Nasal polyps Dental abscess Carcinoma of sinus Cluster headache Structural defects (septum deviation) Nasal foreign body
Codeine for severe pain Rhinocort nasal spray 2 sprays in each nostril every 12 hours for children over 6 years of age.
OTC Medications
Non-pharmacological treatment
Humidifier to relieve the drying of mucous membrances associated with mouth breathing Increase oral fluid intake Saline irrigation of the nostrils Moist heat over affected sinus Prolonged shower to help promote drainage
Patient Education
Child should not dive. Child should not travel by airplane. Urge parent to eliminate triggers in the home (dust, smoking) Have all members of the family treated, if indicated.
Follow Up Guidelines
Instruct parent to call in 48 hours if condition of child has not improved. Instruct parent to bring child in for a recheck in 2 weeks.
Case Study
Austin, 9 years old, was seen in the clinic ten days ago, was diagnosed with rhinitis and sent home with instructions for increased fluids, decongestants, and rest. Austin presents today with worsened symptoms of malaise, low-grade temperature, nasal discharge, night time coughing, mouth breathing, early morning pain over sinuses, and congestion.
References
Boynton, R., Dunn, E., Stephens, G., & Pulcini, J. (2003) Manual of ambulatory pediatrics (5th ed.). Philadelphia: Lippincott Williams & Wilkins. Burns, C., Dunn, A., Brady, M., Starr, N., & Blosser, C. (2004). Pediatric primary care: A handbook for nurse practitioners (3rd ed.). St. Louis, Missouri: Saunders.
References (contd)
Colyar, M. (2003). Well-child assessment for primary care providers. Philadelphia: F. A. Davis Company. Tierney, L., Saint, S., & Whooley, M. (2005). Current essentials of medicine (3rd ed.). New York: Lange Medical Books/McGrawHill.