Sinusitis in children. It is the inflammation of one or more of the sinuses, that is, the bony cavities around the nose . It usually occurs as a result of a viral infection affecting the upper respiratory tract or an allergic reaction in children over two years of age. The condition causes inflammation of the tissue that lines the nose and sinuses.
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- 1 Etiology
- 2 Pathological anatomy
- 3 Symptoms
- 4 Diagnosis
- 5 Treatment
- 6 Local measures
- 7 Surgical procedures
- 8 Sources
Sinusitis in children is commonly seen between the ages of 4 and 10 years. Weather conditions often play an important role.
The ethmoidal sinus is well developed at birth and is probably more frequently affected than the other sinuses. The maxillary sinus is not fully developed until puberty and rarely produces disorders before the tenth year of life. The sphenoid sinus has clinical significance from the third year, but it does not reach its full development until the twelfth year. Frontal sinus involvement is rare before the sixth year.
Many local conditions can be triggers for apparent “ sinusitis, ” and should always be considered. These factors include adenoid obstruction of the nasal airway, foreign bodies and tumors located in the nasal cavities, deviations of the septum, etc. Allergy to the respiratory mucosa should also be considered .
The histopathology of chronic sinusitis in children is similar to that of adults. Two general forms are usually known: hyperplastic (polypoid, edematous, etc.) and atrophic (fibrotic). The first of these two forms of sinusitis suggests an allergic cause.
Child with sinusitis
Rarefaction, resorption or atrophy of the bone is frequently observed . It begins in the form of an erosion of the ethmoid septum or the nasoantral wall. It is often associated with fibrosis and fibrous proliferative disorders of the connective tissue.
Bone atrophy is usually due to endarteritis and vascular thrombosis that prevent blood supply . Sometimes necrosis and hypertrophy of the bone appear. Necrosis can be observed in chronic antral suppuration that affects the nasoantral wall. Bone hypertrophy usually occurs in the inferior turbinate.
In atrophic sinusitis, the epithelial layer of the nasal mucosa and turbinates often shows destruction, exfoliation, or absence of the superficial epithelium. As a general rule, the subepithelial layer is thickened. Infiltration of round cells is commonly observed.
The own robe in atrophic sinusitis, suffers a slow chronic inflammatory process, with glandular atrophy. The periosteum can be thickened and infiltrated. It is common to observe delayed growth of the bone, with sclerosis of the bone framework.
Sinusitis in children is characterized by a chronic runny nose from one or both sides of the nose. As a general rule, frequent colds and soreness occur. The examination will frequently reveal that he is a malnourished and underweight child, and, in addition, distracted and with poor school performance.
Discharge from the middle meatus in a child younger than six years of age generally indicates an ethmoidal or maxillary sinus condition, since the frontal sinuses were not fully developed before this time and are rarely more affected. early.
The discharge from the upper part of the middle turbinate, before the age of thirteen, is indicative of a posterior ethmoiditis, since the sphenoid sinus is not fully developed or hardly becomes infected before this age. The runny nose is more profuse on the affected side. It can be mucoid, mucopurulent or purulent. There is usually a nasal obstruction on the affected side, it is more or less constant, but it can be intermittent.
Headache is a symptom of great diagnostic value in acute cases that occur in children older than five years. Frontal headache often indicates a condition of the anterior group of the sinuses. Occipital headache indicates in most cases a condition of the posterior group. The morning frontal headache, which decreases in intensity towards the afternoon, usually indicates a frontal condition in the older child. Pain in the lower jaw or teeth , which increases in intensity towards the afternoon, generally indicates maxillary sinusitis.
Sensitivity to pressure on thin areas of the sinus walls is helpful for diagnosis in older children. These areas are the same as in the adult.
Recognition of a sinus infection in children often goes unnoticed. This may be due to the fact that radiographic examination and transillumination, as diagnostic means of sinus diseases , are not practiced as frequently as in adults. The diagnosis is also more difficult than adults because children do not express exactly the symptoms subjective.
Older children often experience indefinite pain around the head and face , although these symptoms do not always exist. Any chronic cold with a runny nose should include suspicion of infection of these cavities. The sneezing , headache, irritability and depression are important symptoms. The maxillary and ethmoid sinuses, especially these, are the ones that are mainly affected in children.
Acute sinusitis requires the same general measures as any acute respiratory disease. The patient should be kept on bed rest in a humidified room (45 to 55%) and at a temperature of 21 to 22 degrees Celsius. The pain is usually confronted by the administration of acetylsalicylic acid or similar preparations.
In the most intense cases of sinusitis, in which the temperature rises one or two degrees above the normal figure and there are signs of general toxicity, it will be advisable to resort to the use of sulfa drugs or antibiotics . On many occasions penicillin appears to be very beneficial.
In the early stages, oral administration of ephedrine in small doses, three to four times a day, may be favorable . The vasoconstrictor action of this substance can alleviate some of the generalized headaches.
They can be useful after remission of initial edema and inflammation. Acute nasal obstruction can be alleviated by nasal instillation of vasoconstrictor drops, such as 1% ephedrine. Maximum vasoconstriction is achieved by placing an ephedrine-soaked swab near the anterior extremity of the middle turbinate. In older children, in many cases, the maxillary sinus can be irrigated through the natural orifice. Local anesthesia is sufficient .
Occasionally, the sinus must be irrigated by inserting a trocar through the nasal wall. If this is done, the trocar is inserted into the lower meatus at the brim of the inferior turbinate insertion and is directed upward because, in children, the floor of the antrum is often located above this point.
Whenever possible, surgical procedures should be conservative. Restoring ventilation and drainage with as little trauma as possible is of utmost importance .
The operative procedures in the breasts are not usually indicated in children, since the acute infections of these cavities disappear, in general, spontaneously. Cases classified as chronic empyemas are tributary to non-operative procedures due to two factors:
- The patient’s age excludes prolonged chronicity.
- Obstructive nasal lesions are not frequent at this age.
If the maxillary infection does not clear up after careful conservative treatment, restoration of ventilation and drainage can be achieved by making an opening below the inferior turbinate. In children, these openings generally occlude rapidly.
A properly sized antrum trocar is inserted below the inferior turbinate and through the nasal wall of the antrum, upward and outward. The opening is widened with a rasp or a small puncture forceps to allow the introduction of a rubber catheter, which should reach from the inside of the antrum to the vestibule of the nose.
Irrigations or instillations are made through the catheter. This is extracted around the fifth or sixth day. Subsequent irrigation is carried out with a straight needle or with a curved trocar.