3. • Where are the
sinuses?
• Four pairs of
paranasal sinuses
– Frontal-above eyes
in forehead bone
– Maxillary-in
cheekbones, under
eyes
– Ethmoid-between
eyes and nose
– Sphenoid-in center of
skull, behind nose
and eyes
4. EMBRYOLOGICAL DEVELOPMENT
• 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 2 nd year and the sphenoid
sinus develops during the 3 rd year
5. EMBRYOLOGICAL DEVELOPMENT
• At birth, the ethmoid, sphenoid
and maxillary sinuses are tiny
and cause problems in infants
and toddlers.
• Frontal sinuses develop between
4-7 years of age, causing
problems in school aged children
and adolescents.
7. DEFINATION AND INCIDENCE
• 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
8. PATHOGENESIS:
• Usually follows rhinitis, which may be
viral or allergic.
• May also result from abrupt pressure
changes (air planes, diving) or dental
extractions or infections.
• Inflammation and edema of mucous
membranes lining the sinuses cause
obstruction.
• This provides for an opportunistic
bacterial invasion
9. PATHOGENESIS:
• 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.
10. PREDISPOSING FACTORS
• Allergies, nasal deformities,
cystic fibrosis, nasal polyps, and
HIV infection.
• Cold weather
• High pollen counts
• Day care attendance
• Smoking in the home
• Re-infection from siblings
12. SYMPTOMS:
• History of URI or allergic rhinitis
• History of pressure change
• Pressure, pain, or tenderness over sinuses
• Increased pain in the morning, subsiding in the
afternoon
• Malaise
• Low-grade temperature
• Persistent nasal discharge, often purulent
• Postnasal drip
• Cough, worsens at night
• Mouthing breathing, snoring
• History of previous episodes of sinusitis
• Sore throat, bad breath
• Headache
13. CLINICAL FEATURES:
• Periorbital edema
• Cellulitis
• Nasal mucosa is reddened or swollen
• Percussion or palpation tenderness over a
sinus
• Nasal discharge, thick, sometimes yellow or
green
• Postnasal discharge in posterior pharynx
• Difficult transillumination
• Swelling of turbinates
• Boggy pale turbinates
14. 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.
16. MEDICAL TREATMENT
• Acetaminophen or ibuprofen to
relieve pain
• Decongestants
• Antihistamines
• Nasal saline
17. ANTIBIOTIC TREATMENT:
• Antimicrobials-treat for 10-14
days, depending upon severity,
with one of the following:
• Amoxicillin:20-40mg/kg/d in 3
divided doses(>20kg, 250mg tid)
• CLAVUNATED AMOXICILLIN:25-
50mg/kg/d in 2 divided doses,
Use suspension if child is less
than 40kg.
19. FOLLOW UP INSTRUCTIONS
Humidifier to relieve the drying of
mucous membranes associated
with mouth breathing
• Increase oral fluid intake
• Saline irrigation of the nostrils
• Moist heat over affected sinus
• Prolonged shower to help
promote drainage
20. 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.
• 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.
