If you take your child to an ENT (ear, nose, and throat) specialist, or otolaryngologist, they will examine your child’s ears, nose, and throat. A thorough history and examination usually leads to the correct diagnosis. The doctor may also look for factors that make your child more likely to get a sinus infection, including structural changes, allergies, and problems with the immune system.
Occasionally, special instruments will be used to look into the nose during the office visit. Imaging (X-rays) of the sinuses, such as a CT scan, are not recommended in acute sinusitis unless there are complications from the infection. Radiation safety concerns may limit imaging scans, especially in children younger than six-years-old.2
Acute sinusitis—When bacterial sinusitis is present, most children respond very well to antibiotic therapy. Nasal steroid sprays or nasal saline (saltwater) drops or gentle sprays may also be prescribed for short-term relief of stuffiness. Over-the-counter decongestants and antihistamines are generally not effective for viral upper respiratory infections in children, and should not be given to children younger than two-years-old.
If your child has acute bacterial sinusitis, symptoms should improve within the first few days of treatment with antibiotics. Even if your child improves dramatically within the first week of treatment, it is important that you complete the antibiotic therapy. Your doctor may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.
Chronic sinusitis—If your child suffers from two or more symptoms of sinusitis for at least 12 weeks and has signs of sinus pressure, he or she may have chronic sinusitis.3 Chronic sinusitis or more than four to six episodes of acute sinusitis per year indicates that you should see an ENT specialist, who can recommend appropriate medical or surgical treatment.
Surgery may be considered for a small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. In children under 13-years-old, your doctor may advise removing adenoid tissue4 from behind the nose as part of the treatment for sinusitis. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue, called adenoiditis (infection of the back of the nose that can cause blockage), can cause many symptoms similar to sinusitis—runny nose, stuffy nose, post-nasal drip, bad breath, cough, and headache.
In older children and those for whom medical therapy has been unsuccessful, adenoidectomy or other surgical options may be recommended. An ENT surgeon can open the natural drainage pathways of your child’s sinuses and make the narrow passages wider. This also allows for culturing the infection so that antibiotics can be directed specifically against the bacteria causing your child’s sinus infection. Opening the sinuses allows nasal medications to be distributed more effectively, allowing air to circulate and usually reducing the number and severity of sinus infections.