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Is It Really a Sinus Infection?

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How can you tell the difference between a bad cold and an infection?

kid with runny nose

Dr. Nina Shapiro: "My son has had six sinus infections already this season!"

"Really? How do you know they were sinus infections?"

"Well, he had a green runny nose, was stuffy, and my pediatrician said he had a sinus infection and gave him antibiotics." I have this conversation several times per day this time of year. And I really cannot say whether this story is wrong or right. Sinusitis is one of the most common health problems in adults in this country, affecting over 30 million of us annually. It's such a significant problem that studies have shown it to have as much of a detrimental effect on quality of life as diabetes or congestive heart failure. However, the actual incidence and detriment that sinusitis has in children is remarkably difficult to determine.

Here's why:

1. Kids have SO MANY upper respiratory tract infections (URIs) that it's often impossible to differentiate between a bad cold and a sinus infection.

2. Kids also have environmental allergies, and the congestion caused by these allergies may seem like a sinus infection, more so than in adults.

3. A runny nose that turns yellow or green isn't necessarily a sinus infection -- it may still be a viral cold. Sometimes the mucus becomes thicker overnight, so it becomes more concentrated and changes to a darker color when a child first wakes in the morning.

4. Conventional sinus X-rays are of little value. Most children with a cold will have "abnormal" sinus X-rays, as these studies tend to "overcall" any inflammation in the sinuses as "sinusitis."

5. The accurate study to diagnose sinusitis is a sinus CT scan, which is, for both practical and safety reasons, not feasible to perform on a regular basis.

So when IS it a sinus infection?

Certainly colds (which are viral) can progress, either rapidly (overnight), or gradually (over seven to 10 days) to a sinus infection (which is bacterial, necessitating antibiotics). Many of the symptoms of the two are the same, but in a sinus infection, they tend to be more pronounced, more prolonged, and do not respond to the usual rest and time that a cold does. These symptoms may include facial discomfort/pressure (in a younger child, this may be seen as irritability); a "wet" cough, both day and night; thick, dark nasal discharge; nasal congestion; and fevers. Of course you and your pediatrician know your child best, and are probably pretty adept at telling the difference between mild cold symptoms and symptoms of something more significant. But if it is just a cold, hold off on jumping right away to antibiotics. Overuse of antibiotics has been one of the more difficult hurdles that doctors and patients are trying to overcome. This overuse has led to more and more infections being "resistant" to antibiotics, whereby kids are now on adult doses, and are needing more and more powerful antibiotics to treat run-of-the-mill infections.

So what do you do if it is a sinus infection?

If your child is diagnosed with a sinus infection, your pediatrician will likely prescribe antibiotics. Other local measures help a lot, and may even prevent a cold from turning into a sinus infection. Over-the-counter saline nasal sprays work wonders. To use these, have your child (even infant, with help) sit up. Put the nozzle inside the nostril, then squirt the bottle (give it a good squeeze) into each nostril. Most of it will drip out, but it will really irrigate the nose, and flush out bacteria, debris, and mucus. Do this on each side, as often during each day as you and your child can handle. Any version of this works, including sinus "irrigation kits" and "neti pots," depending on your child's tolerance of nasal hygiene! Also over-the-counter is oxymetazoline (Afrin) nasal spray. This is a decongestant, which most pediatricians feel is safe to use in children (you can dilute this to half-strength by mixing 50 percent of the bottle with saline). This should be used only two times per day, for no longer than three days at a time. The reason for this is, if it's used longer, it will cause a reverse effect, making the nose more congested. Check with your pediatrician before using this at all. A humidifier (cool mist, and keep the lining cleaned) in your child's room also helps clear out the sinuses. Most over-the-counter cold medications for children have been pulled from the market, so local treatments are the way to go.

Sinusitis is indeed a problem, and, in all likelihood, impacts children as significantly as it does adults. However, especially in the cold season, remember that, more times than not, a cold is just a cold.

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9 comments so far | Post a comment now
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Cindy R January 30, 2010, 10:14 AM

The article above is great - thanks. This really helps to clear up the differences between a cold and sinus infection and helps me feel more in control.

Toni February 9, 2010, 10:37 AM

We have been tearing our hair out this winter. Our poor little guy has been hard with constant ent issues. We saw a new specialist last week who suggested considering a balloon sinuplasty procedure, to improve air flow. We are encouraged but still not convinced. At the very least we have learned a lot and hope to find the right solution soon.
Stay warm everybody!

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