How to manage infection of the sinuses

A concerned mother recently sent me this email: “Dr Ombeva, my son aged two years has sinuses. He has flu and cough that keeps recurring, especially at night. I have been prescribed nasal saline, piriton, antibiotics but the problem is not going. I am worried. Do you think the sinuses also cause asthma?”

To answer this concerns, we first need to clarify that each one of us has sinuses.

 Sinuses are air spaces found in the skull bones around the face. They normally connect with the nasal passages, so any fluid that accumulates in the sinus can easily drain out, but can also become blocked when the lining of the channel swells up, for example during a cold or respiratory virus infection. Infection of the sinuses is called sinusitis.

I don’t think the child described here has sinusitis. Most people confuse sinusitis (primarily a disease affecting sinuses) with another similar condition called rhinitis, which is swelling and inflammation of the mucous membranes inside the nose.

Rhinitis is more common in children than sinusitis, affecting one in four of school-going ones.

 It is a common cause of school absenteeism and sleep problems. Unlike sinusitis, rhinitis mostly follows allergy.

A child with rhinitis is more likely to have red itchy and teary eyes, allergic skin rash, asthma, and later sinusitis. Allergic rhinitis is common in children with a family history of rhinitis or first-born children.

Though topical nasal antihistamines do not reduce symptoms at other sites, such as the eyes, they are fast acting and useful as ‘rescue’ options.

 Oral antihistamines are more useful as regular therapy, and are better for persistent allergic rhinitis with their effect seen more on reducing symptoms of itch, sneeze and running nose. Topical intranasal steroid sprays provide good control and are effective for all symptoms of allergic persistent rhinitis, including nasal obstruction, itching, sneezing and running nose.

Oral steroids should be used only as a last resort when other treatments have failed. When drugs fail and a structural abnormality exists, surgery may be required. Photo: www.ivillage.com