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The paranasal sinuses are air-filled spaces "attached" to the air passages of the nose. There are up to 4 sets of these sinuses, each of which usually has 2 sinuses (one on each side):

Maxillary sinuses
These are inside the maxilla (the facial bone beneath the eyes and beside and below the nose).
Ethmoid sinuses
These are on either side of the upper part of the nose.
Frontal sinuses
These are inside the forehead above the nose.
Sphenoid sinuses
These are behind and above the nose.

The ethmoid and maxillary sinuses are present when you are born. The maxillary sinuses enlarge by the time you are 4 years old. The sphenoid sinuses start developing before age 2 years and finish growing by age 12 years. The frontal sinuses can be found on X-rays by age 6-8 years but do not finish growing until age 14-18 years; as many as 1 out of 25 adults have no frontal sinuses at all, while up to 16% of adults have a frontal sinus on only one side.

Sinusitis is inflammation of one or more of the sinuses. It is possible to have sinus inflammation due to chemical irritation or because of respiratory allergies such as hay fever, but most people who hear the term "sinusitis", especially when they have a bad runny nose that has lasted for more than a couple or weeks, think of an infection of the sinuses. These can be, and often are, viral -- usually caused by the same viruses that cause the common cold -- but can also be, and often are, bacterial. The most common bacteria found in sinuses are those also found in the nose and middle ears: these include Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae B ("HiB"), both of which we can vaccinate against, as well as other bugs. Most episodes of sinusitis are acute (single episodes that don't keep coming back), but some people -- I happen to be one, probably because of my many allergies -- have sinus infections fairly frequently.

Since the sinuses are close to a lot of other things in your head, a sinus infection can spread to them. Possible complications of sinusitis can include orbital or periorbital cellulitis (infection of soft tissues in or around the eye socket), encephalitis or meningitis (inflammation of the brain matter or of the membranes covering the brain and spinal cord), osteomyelitis (infection of the facial bones), and abscesses. Luckily these are relatively rare.

In most cases, we diagnose someone with bacterial sinusitis when they have rhinorrhea (a runny nose) that lasts for more than 10 days and is not improving. Rhinorrhea due to a cold can last for more than 10 days, but if the cause is a cold the drainage should be improving by then. We can also see severe symptoms right at the beginning, with a fever (temperature 102 or higher) for 3-4 days combined with purulent (thick, greenish-brown, disgusting-looking) rhinorrhea. (Fever due to a cold usually lasts for less than 2 days.) We also suspect sinusitis when a child with what looks like a cold gets better for a few days and then suddenly gets worse. X-rays of the face and sinuses are usually not recommended unless we suspect complications such as an abscess or orbital or periorbital cellulitis. The "gold standard" for diagnosis of sinusitis is to insert a needle into the sinus and draw out fluid for culture, but this isn't very practical and is generally done only with a sinusitis that doesn't respond to treatment.

We treat bacterial sinusitis with the same antibiotics that we use to treat middle ear infections: the most common antibiotics we use for this include some of the penicillins and cephalosporins, trimethoprim/sulfamethoxazole, and the macrolides (such as erythromycin or azithromycin). Since it's harder for antibiotics to penetrate into the sinuses, we normally treat for a minimum of 2 weeks; some experts suggest treating until 7 days after all symptoms of the infection have disappeared, which pretty much guarantees at least 10 days of treatment while also allowing more time on antibiotics for patients who take a while to improve.

Spraying salt water into the nose may help loosen thick and purulent rhinorrhea, and shouldn't hurt unless you are overenthusiastic with the spray. Decongestants and antihistamines do not seem to help relieve sinusitis, and decongestants may make things worse by thickening the nasal secretions, making it harder for the secretions to flow out and making it harder for the antibiotics to penetrate to the bacteria. Nasal steroid sprays, which are helpful in respiratory allergies, do not seem to help hasten recovery from sinusitis.

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PLEASE NOTE: As with all of this Web site, I try to give general answers to common questions my patients and their parents ask me in my (real) office. If you have specific questions about your child you must ask your child's regular doctor. No doctor can give completely accurate advice about a particular child without knowing and examining that child. I will be happy to try and answer general questions about children's health, but unless your child is a regular patient of mine I cannot give you specific advice.

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Copyright © 2008 Vinay N. Reddy, M.D. All rights reserved.
Written 01/07/2008; last revised 01/07/2008 counter