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Respiratory Disorders (Expert Forum)
2 y/o with Chronic Sinusitis
Answered by
This forum is for questions and support regarding lung and respiratory issues such as: Allergies, Asthma, Bronchitis, Colds - Flu, Chronic Cough, COPD, Cystic Fibrosis, Emphysema, Fibrosis, Lung Abscess, Nasal Polyps, Pleurisy, Pneumonia, Sarcoidosis, Sinusitis, Tuberculosis.
2 y/o with Chronic Sinusitis
by mommytoone, Jan 17, 2006 12:00AM
I have a daughter who will turn two next month. Since she turned one...the same month...we have been fighting repeat sinus infections. The first session lasted from February until June, virtually non-stop. Our dr. continues to put her on antibiotics and her symptoms do ease while she's on them but they return immediately upon cessation of the antibiotics (usually within 3-4 days). We are currently on Nasonex (since November)and after about 3 weeks we had a 2 week let-up (though it was going to work) but the sinus infections have returned again. We have went through allergy testing (I was thinking milk due to timing these have started) but there was only one small allergy to tree pollen. We have seen the ENT dr but he said her adenoids (adenoids) are fine (only mildly enlarged according to xray) so he said there's nothing he can do for her unless we just want to take out her adenoids (adenoids) for the fun of it. Our dr. tested her yesterday for immunoglobulin (sp?). Any other recommended avenues of relief, places to look, help?? Her symptoms usually begin with the gunky nose that just gets worse (usually yellow/greenish...this time it was tinted with blood), watery eye (usually the left one), swelling under the eyes, post-nasal drip (I'm assuming...due to nighttime/morning cough), and halitosis. We would appreciate any help. I don't know if I should be looking for another opinion or just continuing these endless rounds of antibiotics (which just doesn't seem healthy to me). Thank you. Sincerely, Amanda
Doctor's Answer
by National Jewish, Feb 02, 2006 12:00AM
, Feb 02, 2006 12:00AM
Sinusitis is an easy diagnosis to make with a CT scan of the sinus. Often a doctor will treat with a course of antibiotics before performing a CT scan and see if this eliminates the symptoms. If they go away and come back or do not go away at all, the CT is the best next step.
The most common cause of sinusitis is an infection, especially when the mucus is green. Sinus infections can be difficult to treat since they respond slowly. When any of the openings that drain the sinuses are blocked it will take longer to clear a sinus infection. If a viral infection is the cause it’s a matter of time until the sinusitis clears on its own. When a bacterial infection is the cause it may be necessary to take an antibiotic for at least 3 weeks. Bacteria can become resistant to a particular antibiotic, especially when that antibiotic is used repeatedly. When this happens your daughter will need to be treated with a different antibiotic to clear the bacteria. Even after an antibiotic clears the infection, it is possible for the inflammation to linger. However, inflammation of the sinuses could also be due to an allergy or ongoing exposure to an irritant, such as pollution or smoke. Since your daughter had only a small reaction to tree pollen on the allergy testing, allergy is probably not the cause of her sinus disease.
This inflammation can block sinus drainage, cause increased mucus production, and bleeding that may mix with the mucus. The mucus may “sit” there, especially when it is thick, become discolored and cause halitosis. As the sinus infection clears, this mucus drains from the nose and sinuses down the back of the throat causing a constant or intermittent postnasal drip, a cough, and a “gunky nose”. Typically this is worse at night when lying down to sleep. Generally this feels the worst when waking up and gets better as the day goes on. This mucus can fester sinusitis.
The fat content in dairy products can thicken mucus. Generally eating dairy products with less fat content is helpful. Drinking plenty of water will help to thin the mucus so that it moves more easily.
An antihistamine can dry up the postnasal drip. However, it may make the mucus thicker and more difficult to move. A decongestant like Sudafed® (pseudoephedrine) can thin the postnasal drip and relieve your daughter’s blocked sinuses by decreasing the swelling so they drain better. A combination antihistamine-decongestant will do both. Often a prescription antihistamine and decongestant are taken only when the postnasal drip gets bad. It may be more helpful to take the antihistamine and decongestant on a regular basis. Check with your daughter’s doctor to see if either of these would help her more.
A nasal wash helps remove mucus and germs from the nose and sinuses. This can temporarily decrease the postnasal drip and help your daughter’s sinuses to drain better. Please read our nasal wash treatment information at http://www.nationaljewish.org/disease-info/treatments/alt-ther/nasal-wash.aspx to learn more about this technique. Share this information with your daughter’s doctor to see if she would benefit from this daily treatment. A nasal wash is most helpful when done daily. The best time of day to do a nasal wash is before using any nasal spray. Then the nasal spray can work better since the nasal and sinus tissue is free from mucus.
A prescription nasal steroid spray can decrease mucus production and improve sinus drainage by decreasing the inflammation in the nose and openings that drain the sinuses. This generally provides a more lasting decrease in sinus pressure and improves sinus drainage. To get the most help from a nasal steroid spray use it after doing a nasal wash. A nasal steroid spray does not provide immediate relief of symptoms. It may take several weeks of routine use to become effective. Sometimes it takes the antihistamine, the decongestant, and the nasal wash followed by the nasal steroid spray ALL used routinely to keep the postnasal drip from bothering your daughter. Nasonex® (mometasone) is often helpful, but doesn’t appear to be helping your daughter. Check with her doctor to see if trying a different nasal steroid spray will help.
It is difficult to determine the exact reasons for the lack of response you are describing. This could be because the sinuses are totally blocked and are acting as an abscess, which needs to be drained. It could be that the infection is not responding to the antibiotic that is being prescribed. It is possible that this is a problem with your daughter’s immune system. If the immunoglobulin test shows a low level, then further testing would be done to determine the specific immune problem. Please read our sinusitis information at http://www.nationaljewish.org/disease-info/diseases/allergy/about/conditions/sinusitis.aspx to learn more. Your daughter should also be checked for cystic fibrosis.
The most common cause of sinusitis is an infection, especially when the mucus is green. Sinus infections can be difficult to treat since they respond slowly. When any of the openings that drain the sinuses are blocked it will take longer to clear a sinus infection. If a viral infection is the cause it’s a matter of time until the sinusitis clears on its own. When a bacterial infection is the cause it may be necessary to take an antibiotic for at least 3 weeks. Bacteria can become resistant to a particular antibiotic, especially when that antibiotic is used repeatedly. When this happens your daughter will need to be treated with a different antibiotic to clear the bacteria. Even after an antibiotic clears the infection, it is possible for the inflammation to linger. However, inflammation of the sinuses could also be due to an allergy or ongoing exposure to an irritant, such as pollution or smoke. Since your daughter had only a small reaction to tree pollen on the allergy testing, allergy is probably not the cause of her sinus disease.
This inflammation can block sinus drainage, cause increased mucus production, and bleeding that may mix with the mucus. The mucus may “sit” there, especially when it is thick, become discolored and cause halitosis. As the sinus infection clears, this mucus drains from the nose and sinuses down the back of the throat causing a constant or intermittent postnasal drip, a cough, and a “gunky nose”. Typically this is worse at night when lying down to sleep. Generally this feels the worst when waking up and gets better as the day goes on. This mucus can fester sinusitis.
The fat content in dairy products can thicken mucus. Generally eating dairy products with less fat content is helpful. Drinking plenty of water will help to thin the mucus so that it moves more easily.
An antihistamine can dry up the postnasal drip. However, it may make the mucus thicker and more difficult to move. A decongestant like Sudafed® (pseudoephedrine) can thin the postnasal drip and relieve your daughter’s blocked sinuses by decreasing the swelling so they drain better. A combination antihistamine-decongestant will do both. Often a prescription antihistamine and decongestant are taken only when the postnasal drip gets bad. It may be more helpful to take the antihistamine and decongestant on a regular basis. Check with your daughter’s doctor to see if either of these would help her more.
A nasal wash helps remove mucus and germs from the nose and sinuses. This can temporarily decrease the postnasal drip and help your daughter’s sinuses to drain better. Please read our nasal wash treatment information at http://www.nationaljewish.org/disease-info/treatments/alt-ther/nasal-wash.aspx to learn more about this technique. Share this information with your daughter’s doctor to see if she would benefit from this daily treatment. A nasal wash is most helpful when done daily. The best time of day to do a nasal wash is before using any nasal spray. Then the nasal spray can work better since the nasal and sinus tissue is free from mucus.
A prescription nasal steroid spray can decrease mucus production and improve sinus drainage by decreasing the inflammation in the nose and openings that drain the sinuses. This generally provides a more lasting decrease in sinus pressure and improves sinus drainage. To get the most help from a nasal steroid spray use it after doing a nasal wash. A nasal steroid spray does not provide immediate relief of symptoms. It may take several weeks of routine use to become effective. Sometimes it takes the antihistamine, the decongestant, and the nasal wash followed by the nasal steroid spray ALL used routinely to keep the postnasal drip from bothering your daughter. Nasonex® (mometasone) is often helpful, but doesn’t appear to be helping your daughter. Check with her doctor to see if trying a different nasal steroid spray will help.
It is difficult to determine the exact reasons for the lack of response you are describing. This could be because the sinuses are totally blocked and are acting as an abscess, which needs to be drained. It could be that the infection is not responding to the antibiotic that is being prescribed. It is possible that this is a problem with your daughter’s immune system. If the immunoglobulin test shows a low level, then further testing would be done to determine the specific immune problem. Please read our sinusitis information at http://www.nationaljewish.org/disease-info/diseases/allergy/about/conditions/sinusitis.aspx to learn more. Your daughter should also be checked for cystic fibrosis.
Member Comments (4)
by mommytoone, Jan 19, 2006 12:00AM
Just a follow-up....Immunoglobulin tests were all within normal range.
by shanspaz, Jan 21, 2006 12:00AM
To: mommytoone
Has your doctor considered acid reflux? both my kids have acid reflux (and seasonal allergies) which cause constant sinus infections.
by littlevicko, Jan 31, 2006 12:00AM
my 10 year old daughter was really sick for 6 months with chronic cough and sinus infections and would gag and spit up huge amounts of phlegm,doctors around home treated her from asthma to a cold,one antibiotic after another,steroids which wound up giving her high blood pressure and made her gain weight,she was tested for allergies,everything,i got fed up and took her 2 hours away to lebonheur childrens hospital where they took her right in and she spent 2 weeks there,they tested her for everything,whooping cough,tb,cystic fibroisis,you name it,finally was diagoned with sever acid reflux,sinus disease which she was 100 percent blocked in her sinuses and a regular doctors sinus xray will not show anything you must have a ct scan,and she had an infected esophagus due to all the steroids and antibiotics,she had sinus surgery and got on meds to control the other problems and luckily to say almost a year later has been doing greqt-hope some of that helps-littlevick0
