Wednesday, March 21, 2018

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Could your child be suffering from chronic sinus problems?

Written by  Rick Piester

8-year-old Chloe Waller of Richmond had suffered from sinus problems since birth – but thanks to an outpatient surgery procedure, her chronic condition is finally cured.

You think it’s probably a cold.   

Your child is coughing and sneezing and seems tired all the time. She has congestion, a sore throat, a headache, and maybe even a slight fever.
It’s probably a cold, although it sure is lasting longer than it should – almost two weeks now. The symptoms never ease, and then they get worse. Your daughter’s eyes seem puffy, and she’s been really blocked up.

It might be time to see your pediatrician, and, if so, there’s a good chance that the diagnosis will be a sinus infection. They’re very common, second only to ear infections as the most common reason for kids to visit the doctor. The good news is that bacterial sinus infections are most often easily treated with antibiotics and other measures. When undiagnosed and untreated, however, the infections can lead to very serious problems.

The sinuses are actually air-filled spaces in the bones of the head and face that start developing before birth and continue growing until about age 20. There are four pairs of sinuses, eight spaces in all. They’re near each cheek, behind and between the eyes, in the forehead and at the back of the nasal cavity. Like the nose, the sinuses are lined with thin layers of moist tissue — mucus membranes — that help moisten inhaled air. Sticky mucus secreted by the membranes helps to trap dust and germs in the air we breathe.

Sinusitis is the medical term for a bacterial infection of the sinuses. A cold that doesn’t go away can damage the delicate, microscopic hairs (cilia) in the nose that sweep mucus away. It can also allow mucus membranes to become swollen, narrowing and blocking the small opening between the sinuses and the nose. In turn, trapped mucus in the wet, warm environment of the sinuses makes an ideal breeding ground for bacteria.

But if a sinus infection becomes chronic — in other words, if you experience four or more within a year — it’s probably time to seek out specialized care. “Pediatricians provide excellent care, but sometimes, you simply need the care of a specialist,” notes Robert J. Brager, MD. Dr. Brager is part of the Richmond-based Virginia Ear, Nose and Throat Associates (ENT) and takes care of patients who have complex problems stemming from sinus infections.

8-year-old Chloe had been treated for severe ear infections almost since birth. She went through several rounds of antibiotics and steroids, with no lasting improvement. She also suffered from repeated bouts of heavy nasal congestion, a bad cough, and a typically “nasally” voice. Her mom, Kira, notes that Chloe — a “real trooper” – never complained of headaches or any other type of associated pain.

“A sinus infection can typically start with a ‘cold,’ but not every congested nose ends up as an infection,” Dr. Brager cautions, “and not every sinus infection needs aggressive treatment. Every child is different, so it’s usually a good idea to wait for 10 or even 14 days of persistent nasal symptoms, along with a worsening trend, before suspecting that a youngster has a sinus infection that needs antibiotic treatment.”

Under Dr. Brager’s care, Chloe was given an adenoidectomy, the usual first surgical step for young patients with chronic sinus infections that don’t respond to medication. In this procedure, adenoid tissue behind the nose is removed to reduce the likelihood of infections that produce symptoms similar to sinusitis as well as to open the pathways for draining and allowing air to circulate.

Chloe’s adenoidectomy was successful, but it was less than fully effective. Dr. Brager then ordered a CT scan for Chloe. The scan was performed on Virginia ENT’s in-office scanning equipment. Designed especially for scans limited to the sinuses and ears, the equipment is capable of producing high-quality images with about a third of the radiation dose of a conventional full-body scanner.

The CT scan showed the problem clearly: Chloe’s sinuses were heavily blocked, with one of her sinus cavities not developing well as she grew. The very poor drainage caused mucus to build up and become infected.

Dr. Brager performed a minimally invasive procedure using a small balloon catheter to open up Chloe’s blocked sinuses and passages to ease drainage and increase air flow. Chloe did very well during and after the December 2015 surgery, leaving for home on the same day as the procedure.

In the months since her surgery, Chloe is still “doing great,” according to Kira. So far, Chloe has been having no further trouble with her sinuses, apart from the occasional runny nose.

Kira says that even though she is a nurse, “It still is scary to put your child in surgery, especially anything using anesthesia.” That’s why it’s so important, she says, for parents to ask questions to be sure that they understand every aspect of their child’s procedure, including why it’s being done, what it entails, and what to expect afterwards.

“The surgeons and everyone involved want you to be comfortable,” she notes. “I’m really happy that my little girl was finally able to breathe comfortably.”

Symptoms of sinus infection in a child:

  • A “cold” lasting more than 10 -14 days, sometimes with a low-grade fever
  • Thick, yellow-green nasal drainage
  • Post-nasal drip, sometimes leading to or exhibited as a sore throat, a cough, bad breath, nausea and/or vomiting
  • A headache, usually in children age 6 or older
  • Irritability or fatigue
  • Swelling around the eyes



Expert Contributor:
Robert J. Brager, MD of Virginia Ear, Nose and Throat Associates (ENT) in Richmond