Click here to view next page of this article SinusitisSinusitis. Risk factors are the same as otitis media, viral upper respiratory infection can be complicated by sinusitis. Allergic kids are more likely to have sinusitis. Children with cystic fibrosis may have recurrent sinusitis, and then Kartagener’s is another one of those syndromes that’s worth remembering, the immotile cilia syndrome where they will have immotile cilia and then recurrent sinusitis. Older kids present similarly to adults, where you think of the adults with headache, pressure, that kind of thing. But younger kids, probably less than 3,4,5 years of age, generally don’t have localized symptoms. This table, which I think illustrates pretty nicely, that if you look down at the bottom, for example, headache first: only about 30% of kids with acute sinusitis will actually complain of headaches. Chronic sinusitis also only about 30% will have headaches. Reasonable to do but its absence doesn’t mean you don’t have sinusitis. Only 20% of kids with acute sinusitis will have sinus tenderness. Only 10% of children with chronic sinusitis will have sinus tenderness as well. The other thing I think is a common misconception is that people expect these kids to be kind of sick and they don’t have to be. You’ll notice again, that with acute sinusitis only half of them have fevers. So half are afebrile and 80% of kids with chronic infection don’t have fever at all. So you don’t have to have this very ill kid. It may just be a child who either has a chronic wet cough - and that’s one of the patterns again - that if you have a child who has chronic nasal discharge, chronic wet cough, think of sinusitis. Again, I guess one last thing about the diagnosis is that you probably should not make the diagnosis if the symptoms have been present for any less than about 10 days. If you treat kids who have kind of cloudy nasal discharge who’ve only had cloudy nasal discharge for four or five days, you are going to be treating a lot of kids who just have viral upper respiratory infections. The treatment: antibiotic choice is similar to otitis media. One important thing is you need at least two weeks, I think still in pediatrics, for treating sinusitis. And our general rule of thumb is that if they have symptoms that are more chronic in nature - so once they have symptoms for three or four weeks - I’ll often use three weeks of antibiotics. Frontal sinusitis is one that you have to take very seriously. They may spread backward and cause subdural collections or pus and can be very very serious. Neck masses. This is one where again pattern recognition is key and I’ll try and stress that as we go through these talks. And we’ll divide these up by ages to a degree. The first group is in newborns and the first one is lymphangioma, also called cystic hygroma. Patterns for these are that they are soft, diffuse, painless, non-erythematous. They transilluminate extremely well. Often found in the posterior triangle but can be anterior as well. Really serious problems. These do not regress. Diagnosis is generally made by, initially, transillumination and the extent of the lesion can be found through MRI. Hemangiomas. A pattern here is that they are also soft. They often have some color though to them, unlike the lymphangioma or cystic hygroma. They may have a dusty blue or reddish color to them and you may have an associated surface hemangioma in about 50% of the time. The course that you will see with these is that is that you will get rapid growth for the first six months or so, maybe even up to a year, and then most will regress by somewhere about five years. Though they can take a bit longer. Very difficult problems for parents to deal with, a lot of times, as they see these things growing and they want to intervene. |