At what age does a child get sinusitis. Diagnosis and symptoms of sinusitis in children

Usually, sinusitis, especially in children, is perceived as very serious and dangerous disease, which, if not treated in time, can “provide” the child with lifelong suffering due to severe runny nose and unbearable pain in the sinus region. Is it really? What are sinusitis? And which one is the most dangerous for children?

Sinusitis in children: everything has its time and place

The human body is arranged in such a way that from the moment of inhalation until the moment air enters the lungs, this very air must have time to warm up to the required temperature, to be moistened and cleansed. In fact, it looks like this: no matter what air we inhale (be it the sultry and hot air of the desert, or vice versa - the frosty air of the Siberian taiga), the air that “gets” to the very bottom of our lungs will always be the same - it will have body temperature and 100% humidity. Directly in the nose, the air does not have time to warm up, moisten, or purify, of course.

That's exactly why in facial bones we also have sinuses - special cavities - lingering in them for a while, the air manages to reach the desired "condition" (warm up, moisturize and to some extent cleanse). And only after having been in the sinuses, the “processed” air moves further along respiratory tract to the lungs.

When a child has a runny nose (in medical terms - sinusitis), then inflammation and increased secretion of mucus occurs throughout the nasal cavity, in all sinuses at the same time, because there is no isolation between them. Thus, with a runny nose in the first days of the disease, the child also demonstrates symptoms of sinusitis (inflammation maxillary sinus), and symptoms of frontal sinusitis (inflammation of the frontal sinus). However, all these symptoms safely pass exactly at the same time when the runny nose also passes. And only in one case out of a hundred, sinusitis turns into a form that is really dangerous for the health of the child ...

However, the facial sinuses themselves (frontal, maxillary and the so-called ethmoid labyrinth) are formed in people not at the time of birth, but much later. For example, newborn children do not have frontal sinuses at all - they are fully formed only by the age of 10-12 years. And the maxillary sinus in children under five years old is almost embryonic in size.

In connection with these anatomical features in children under the age of 3-4 years, in principle, there are no sinusitis. And frontal sinuses (inflammation of the frontal sinuses) do not happen even longer - up to about 8-10 years.

Runny nose and sinusitis: what is the connection?

In the nose of children (and even adults) there is often a runny nose - inflammation of the mucous membrane and swelling. For example, at or at . Unbeknownst to us, the same edema and the same inflammation also affects the sinuses, because the nasal cavity is a single space in which there are normally no isolated corners.

To the surprise of parents, there is no difference between a runny nose and sinusitis in children. Nature is arranged in such a way that immediately after inhalation, the air first of all enters the so-called sinuses of the child - in other words, into the sinuses. The maxillary sinus, well known to everyone for such a diagnosis as "sinusitis", is also one of the sinuses.

Therefore, to be precise, sinusitis in children is essentially only one of the varieties of sinusitis - that is, inflammatory process in the sinuses.

Sinusitis in 99 cases out of 100 is just a special case of sinusitis. Which does not threaten the health of the child with any complications and consequences.

Imagine: a child took another breath, and some kind of viral infection rushed into his body with the air (the one that usually causes 99% of cases of SARS in children). First of all, it enters the nasal cavity. However, in nature there cannot be such a situation in which the virus would settle on the nasal mucosa, but at the same time it would not penetrate and begin to “be active” in the sinuses, including the maxillary one.

All sinuses of the nose are a single complex - if the virus enters the nasal cavity, it penetrates into all the sinuses at the same time. And if inflammation starts somewhere, it will also develop simultaneously in all nasal cavities.

If a child has a nosebleed, this by definition “guarantees” that the same child also has acute viral sinusitis and often frontal sinusitis as well. In fact, these "sores" are like twin brothers, they cannot exist one without the other: in each sinus there is inflammation, which simply has its own name, and all of them together constitute a common sinusitis (runny nose).

Popular pediatrician, Dr. Komarovsky: “If a hundred children with a runny nose in the first days of the development of ARVI take a picture of the nasal cavity, the whole hundred will have sinusitis in unison. But there is nothing wrong with that! It's perfect normal phenomenon with respiratory viral infection. Such sinusitis does not need treatment - it will pass by itself as soon as the runny nose passes.

It's too early to rejoice: sinusitis sinusitis discord

In essence, the word "sinusitis" refers to the inflammatory process in the maxillary sinus. However, it can be caused not only by a viral infection (as in the case of the common cold, which we discussed above). In addition, the "causative agents" of sinusitis (that is, the culprits of inflammation in the maxillary sinus) can also be bacteria and allergens.

Thus, sinusitis in children can be viral, bacterial or allergic origin. Just like the cold itself.

At allergic rhinitis in a child (as in an adult), allergic sinusitis also naturally occurs - after all, if swelling occurs in the nasal cavity, it is not localized only somewhere in one “corner”, it spreads to all the sinuses at once.

And viral and allergic sinusitis pass easily, without any consequences or complications exactly at the same time when the runny nose itself passes.

But with bacterial sinusitis(the most difficult and dangerous of all!) the situation is slightly different. As a rule, bacterial (that is, essentially purulent) sinusitis occurs when the maxillary sinus is deprived of natural ventilation. Namely: through a thin tubule, air enters the maxillary sinus (and also leaves it) - that is, this cavity is constantly “ventilated”. However, if this thin tube (air channel) is suddenly clogged, for example, with a lump of dried mucus, then air stops flowing into the cavity. In such a “locked” environment, bacteria instantly begin to multiply, which periodically enter any sinuses with air, including the maxillary sinuses. Bacteria multiply and pus forms. This is the beginning of purulent sinusitis, which, unlike viral or allergic, can really be considered as a serious complication against the background of another disease (for example, SARS).

If viral and allergic sinusitis often go away on their own - simultaneously with recovery from a common illness (from SARS or from an allergy attack), then purulent sinusitis almost always requires serious and surgical therapy.

Sinusitis, which disappears within three weeks, is called sharp(acute viral, acute allergic, acute bacterial). If the maxillary sinuses are not cleared of pus in 21 days - sinusitis should already be considered chronic.

Symptoms of bacterial sinusitis in children

Symptoms of viral and allergic sinusitis are similar to those of the common cold. But when there is a blockage of the channel that supplies air to the maxillary sinus and bacteria begin to multiply and accumulate in it (roughly speaking, the sinus fills with pus) - the first signs of classic bacterial sinusitis appear:

• Nasal congestion;
• Violation of smell (temporarily the baby will not be able to distinguish smells);
• elevated temperature;
• Pain in the region of the maxillary sinuses.

The most important and main symptom of bacterial (purulent) sinusitis in children is severe aching pain in the area of ​​the maxillary sinuses, which increases significantly when leaning forward.

It is important to understand that nasal radiography is not a diagnostic tool for bacterial sinusitis. The picture will only indicate that there is some kind of filling in the maxillary sinuses. But what exactly has accumulated there - just excess mucus, or dangerous purulent clots, an x-ray, alas, will not be able to recognize.

Throughout the civilized world, the diagnosis of bacterial sinusitis (and the rest are not even considered as serious illnesses, being essentially a common cold) occurs only on the basis of symptoms: runny nose, heat and aching, constant pain, aggravated by bending over.

How to treat sinusitis in children

Treatment of viral sinusitis

Recall that viral sinusitis in a child is the same as a runny nose. If there are all signs of SARS, but there is no strong aching pain in the area of ​​​​the sinuses, which sharply increases when leaning forward - then a runny nose in such a child can be safely called a viral sinusitis, or vice versa, sinusitis - a runny nose. Viral sinusitis does not need any special treatment - it will pass on its own along with SARS.

Treatment of allergic sinusitis

Allergic sinusitis is not caused by the activity of viruses or bacteria, but by swelling of the mucosa in the process allergic reaction. As soon as you eliminate the allergen and carry out antihistamine therapy, the swelling will decrease, and the runny nose (aka allergic sinusitis), respectively, too.

Antibiotics for the treatment of bacterial sinusitis

The most reasonable and adequate method of treating acute bacterial sinusitis in a child is antimicrobial therapy. Nevertheless, do not forget: not parents, relatives or neighbors have the right to prescribe antibiotics, but qualified doctors and only they!

Alas, the doses of antibiotics in the treatment of sinusitis in children are usually large - and even the course itself is not the traditional 7 days, but 10-14. The fact is that for the effective treatment of sinusitis it is necessary that the desired concentration medicinal product accumulated not in the blood, but in the mucous membrane of the maxillary sinus itself.

Therefore, if you started treatment of sinusitis with a course antimicrobials- in no case do not interrupt it, even if you observe a noticeable improvement in the child's condition.

AT modern therapy against purulent sinusitis, painful injections of antibiotics are no longer resorted to. And they use pills.

Chronic sinusitis in a child

As a rule, within 21 days, acute sinusitis (any: viral, allergic, and the most severe - bacterial) is cured. Otherwise, doctors attribute the definition of "chronic" to it. However, modern pediatricians tend to believe that a child cannot have chronic sinusitis as such - there must be some kind of weighty condition that “warms up” the inflammatory process. The most likely conditions are:

• 1 In the environment of the child there is an unidentified allergen - it is he who provokes a constant swelling of the mucous membrane of the nasal cavity, including the maxillary sinus. And until this allergen is identified and eliminated, the child will have signs of sinusitis (either weakening, or intensifying).
• 2 The bacteria that caused purulent inflammation in the maxillary sinus turned out to be resistant to the antibiotics that were used to treat sinusitis (this often happens when a child is given antibiotics “for no reason” - for example, with acute respiratory viral infections, in order to prevent the development of pneumonia).

If the treatment of sinusitis was adequate and correct, then the disease should recede in a maximum of 21 days.

Puncture in the treatment of acute bacterial sinusitis

There are situations in which pus in the sinus accumulates too quickly (bacteria multiply too actively), the child suffers from terrible pain, experiencing temperature "overloads", and antibiotic treatment does not bring positive result. In such extraordinary conditions, the question arises - how to quickly eliminate the abscess from the sinus, until a rupture occurs? Until recently, doctors solved this problem with the help of a special puncture - through the nose with a sharp and long needle, they penetrated into the maxillary sinus and washed it, freeing it from accumulated pus.

A puncture in the area of ​​the maxillary sinus is a painful and unpleasant procedure, especially for a child. But in situations where antibiotics do not work, it becomes the only way out saving the baby from unbearable pain and the risk of rupture of the abscess.

Meanwhile, in fairness, it is worth noting that in recent years, domestic medicine is less and less using punctures of the maxillary sinus for the treatment of sinusitis - there are already modern antibacterial drugs that can quickly alleviate the condition of the child with this disease.

However, often today a puncture in the sinus area is used for the most accurate diagnosis- with the help of this technique, a puncture is taken from the sinus in order to determine which bacteria caused the inflammation.

Parents should realize and believe that there is no tragedy in the diagnosis of sinusitis. Two types of this disease - viral and allergic sinusitis - are generally akin to the common cold and do not need any special treatment. Their bacterial "brother" is much more insidious and dangerous - it's true. But he is also a banal "sore", which, with adequate and timely treatment, passes quickly and without consequences.

Sinusitis (maxillary sinusitis) is an inflammation of the mucous membrane of the maxillary (maxillary) sinus.

Causes of sinusitis in children

The disease can be both acute and chronic. In children, acute sinusitis is more common, and develops as a complication of acute or allergic rhinitis(cold), viral (flu, SARS) and infectious (measles, scarlet fever) diseases, immune disorders, diseases of the teeth (caries) and oral cavity (stomatitis, tonsillitis - inflammation of the tonsils). The cause of sinusitis can also be adenoids, which disrupt the process of nasal breathing and serve as a constant source of infection.

The chronic form of the disease is usually the result of acute inflammation, if there not favorable conditions for the outflow of pathological secretions accumulated in the sinuses. The reason for this may be thickening of the nasal mucosa, curvature of the nasal septum, hypertrophy of the turbinates.

Most often, sinusitis occurs in winter, when there is a natural decrease in immunity, seasonal hypovitaminosis.

According to the mechanism of occurrence, the following types of sinusitis are distinguished: rhinogenic (as a result of rhinitis), hematogenous (an infectious agent is introduced into the maxillary sinus with blood from other, distant, foci of infection), odontogenic (due to diseases of the teeth), traumatic.

The maxillary sinuses (paired) are one of the paranasal sinuses. There are also two frontal sinuses (above the orbits), two ethmoid sinuses (in the nasal cavity), one sphenoid sinus (at the base of the skull). They are air cavities that lie around and inside the nasal cavity in the thickness of the bones of the skull.
All of them communicate with the nasal cavity through small openings and tubules. Through these holes, the sinuses are cleansed and ventilated. Closing them due to any reason leads to the accumulation of pathological secretions in the sinuses, which leads to the occurrence of sinusitis (inflammation of the mucous membranes of the sinuses).

The paranasal sinuses are involved in warming, cleansing and moisturizing the air passing through the nose, shaping the individual sound of the voice and individual facial features.

The maxillary sinus is a cave upper wall which forms the lower wall of the orbital cavity, the lower - the wall of the hard part of the palate, the inner - the side wall of the nasal cavity. Through the holes and tubules of the walls, the infection penetrates into the maxillary sinus and can spread from it.

The clinical picture of acute sinusitis is as follows. Nasal congestion is typical copious discharge mucosal, mucopurulent or purulent nature (with severe swelling of the mucosa, there are no discharges), arching head pain that spreads to the cheek, forehead, temple, root of the nose, teeth (usually on the side of the lesion), aggravated by bending, turning the head , coughing, sneezing. The pain is associated with the accumulation of pathological secretions in the sinuses, and decreases in the supine position, or after the night, as the outflow of pus from the sinuses improves. Decreased sense of smell, nasal voice, swelling on the face (more often on the cheeks, eyelids), intoxication syndrome (fever, chills, lethargy, capriciousness, disturbances in appetite and sleep) are also characteristic.

To distinguish sinusitis from a simple runny nose in a child will help following points. So, with sinusitis, the child will complain that “one side does not breathe” (there may be an alternating change of the “breathing” nostril), while with a common cold, both nostrils are blocked. With sinusitis, the baby will feel a dull pain and heaviness in the sinus, but blowing your nose does not bring long-term relief. With gentle pressure on the points in the center of the cheek ("dog's fossa") and on the inner corner of the eye, the child will feel pain.

The duration of a cold is more than 5-7 days, the appearance of a temperature on the 5-7th day from the onset of a cold, the appearance of a discharge from the nose of a purulent nature should alert parents and force the doctor to pay attention to this.

With the transition of an acute process into a chronic one, perspiration, soreness in the throat when swallowing, dryness may appear. Chronic sinusitis is characterized by the presence of headaches, malaise, general weakness, nasal congestion, recurrent runny nose. In this case, the child's temperature can be normal or subfebrile (37.1 - 37.9 ° C). One of the most pronounced symptoms of the disease is a persistent nocturnal cough that does not respond to traditional treatment. It occurs due to the draining of pus from the affected sinus along back wall throats. Sometimes there is keratitis (inflammation of the cornea of ​​the eye), or conjunctivitis (inflammation of the conjunctiva), as a result of constant infection from a persistent pathological focus in the maxillary sinus.

Examination of a child with suspected sinusitis

Diagnosis of sinusitis is based on the clinical picture of the disease (revealed symptoms), the presence of an inflammatory process according to general analysis blood and additional diagnostic methods. In the presence of the above complaints, it is appropriate to conduct instrumental examination to confirm the diagnosis. most convenient and accessible method is an x-ray of the paranasal sinuses. On the x-ray you can see the blackout in the area of ​​the maxillary sinuses ( White color on the picture).

An informative method is the puncture of the maxillary sinus. However, it is used when other diagnostic and treatment methods have failed, since after its use complications such as emphysema of the cheek or eye sockets may occur (air entering from the syringe into soft tissues), an abscess (a cavity filled with pus and surrounded by dying inflamed tissues) or phlegmon of the orbit, blockage (embolism) of blood vessels.

In doubtful cases, you can computed tomography paranasal sinuses. Most often it is carried out with suspicion of odontogenic sinusitis.

Treatment of sinusitis in children

Depending on the severity of the disease, the causes of sinusitis, sinusitis will also be treated. Mandatory home or stationary mode for 7-10 days. In any case, the main point will be the elimination of edema in the sinus, the improvement of sinus drainage and the outflow of pathological secretions. To do this, use nasal sprays and drops that contain vasoconstrictors(naphthyzinum, farmazolin, nazivin, for nose, etc.). Such sprays provide instant relief from mucosal edema and improve sinus cleansing. But their use is limited in time (5-7 days), because there is a risk of atrophy of the mucous membrane, and in the future - vasomotor rhinitis.

An important point in the treatment of sinusitis is antibiotic therapy. Good results are obtained by systemic (inside) use of new generation antibiotics (augmentin, cephalosporins, azithromycin). Antibiotics are widely used today. local action(isofra, bioparox), which create a high concentration active substance directly at the site of infection.

If the cause of sinusitis is a deviated septum, then therapeutic treatment may not give proper results. In this case, resort to surgical intervention.

Symptomatically used antipyretic, anti-inflammatory and analgesic, antiallergic drugs.

Effective additional methods treatment of sinusitis are punctures of the maxillary sinus with the introduction medicinal substance in the sinus, setting the sinus catheter YAMIK, washing the nasal passages according to Proetz (cuckoo). Also, in the recovery stage, the child is prescribed physiotherapeutic procedures (UHF, blue beam, microwaves). Such procedures can reduce the dose and duration of antibiotics, and shorten the period of the disease.

Complications of sinusitis

If the inflammatory process lasts more than 3 months, irreversible damage to the mucous membrane of the maxillary sinus often develops, and it loses its protective properties.

Thus, acute sinusitis becomes chronic. Intraorbital or intracranial complications of sinusitis may also occur, when the infection penetrates from the cavity of the maxillary sinus into neighboring sections: the orbit or the cranial cavity, damaging the tissues and function of these areas. So, when an infection enters the orbit, there is a reactive swelling of the tissue of the orbit and eyelids, osteoperiostitis (inflammation of the bone tissue) of the orbit, thrombosis (blockage of the lumen of the vessel by a thrombus) of the veins of the orbit. When an infection enters the cranial cavity, such dangerous intracranial complications as serous or purulent meningitis, meningoencephalitis, rhinogenic brain abscess.

Folk methods of treatment of sinusitis and herbal medicine

Inhalations are safe method self-treatment. They should be done from the 5-7th day of an incessant runny nose. For the procedure, use a ready-made inhaler, or a porcelain teapot. Mix 1 tablespoon each of sage leaves, chamomile flowers and calendula. Pour a glass of boiling water, bring to a boil and immediately remove from heat. In the absence of allergies, menthol oil and propolis can be used for inhalation, dripping a few drops of both into boiling water.

With chronic non-purulent sinusitis, a Russian bath can help a child, especially with pine and fir decoction. You can also apply pieces of copper to the area of ​​​​the sore sinus at night, and fix them with a band-aid.

Massage is also recommended breathing exercises. Gently tap the bridge of your nose for 2-3 minutes big phalanx thumb. At first, you need to do such drainage tapping at least once every half an hour.

Helps with sinusitis acupressure. Find the following points: the inner upper corner of the eyebrow, the center point between the eyebrows, the inner lower part eye sockets, midpoint along the nasolabial fold. These points should be slightly painful. Massage them clockwise (20-30 seconds for each point).

Breathing exercises. Let the child take turns breathing 10 times the right and left nostrils (4-6 seconds each), closing them with a large and index fingers. This exercise helps improve blood circulation.

You can also apply the following recipe. Soak 2 cotton turundas with propolis ointment. Then insert them into the child's nose and hold for 5 minutes.

Prevention of sinusitis in children

Prevention of sinusitis is the timely detection and full treatment SARS and acute respiratory infections, strengthening general and local immunity (hardening, regular and proper nutrition, good sleep, compliance with the regime of work and rest, frequent stay at fresh air). You can also plan to eliminate predisposing factors, such as a deviated septum, enlarged adenoids.

Family doctor Andriana Pavliuk

Sinusitis is called inflammation of the maxillary sinuses, which is very common in children at the age of three. Therefore, every parent should know how to identify and cure sinusitis. Let's talk about this in more detail.

The main reason for the development of sinusitis in children is a common cold. Also, the disease occurs if the child's immune system is weakened. In addition to all of the above, it can provoke sinusitis a large number of infections and viruses, including influenza, measles, scarlet fever.
What symptoms indicate that a 3-year-old child has sinusitis? Signs of the disease include:

• Difficulty breathing and nasal congestion.
• Headache.
• Heat.
• Yellow or greenish discharge from the nose.
• Increased fatigue.
• Poor sleep and appetite.
• Puffy eyelids and cheeks.

When the first signs of the disease occur, it is urgent to show the child to an otolaryngologist, since sinusitis is a dangerous disease that is fraught with various unpleasant consequences.

How to treat sinusitis in a three-year-old child?

Treatment of sinusitis in a child of 3 years is usually carried out in a complex manner. The treatment regimen includes:
medications that eliminate the symptoms of the disease;
local procedures to strengthen immunity;
with exacerbation - surgical intervention.
As medications drops and sprays, antibiotics and antibacterial drugs are used. Also, the baby is assigned physiotherapy.
Among other things, the doctor may prescribe medications with analgesic and antihistamine effects that will help eliminate the symptoms of the disease in the baby. Antibiotics are used for the advanced form of sinusitis. Very often, children are prescribed UV radiation, UHF currents. But all procedures are used exclusively in combination with medicines.
Washing of the maxillary sinuses and nose is carried out with a severe course of the disease. With the help of these procedures, accumulated mucus, as well as microbes, are removed, and swelling is reduced. In addition, in the focus of infection with this procedure is introduced into the drug.
No need to be scared and panic if your baby has all the symptoms of sinusitis. If you notice signs of the disease, immediately make an appointment with the doctor. He will appoint effective treatment, focusing on the age of the child and the severity of the course of the disease, and your baby, subject to all the recommendations, will definitely recover.

Sinusitis in children is an inflammation of the maxillary paranasal (maxillary) sinuses, often found in pediatric practice. The incidence of sinusitis has a pronounced seasonality - it increases sharply in the autumn-winter period, which is explained by the natural decrease in the immunity of the children's body during this period of time.

Children under the age of 3-4 years do not have sinusitis, this is due to age-related anatomical features: by the time the child is born, the maxillary sinuses are in their infancy, their development begins after 5-6 years and continues up to 10-12 years. Therefore, from 5 to 12 years of age, sinusitis in children is rare, and after 12 years, the incidence of it becomes as high as among adult patients, and is 10 cases for every 100 people.

Causes and risk factors

The maxillary sinuses communicate with the nasal cavity through small openings. If for any reason (more often due to inflammatory swelling of the nasal mucosa) these openings close, then the sinuses cease to be cleared and ventilated. This creates a favorable environment for them to live. pathogenic microflora, which causes the development of an inflammatory process in the mucous membrane of the sinuses.

The causative agents of sinusitis in children are most often viruses. Less commonly (5–10% of cases), the disease is caused by pathogenic and opportunistic bacterial agents (Hemophilus influenzae, staphylococci, streptococci, moraxella), and even more rarely by a fungal infection.

Risk factors for the development of sinusitis in children are diseases that contribute to the penetration of infection into the maxillary sinus or disrupt its normal ventilation:

• chronic rhinitis of various etiologies;
• congenital anomaly in the structure of the nasal passages;
• diseases of the teeth of the upper jaw;
• dental interventions on the teeth of the upper jaw;

Forms of the disease

Sinusitis in children may be catarrhal or purulent. At purulent inflammation purulent or purulent-mucous discharge from the maxillary sinus, with catarrhal form diseases are serous. Catarrhal inflammation can turn into a purulent form.

Depending on the route of infection penetration into the maxillary sinus, there are the following types sinusitis in children:

• rhinogenic - microbes penetrate from the nasal cavity; this is the most common way;
• hematogenous - the infection with the blood flow enters the sinus from another focus of infection in the body;
• odontogenic - the focus of infection is the carious teeth of the upper jaw;
• traumatic.

Inflammation of the maxillary sinus can be unilateral or bilateral.

By the nature of the inflammatory process - acute and chronic.

Children suffering chronic sinusitis swimming in public pools with chlorinated water is contraindicated.

Depending on the morphological changes chronic sinusitis in children is:

• exudative (catarrhal or purulent) - the predominant process is the formation of exudate (serous or purulent);
• productive (parietal-hyperplastic, atrophic, necrotic, polyposis, purulent-polyposis). With this form of the disease, pronounced changes in the structure of the mucous membrane of the maxillary sinus occur (hyperplasia, atrophy, polyps).

In clinical practice, polypous-purulent and polypous forms of chronic sinusitis are most common.

Symptoms of sinusitis in children

In the stage of remission in chronic sinusitis in children, there are no signs of the disease. Children feel healthy and do not show any complaints. With an exacerbation of the inflammatory process, symptoms of intoxication occur (muscle pain, weakness, headache, loss of appetite) and the body temperature rises to subfebrile values ​​(up to 38 ° C). The amount of discharge from the nose increases.

Children under the age of 3-4 years do not have sinusitis, this is due to age-related anatomical features: by the time the child is born, the maxillary sinuses are in their infancy, their development begins after 5-6 years and continues up to 10-12 years.

If during exacerbation of chronic sinusitis there is a violation of the outflow from the maxillary sinus, a headache occurs. It has a bursting or pressing character and is localized "behind the eyes". Gain pain promote pressure on the eyes and cheekbones, look up. In the supine position, the outflow from the maxillary sinus improves, and therefore the intensity of the headache weakens.

Another symptom of chronic sinusitis in children is a cough that occurs at night and is not amenable to traditional therapy. The appearance of a cough is due to the fact that in the supine position, pus from the affected maxillary sinus flows down the back wall of the pharynx and irritates it, that is, the cough is reflex in nature.

In chronic sinusitis in children, damage (weeping, maceration, swelling, cracks) is often detected in the vestibule of the nasal cavity.

Diagnostics

Diagnosis of sinusitis in children is carried out on the basis of characteristic clinical picture diseases, complaints of the patient (or his parents), the results of a medical examination and laboratory and instrumental studies.

During rhinoscopy, inflammation of the mucous membrane of the nasal cavity, its swelling, and the release of inflammatory exudate from the sinus are revealed.

X-rays are taken to confirm the diagnosis. With sinusitis, the x-ray shows a darkening of the maxillary sinus from the side of the lesion, however, it should be borne in mind that the x-ray of an acute inflammatory process, especially at the onset of the disease, may be uninformative.

Carry out if necessary bacteriological examination discharge from the nose with the definition of the pathogen and its sensitivity to antibacterial agents.

The causative agents of sinusitis in children are most often viruses. Less commonly (5–10% of cases), the disease is caused by pathogenic and opportunistic bacterial agents, and even more rarely by a fungal infection.

Treatment of sinusitis in children

With uncomplicated acute sinusitis in children, treatment is usually conservative, carried out on an outpatient basis. The treatment regimen includes:

• antibacterial drugs (eliminate the pathogen);
• non-steroidal anti-inflammatory drugs (have antipyretic, analgesic and anti-inflammatory effect);
• vasoconstrictor nasal drops (improve outflow from the affected sinus).

In the absence of the effect of the ongoing conservative treatment sinusitis children are hospitalized in the specialized department for punctures or probing of the maxillary sinuses.

In the treatment of sinusitis, children are prescribed antibiotics in tablets.

With exacerbation of chronic sinusitis in children, treatment should be comprehensive, combining methods of local and general therapy.

To suppress the microbial flora, antibiotics are prescribed, selected taking into account the sensitivity of the pathogen. If the causative agent of the disease is staphylococcus, then staphylococcal γ-globulin, antistaphylococcal plasma is used. Treatment of sinusitis in children of fungal etiology is carried out with antifungal drugs.

If necessary, drain the affected sinus. Later, through the drainage tube, the sinus is washed with antiseptic solutions, antibiotics are administered, taking into account the sensitivity of microflora to them or antifungal drugs. To thin the pus and its better outflow, enzyme preparations can be used.

In the stage of remission of chronic sinusitis, children are recommended to carry out physiotherapeutic methods of treatment (mud therapy, microwave currents). With cystic, polypous and hyperplastic forms of the disease, physiotherapy is contraindicated.

With the ineffectiveness of conservative treatment of exudative forms, as well as with mixed or polyposis forms of the disease, surgical treatment is performed. Most often performed radical operations, the purpose of which is the formation of an artificial anastomosis between the maxillary and nasal cavities (methods according to Dlicker - Ivanov, Caldwell - Luke).

Cysts of the maxillary sinus.

Forecast

In acute sinusitis in children in conditions of timely initiation of therapy, the prognosis is favorable in most cases. At chronic form disease often necessitates surgical treatment aimed at restoring normal ventilation of the maxillary sinus. After surgery, the disease usually goes into long-term remission.

Prevention

Prevention of sinusitis in children includes:

• air humidification in the room;
• child's compliance with the water regime;
• use of nasal saline sprays in the treatment of rhinitis or saline solution who not only struggle with infectious agents, but also moisturize the mucous membrane of the nasal cavity;
• in case of acute rhinitis or exacerbation of a chronic one, it is advisable to refuse to travel with a child by plane (if this is not possible, then a vasoconstrictor should be used before the flight, and a saline spray should be used during the flight).

Swimming in public pools with chlorinated water is contraindicated for children suffering from chronic sinusitis.

With frequent exacerbations of sinusitis, children are referred for a consultation with an allergist.

Video from YouTube on the topic of the article:

AT childhood acute sinusitis ranks second among the inflammatory processes of the upper respiratory tract. Diagnose sinusitis in children from 1 year. Parents should know the features of the course of the disease in order to consult a doctor in time. Indeed, many young mothers associate nasal congestion in their child, the presence of mucous secretions with a common cold due to a viral infection. And the absence timely treatment dangerously severe consequences. In the article we will consider the main symptoms of sinusitis in children, methods of diagnosis and treatment.

Causes

The main pathogens are streptococci, pneumococci, E. coli, influenza virus and their combinations. The most favorable conditions are created during an acute viral infection, since viruses suppress the work of epithelial cells, disrupt the production of immunoglobulins, and reduce the content of lymphocytes and macrophages - the protective cells of the body. And the "bare" layers of the nasal mucosa are the optimal factor for the reproduction of coccal flora.

The source of infection in the body is also often an inflamed pharyngeal tonsil. Arises acute sinusitis in most cases as a complication of rhinitis or adenoiditis.

Specialists divide acute sinusitis depending on the source of infection into:

• rhinogenic;
• hematogenous;
• odontogenic.

According to the form of the inflammatory process, there are:

1. catarrhal sinusitis.
2. Purulent sinusitis.
3. Hemorrhagic sinusitis.
4. Necrotic sinusitis.

Pathogenesis

Why can sinusitis develop as a result of banal rhinitis? This happens due to dysfunction of the mucous membrane, blocking the drainage and aeration of the sinus.

Occlusion of natural openings connecting nasal cavity with the maxillary sinus, occurs due to mucosal edema, in the presence of thick exudate, hyperproduction of mucus containing a high concentration of mucoid. All this eventually leads to a breakdown in ventilation, a decrease in the partial pressure of oxygen, an increase in the content carbon dioxide, suppression of the function of the ciliated epithelium. This creates favorable conditions for the development of anaerobic infection.

Most often, acute sinusitis is detected in children. It is connected with anatomical structure sinuses. Due to the low location of the outlet openings, with a slight swelling of the nasal mucosa, its drainage may be disturbed, which leads to the occurrence of congestion.

Clinic

Sinusitis is clearly worse general condition. Acute sinusitis occurs with fever, weakness, loss of appetite (a complete refusal to eat is also possible). Children become capricious, irritated. Locally, you can determine the violation of nasal breathing, nasal congestion (usually bilateral). In the catarrhal form of inflammation, discharge from the nose is insignificant.

Purulent, necrotic, hemorrhagic sinusitis in a 3-year-old child is severe. There are pronounced general and local manifestations diseases. Mucous, mucopurulent discharges appear, sometimes. Children 5 years old can also tell about the presence of a severe headache. In children 3 years old, it is far from always possible to identify subjective signs. This complicates the diagnostic process a bit.

During a clinical examination, an otolaryngologist diagnoses cheek swelling, eyelid edema, signs of conjunctivitis. On palpation, the area that corresponds to the outer wall of the maxillary sinus is painful. Breathing through the corresponding half of the nose is difficult.

Diagnostics

To confirm whether a child has sinusitis, otolaryngologists conduct an additional examination - anterior rhinoscopy. With inflammation of the maxillary sinus, it is possible to identify:

• Hyperemic, edematous nasal mucosa.
• Mucous, mucopurulent discharge under the middle shell. With severe edema due to compression of the excretory opening, pathological exudate is often absent.

Since the presence of discharge in the area of ​​​​the middle nasal passage may also indicate acute ethmoiditis, frontal sinusitis (in children over 5 years old), radiography is indicated for a more accurate diagnosis.

Treatment

How to treat acute sinusitis? When acute sinusitis is combined with viral rhinitis, therapeutic measures are carried out in accordance with treatment protocols respiratory infection. Primary is indicated in the presence of at least one of the following symptoms:

1. Soreness in the sinus region.
2. Availability purulent discharge.
3. The appearance of signs of intraorbital, intracranial complications.

An interesting fact: when symptoms of the disease are detected in France, treatment is carried out from the very first days. Whereas in America, drug therapy is prescribed while maintaining a characteristic clinic for up to 10 days and even more (in the case of a bacterial infection).

Antibacterial drugs are used from the group of semi-synthetic penicillins, cephalosporins. Most effective tool for penicillin-resistant pneumococci, amoxicillin is considered.

Amoxicillin clavulanate (Augmentin) is active against Haemophilus influenzae, Moraxella. A good alternative to Augmentin are drugs such as Sumamed, Clarithromycin.

When detecting sinusitis in a child of 3 years characteristic symptoms, physiotherapeutic treatment is carried out only in the presence of an outflow of exudate. When severe course hospitalization indicated. includes:

1. Antibacterial agents, the purpose of which is the elimination of pathogens, the prevention of chronicity of the process, the prevention of severe complications.
2. Antihistamines are used to eliminate sensitization of the body.
3. General strengthening measures: bed rest, taking multivitamin complexes, eating protein foods, drinking plenty of water.

locally prescribed vasoconstrictor drops(Nazivin, Sanorin), aerosols (Miramistin). It is better to use turundas pre-soaked in the same solutions. With the ineffectiveness of conservative treatment, the presence of purulent discharge, sinus puncture is indicated. Next, a Teflon drainage is installed, with the help of which the outflow of exudate is improved, the necessary conditions for washing the sinus. The effectiveness of using the Yamik sinus catheter in children is still being studied.

Surgical intervention is performed regardless of the age of the child in case of suspected intracranial, orbital complications.

If nasal congestion persists for more than 7 days, while your baby fever, he is capricious, eats poorly, sleep is disturbed - do not waste time, consult a doctor immediately. These may be the first symptoms of sinusitis.