My 7yo son has been diagnosed (by CT scan) as having a "severe" sinus infection. He has a small amount of air in each maxillary sinus and one of his ethmoid sinuses is clear, the rest are apparently totally occluded. He had been treated for 10 days of Cefzil, 14 days of Vantin with worsening symptoms so the CT scan was done. Now seen by an ENT Dr who has him on Biaxin 250 BID, Deltasone 20mg QD and Vancease Inhaler BID. How serious is this? Is there more aggresssive therapy that we should be taking? How long should he go before repeating the CT Scan? Any comment would be appreciated!
Reply: --------------------------
Your son may have chronic sinusitis depending on the overall duration of symptoms. The medications you have listed are commonly used in the treatment of upper respiratory infections including sinusitis. Chronic sinusitis may require several weeks of sustained medical therapy including antibiotics, nasal steroid sprays, mucolytic agents, and occasionally systemic steroids. It is important to address allergy if it has not already been done but it is important to avoid antihistamine therapy (if possible) in the presence of chronic sinusitis since antihistamines can interfere with drainage of secretions from the sinuses. A mucolytic agent known as guaiafenesin is often recommended to help reduce the viscosity of sinus secretions - it can be found in many expectorants. Increased fluid intake and reduced intake of milk products may be helpful. Nasal saline sprays can also help promote sinus drainage (Ocean, Ayr, etc.). Ultimately, if symptoms and radiographic evidence of sinusitis persist despite 6-8 weeks of sustained treatment measures, surgical intervention may be recommended - some otolaryngologists will recommend adenoidectomy combined with lavage of the sinuses and if that fails to resolve the problem, they would subsequently recommend endoscopic sinus surgery. Other otolaryngologists would recommend endoscopic sinus surgery as the initial surgical procedure. Endoscopic sinus surgery is a surgical procedure designed to open or enlarge the natural sinus drainage pathways with as minimal tissue removal as is necessary to promote return to normal function. While endoscopic sinus surgery is commonly performed in adults, it is not commonly performed in children. It is therefore important to make sure the surgeon is experienced with pediatric endoscopic sinus surgery. Untreated, chronic sinusitis can lead to serious complications such as spread of infection into the structures of the eye socket or into the brain.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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