Host: Sometimes kids get headaches and they have some mucous from their nose, and sometimes it could be sinusitis? First of all, how old does a kid have to be to even have sinusitis?
Ari Goldsmith: There is no official number, but in general a newborn can't really have sinusitis.
Host: Why is that?
Ari Goldsmith: Their sinuses are almost like too small to clog. Babies can have congestion, but in general, sinusitis isn't seen till kids have sinuses, which is usually age two or three or four, and beyond that.
Host: So the kid has a runny nose, doesn't mean he has sinusitis?
Ari Goldsmith: No, the most common cause of runny nose is obviously a cold or an respiratory infection, or virus.
Host: What about a little greenish or something, does that mean its sinusitis?
Ari Goldsmith: All colds would have a little bit of greener stuff; green or yellow or thick drainaged towards the middle of the cold, and that's actually normal, but that normally goes away itself within five, seven, ten days, that will be a normal cold.
Host: What would you to like to hear in the history that say it's more likely a sinusitis than it's a cold or a little allergy, what would be the hallmark?
Ari Goldsmith: If the congestion starts and it goes and gets worse, and instead of getting better and turning the corner at five or seven days, suddenly he starts to get worse; child has more coughing at night, more green from the nose, and this is going beyond the normal cold duration, then that most likely will be a sinus infection.
The other possibility would be, if the cold starts and its really, really bad from day one; where there is a lot of coughing at night, severe headache, fevers, and the green stuff in the nose, that would also be a sinus infection.
Host: Sometimes they get a headache with this?
Ari Goldsmith: Yeah, older kids typically will complain of headache. Little kids don't normally know what a headache is, so they don't normally complain of it, but older kids will, just like adults.
Host: Can he get puffy eyes?
Ari Goldsmith: Yeah, you can get swelling under the eyes. You can get eye pain, because sinuses are right next to the eye.
Host: If we treat sinusitis, what do we usually treat it with?
Ari Goldsmith: We usually start with a basic antibiotic, like Amoxicillin. We normally want to get the child completely better with the antibiotics, and then continue the antibiotics for a couple of days after that. So in sinusitis very often, as opposed to strap or ear infections, the antibiotic treatment can't be longer than ten days, otherwise you --
Host: Before --
Ari Goldsmith: Before it is 21, we want the child to be completely better, and then a couple of days after that we continue the antibiotics. If we stop it too early, the sinusitis tends to come back.
Host: What about over-the-counter nose drops, are they okay to use for sinusitis?
Ari Goldsmith: You probably should. You can use saline spray freely. So lot of over-the-counter saline spray, washes for the nose, which will make the nose get better quicker. Try to avoid the decongestant sprays.
Host: Why is that?
Ari Goldsmith: They may make you feel a little better initially, however after three or four days, they can actually cause more congestion, and they can actually become addicting, where if you don't have them, you are very congested.
So in general, try to avoid -- maybe a couple of days in the beginning you can use Synephrine or Afrin, however after three or four days, definitely not. Saline spray to wash out the nose is probably the best thing; its completely safe, its got no side effects, and it will make you feel better.
Host: So can you apply these steroid nose drops you see advertised in TV every morning?
Ari Goldsmith: For a kid infection, meaning where the child gets an infection, steroid sprays are probably not needed. Those are used more for kids that are having a lot of infections or are always congested or have some allergy. In general for the infection, some people use it, some people don't. There is no right or wrong, but it doesn't have to be used.
Host: Do antihistamines play a role in controlling sinusitis?
Ari Goldsmith: If an older child is very allergic and is getting frequent sinusitis from allergy, then we would consider using one of the newer antihistamines; not Benadryl or the old stuff, because those can actually make the mucus sticker. However, in an older child, who has some allergy, who is getting sinusitis, the newer antihistamines like Clarinex and Zyrtec do play a role, and will probably help the child get better quicker and avoid new infections.
Host: Is there anything in the environment that could cause sinusitis?
Ari Goldsmith: Smoking in the household is probably the number one irritant in the house. Whether or not a child is allergic, if they are exposed to second hand smoke, they are going to have more ear infections, more sinus infections, and obviously that could be exacerbated and make asthma worse. So smoking would be the number one irritant around the house.
Then of course there is allergy. If the child was allergic, older kids that are allergic to pollens, trees, grasses, that can make sinusitis worse.
Host: Some kids end up, sometimes with surgery, why?
Ari Goldsmith: If children are getting a lot of sinus infections or having a lot antibiotics, then at some point we would consider surgery; the most common surgery being removal of something called the adenoid, which is the little tonsil in the back of the nose. That will be the initial surgery, but its only done if a child is really suffering, and the medical therapy is not making them better.
Host: So in general we can usually control these things, get over easily?
Ari Goldsmith: Sinusitis is a miracle disease, and the pediatrician and the parents working together can usually make the kid better and keep their nose better.
Host: So good old Amoxicillin usually is the drug of choice?
Ari Goldsmith: Amoxicillin, the drug of choice for most of this stuff.
Host: So we don't have to spend $200?
Ari Goldsmith: We don't want to spend $200, and also, we want to keep those strong antibiotics for when they are needed; pneumonias, and real bad infection.
Host: Thank you very much.
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