Cause Viruses that cause colds also can cause inflammation of the sinuses, the air spaces found in the facial bones around the nose. Acute bacterial infections of the sinuses around the nose are caused by the same germs that cause middle ear infections: Streptococcus pneumoniae, Moraxella catarrhalis, and Hemophilus influenzae. In chronic sinusitis, Staphylococcus aureus or multiple types of bacteria may be involved.

Symptoms Cough and nasal discharge are the most common symptoms of acute sinusitis. The cough occurs during daytime and often is worse when lying down for naps or at bedtime. Nasal discharge may be clear or cloudy. The child may have a sore throat as a result of postnasal drip, and the child may sniff, snort, or snore to clear the drainage. Viral upper respiratory infections usually clear up within 10 to 14 days. If symptoms persist without improvement for more than 10 to 14 days, bacterial sinusitis should be suspected. A more severe but less common form of sinusitis can occur in which the child develops a fever higher than 101 degrees Fahrenheit, a cloudy nasal discharge, headache, and eye swelling. In chronic sinusitis, cough, nasal discharge, and bad breath last for more than 30 days.

How It Spreads Bacteria and viruses are passed via throat and nose droplets.

Incubation Period The incubation period varies.

How Long Symptoms Last Viral infections resolve on their own within 10 to 14 days. With bacterial infections, once the child begins antibiotics, symptoms will usually subside within several days, but it may take several weeks for symptoms to completely disappear.

When to Call Your Child's Doctor Call your child's doctor if your child has a "cold" that lasts more than 10 to 14 days, if there are any symptoms of "allergies" that don't clear up with the usual allergy treatments, if she complains about a headache or pressure behind her cheeks or forehead, or if she has facial swelling.

How the Diagnosis Is Made The doctor will ask about symptoms, how long your child has had them, and where the pain and pressure is to try to distinguish whether the symptoms are caused by nasal allergies or viral or bacterial infection of the sinuses. X-rays or other imaging studies are sometimes used to diagnose sinusitis.

Treatment For viral infections, there is no specific treatment. For bacterial infections, antibiotics are given for 14 to 21 days. Decongestants may improve symptoms but do not clear the infection faster. Antihista-mines are not helpful and may interfere with sinus drainage because they may cause thickening of secretions.

Home Treatment Acetaminophen, ibupro-fen, and/or warm compresses may help reduce facial pain. Do not use aspirin because of the rare but potentially fatal Reye syndrome. If the child is old enough, saline nose drops can be used to help promote drainage of secretions and reduce swelling. A cool-mist vaporizer can help keep secretions moist so that the sinuses can drain more easily.

Prevention Encourage your child to cover her nose and mouth when she coughs or sneezes and not to share food or utensils. In the winter months, use a humidifier to keep home humidity at 45 to 50 percent; this will help make sinuses less of a target for infections. Avoid exposing your child to cigarette smoke—this can irritate mucous membranes and set the stage for sinusitis.

Complications In rare cases, the infection can spread out of the sinuses into other parts of the head, invading the bones (osteomyelitis) of the skull or spreading toward the eyes, causing an abscess (collection of pus) in or near the eye (orbital cel-lulitis). The infection can also invade the membranes surrounding the brain causing meningitis, which can be life-threatening.

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