Chronic sinusitis

Key points below

What is sinusitis?

Sinuses are air-filled spaces in the face and head. Four pairs of sinuses connect to the nose by small drainage paths. Healthy sinuses make mucus, which drains into the nose. The nose also makes mucus. Mucus is a clear, slimy fluid that protects the nose and sinuses.  Chronic swelling may block the flow of mucus through the nose or sinuses. This may cause bacteria to grow. It could lead to a sinus infection called sinusitis.

Symptoms of sinusitis

If the symptoms last for 14 days, it is called chronic sinusitis.  If symptoms last longer than 3 months, it is called chronic sinusitis.

What tests might be needed?

HISS panel. This is a blood test that checks for immune function. It can tell us if your child’s body can fight infection. The HISS panel is done in a lab. Results take about three weeks. 

Allergy Consult.  An allergist is a doctor who tests for allergies and asthma.  Treatment of allergies may help sinusitis get better.

Lateral neck. An X-ray of the neck. It looks at the size of your child’s tonsils and adenoids. This test is done in Imaging (Radiology). 

CT of the sinuses. The CT scan uses x-rays and a computer to look inside your child’s body. It will show us a picture of your child’s sinuses and head. It is important for your child to lie very still for the CT scan. If your child does not feel well, it may be hard to lie still. If you child has a cold or is sick on the day of the appointment, call the Imaging Department. Your child’s appointment may be changed to another day. Sometimes a child may need sedation to help keep them still. This will be decided by the Imaging staff. Please be at the hospital 30 minutes before your child’s scan. Do not let your child eat or drink anything before the CT scan. Use the guidelines below based on your child’s age:
• Less than 6 months old. No food, formula or breast milk 4 hours before the scan. May have clear liquids (such as apple juice or water) up to 2 hours before the scan. Nothing to eat or drink 2 hours before the scan.
• 6 months or older. No food, formula or breast milk 6 hours before the scan. May have clear liquids (such as apple juice, clear broth, gelatin or water) up to 2 hours before the scan. Nothing to eat or drink 2 hours before the scan.

CT is in Imaging (Radiology) on the first floor of Children’s Wisconsin Hospital in Milwaukee.
To schedule an appointment call Central Scheduling at (414) 607-5280.

Sweat test. This test, which is also called Sweat Chloride Test checks for Cystic Fibrosis (CF). It is a rare condition but chronic sinusitis commonly occurs with CF. 
The Sweat Test is done in a lab and takes about one hour.
• A liquid is put on the forearm. 
• Next, the skin is stimulated to make the skin sweat. Your child may feel a tingling in the arm. It does not hurt. 
• The sweat is collected on a piece of gauze.

What surgeries may be done? 

All surgeries are done under general anesthesia.

• Adenoidectomy. The adenoids, which are behind the nose, are removed. They are hidden from view by the roof of the mouth (palate). Adenoids may act as a storage place for bacteria causing sinusitis. Adenoid removal helps reduce sinus infections. This procedure takes about 30 minutes. 
• Sinus tap. With this procedure the doctor puts a tube through your child’s nose into the sinuses. A sample, called a culture, of mucus is taken, and then water is flushed through the tube to clean out the maxillary sinus. It takes about 15 minutes. It takes several days to get the final results of the culture. 
• FESS (Functional Endoscopic Sinus Surgery). FESS is used to open the blocked passages between the sinuses and the nose. This will help the mucus drain. The surgeon will use a small tube with a light and camera (endoscope) to look at the inside of the nose. The doctor will use the endoscope and other tools to clear or open the blocked passages. After this surgery, mucus can drain more easily and air can flow better. It normally takes one to two hours and is done in the operating room. 
• Tissue biopsy for PCD (Primary Ciliary Dyskinesia). PCD is a rare disease that occurs in about 1 out of 16,000 people. It affects the tiny hairs, called cilia, which line the inside of the sinuses, ears and lungs. Cilia are what keep the sinuses clear of mucus. A diagnosis is made by taking a small sample of tissue (biopsy) from inside of the nose or breathing passage. 

ALERT

Call your child’s doctor, nurse, or clinic if you have any questions or concerns or if, after surgery, your child:
• Is bleeding from the nose or mouth (more than a tablespoon).
• Has a temperature greater than 102ºF (38.8ºC).
• Vomits for more than 24 hours.
• Has severe pain that seems to be getting worse and is not helped by medicine.
• Has a cough that will not go away.
• Has not had any liquids for more than 24 hours or is not able to urinate.
• Has special health care needs that were not covered by this information.