Sinus Pain or Congestion

Definition

• A sensation of fullness, pressure or pain on the face overlying a sinus cavity (above the eyebrow, behind the eye, around the eye, or over the cheekbone)

Symptoms

• The pain or pressure usually is just on one side of the face.
• Puffiness or swelling around just one eye.
• Commonly associated symptoms are a congested nose, blocked nose, nasal discharge, and/or postnasal sinus drip.
• Less common symptoms are bad breath, mouth breathing, sore throat from postnasal drip and throat clearing.
• Age limitation: sinus pain is not a reliable symptom before 5 years of age.

Causes of sinus congestion

• Viral Sinusitis: part of the common cold. Viral inflammation of the lining of the nose also involves the lining of all the sinuses.
• Bacterial Sinusitis: viral sinusitis becomes secondarily infected with bacteria (occurs in 5% of colds). Main symptoms are increased sinus pain and the return of fever.
• Allergic Sinusitis: Sinus congestion commonly occurs with nasal allergies (e.g., from pollens). Associated sneezing, itchy nose and clear nasal discharge point to this cause.

Treatment of sinusitis

• Viral Sinusitis: Nasal washes with saline. Antibiotics are not helpful.
• Bacterial Sinusitis: Oral antibiotics.
• Allergic Sinusitis: Treatment of the nasal allergy with antihistamines also usually relieves sinus symptoms.

Return to school

• Sinus infections are not contagious. If the sinus pain or congestion is associated with a cold or other infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.

Color of nasal discharge with colds

• The nasal discharge normally changes color during different stages of a cold.
• It starts as a clear discharge and later becomes cloudy.
• Sometimes it becomes yellow or green colored for a few days; and this is still normal.
• Intermittent yellow or green discharge is more common with sleep, antihistamines or low humidity. (Reason: All of these events reduce the production of normal nasal secretions.)
• Yellow or green nasal secretions suggest the presence of a bacterial sinusitis ONLY if they occur in combination with [1] sinus pain OR [2] the return of a fever after it has been gone for over 24 hours OR [3] nasal discharge lasts over 14 days without improvement.
• Nasal secretions need treatment with nasal washes when they block the nose and interfere with breathing through the nose. During a cold, if nasal breathing is noisy but you can't see blockage in the nose, it usually means the dried mucus is farther back. Nasal washes can remove it.

When to Call Your Doctor for Sinus Pain or Congestion

Call your doctor now (night or day) if

• Your child looks or acts very sick
• Confused speech or behavior
• Fever over 104° F (40° C) and not improved 2 hours after fever medicine
• Redness or swelling on the cheek, forehead or around the eye
• Severe pain

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

• You think your child needs to be seen
• Frontal headache present over 48 hours
• Fever present for more than 3 days
• Earache occurs
• Sinus pain with fever

Call your doctor during weekday office hours if

• You have other questions or concerns
• Sinus pain persists after using nasal washes and pain medicine for 24 hours
• Sinus congestion and fullness lasts over 2 weeks
• Nasal discharge lasts over 14 days

Parent care at home if

• Sinus congestion as part of a cold and you don't think your child needs to be seen

Home Care Advice for Sinus Congestion

1. Reassurance:
   • Sinus congestion is a normal part of a cold.
   • Usually home treatment with nasal washes can prevent an actual bacterial sinus infection.
   • Antibiotics are not helpful for the sinus congestion that occurs with colds.
2. Nasal Washes to Open a Blocked Nose:
   • Use saline nose drops or spray to loosen up the dried mucus. If not available, can use warm tap water.
   • STEP 1: Instill 2-3 drops in each nostril followed by blowing or suctioning of the nose.
   • STEP 2: Repeat nose drops until clear.
   • STEP 3: Do nasal drops 4 times a day or whenever your child can't breathe through the nose.
   • Frequency: Do nasal washes whenever your child can't breathe through the nose.
   • Saline nasal sprays can be purchased OTC.
   • Saline nose drops can also be made: add 1/2 tsp (2.5 ml) of table salt to 1 cup (8 oz or 240 ml) of warm water.
   • Reason for nose drops: suction or nose blowing alone can't remove dried or sticky mucus.
   • For nose suctioning, do not pull the suction tip very far inside the nasal opening.
   • Another option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
3. Humidifier: If the air in your home is dry, run a humidifier.
4. Decongestant Nose Drops or Spray (no prescription needed):
   • Use decongestant if the sinus still seems blocked up after nasal washes AND age 6 years or older. Use the long-acting type (e.g., Afrin).
   • Dosage: 1 drop or spray on each side 2 times/day.
   • Always clean out the nose before using.
   • Use routinely for 3 days, thereafter only for symptoms.
   • Don't use for more than 5 days (Reason: rebound congestion).
5. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief. The application of a cold pack or ice in a wet washcloth over the sinus for 20 minutes may also help.
6. Antihistamines: Give oral antihistamines only if the child also has nasal allergies.
7. Expected Course:
   • With treatment, the viral sinus congestion usually resolves in 7 to 14 days.
   • The main complication occurs if bacteria multiply within the blocked sinus (bacterial sinusitis). This leads to a fever and increased pain. It needs antibiotics.
8. Contagiousness: Sinus infections are not contagious. If the sinus pain or congestion is associated with a cold or other infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.
9. Call Your Doctor If:
   • Sinus pain persists for over 1 day after starting treatment
   • Sinus congestion persists for over 2 weeks
   • Sinus pain present and fever occurs
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

References

1. Abbasi S and Cunningham AS. Are we overtreating sinusitis? Contemp Pediatr. 1996;13(10):49-62.
2. American Academy of Pediatrics, Subcommittee on Management of Sinusitis and Committee on Quality Improvement Clinical practice guideline: management of sinusitis. Pediatrics. 2001;108:798-808
3. Butler CC, Kinnersley P, Hood K, et al. Clinical course of acute infection of the upper respiratory tract in children: cohort study. BMJ. 2003:327;1088-1089.
4. Isaacson G. Sinusitis in childhood. Pediatr Clin North Am .1996;43:1297-1318.
5. Nash D and Wald E. Sinusitis. Pediatr Rev. 2001;22:111-116.
6. Wald ER. Sinusitis in children. N. Engl. J. Med. 1992, 326:319-323.
7. Wald ER. Sinusitis. Pediatr Ann 1998;27:811-818.

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/4/2010

Last Revised: 12/16/2009 1:07:50 PM

Version Year: 2010

Copyright 1994-2010 Barton D. Schmitt, M.D.