Sinusitis Complications in High Risk Children

Sinusitis Complications in High Risk Children, Russell Faust, boogordoctor, sinusitis

Image: Sinusitis Complication in High Risk Child

Sinusitis Complications in High Risk Children Can Be Challenging!

One of the most widely-read articles on this site is my post on the Complications of Sinusitis in Children. I wrote that nearly two years ago; it’s time for an update. Many parents worry about these complications. Every time their little boogor-head has nasal congestion, they wring their hands, worrying about the possibility of a brain abscess, or blindness. Keep in mind: these are extremely rare complications of sinusitis!

On the other hand, there is a population of children who are at increased risk: these are children who are high risk for complications of sinusitis. Parents of these children should be aware of the increased risk, and be especially vigilant when their little one becomes ill with sinusitis.

It should be obvious that a child who is immune-suppressed (from chemotherapy, or even a rare congenital gene mutation) may be at increased risk of complications from infections – any infection. In addition, there are a couple less-obvious, common diagnoses that can be associated with increased risk of complications from sinusitis.

This brief article reviews a couple of the “obvious” ones, and a couple of the “non-obvious.” And although my comments are focused complications of sinusitis in high risk children, most of my comments are applicable to adults who have these diagnoses as well. In some ways, all of the following diagnoses share the condition of “functional impaired immunity.”

Immune-suppression and Immune-compromise:

Any condition that results in reduction of absolute neutrophil count (ANC) below 500 cells /mm3 increases the risk of invasive fungal infection. Fungus and bacteria are always around us, everywhere. We don’t pay any attention because our neutrophils normally deal with fungus and bacteria in a number of very cool ways (at least, from the perspective of a cell biologist).

Our neutrophils provide “innate immunity,” stopping infections even before we have a chance to make antibodies against the would-be invader. However, children who have undergone bone marrow transplant, and children who are infected with HIV, can have low ANCs; this impairs innate immunity. If the ANC is low enough, bacteria and fungi can rapidly cause severe sinus infection. Acute fungal sinusitis can quickly become life-threatening in these children, even in this day of advanced surgical techniques and antibiotics.

Cystic Fibrosis (CF):

Despite the triumphant discovery in 1989 of the gene responsible for CF, children with CF continue to experience chronic, debilitating respiratory infections. This gene – the CFTR, or CF transmembrane conductance regulator – regulates NaCl transport across the cell membrane. But its effects go far beyond regulating the salt content across membranes. In fact, based on recent studies, we now understand that the CFTR mutation causes malfunction of several levels in their innate immunity. Thus, these children are also at increased risk of sinusitis complications.

Diabetes:

Chronic hyperglycemia (elevated blood glucose) from diabetes can impair innate immunity. When measured, the ANC in these children may be well above the 500/mm3 level mentioned above, but if the neutrophils can’t do their job, the real, functional number may be below this danger level. Therefore: Diabetic children who experience poor diabetes control, resulting in chronic hyperglycemia, may have functional immune-compromise at multiple levels in the immune system, and thus be susceptible to the infections mentioned above. They can be at increased risk of sinusitis complications.

Sickle-cell:

Unlike immune-compromise, CF, and diabetes, the problem caused by the sickle cell mutation is more of a mechanical, plumbing problem and less of a complex immune problem. Specifically, a single amino acid substitution in the hemoglobin molecule results in red blood cells becoming elongated, spiked, or “sickle” in shape.

Sinusitis Complications in High Risk Children, Russell Faust, boogordoctor, sinusitis

Image: Sickle Cells
From Dr. Graham Beards: http://commons.wikimedia.org/wiki/File:Sickle_cells.jpg

These red blood cells are no longer compressible and pliable. These sickle cells cannot make it through the tiniest of capillaries – the microcirculation – like normal red blood cells. This can cause poor blood supply, and poor oxygen supply, to sites of infection.

When an infection is developing, good blood supply is important to bring those neutrophils to the site so they can kick some bacteria butt! If there’s a road-block of stacked-up sickle cells, neutrophils can’t do their job. Functional impaired immunity.

As infection continues, the reduced oxygen cause by reduced circulation causes a shift in the types of bacteria that thrive: there is a rapid trend toward anaerobic bacteria. Anaerobes generally pose a nasty infection. The reduced oxygen levels cause more sickling of the red blood cells, and things just get worse.

Bottom line: infections in children with sickle cell disease can rapidly escalate due to this expanding area of reduced oxygen, impaired circulation, and impaired immunity. They can be at high risk for sinusitis complications.

Primary Ciliary Dyskinesia (PCD):

I have written about immotile cilia / dysmotile cilia / ciliary dyskinesia here previously.

Sinusitis Complications in High Risk Children, Russell Faust, boogordoctor, sinusitis

Image: Dysmotile Cilia Syndrome / Primary Ciliary Dyskinesia
From Katherine Connolly: http://remf.dartmouth.edu/images/ciliaTEM/source/1.html

Mucociliary clearance is the primary innate immune function of the respiratory mucosa (the lining of the nose, sinuses, respiratory tract). So it stands to reason that children with PCD experience frequent infections of their respiratory tract.

These infections include ear infections (otitis media and mastoiditis), infections of their nasal lining (rhinitis), sinuses (sinusitis), and lower respiratory tract (including tracheitis, bronchitis, and pneumonitis).

These children experience severe, recurrent, and chronic infections as listed above; but aside from impairment of their mucociliary clearance mechanism, the remainder of their immune systems are intact. The result is that, unlike children with frank immune-compromise, diabetes, or sickle cell, infections in children with PCD are less likely to become life-threatening.

In Conclusion

For all of these children described above, extra vigilance is necessary when they experience sinusitis. They may require unusually aggressive intervention, including hospitalization for IV antibiotics and possibly even very aggressive surgery, in addition to strong anti-inflammatories and regular saline nasal rinses.

Through the years, I have successfully treated children with all of these diagnoses. The sinusitis complications in high risk children that scared me the most – the ones for whom I came closest to failing – included children who had bone marrow transplants, teenagers with severe uncontrolled diabetes, and children with sickle cell disease. During their recovery, each and every one of them took years off my own life with worry.

 

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Hi, I’m Russell Faust, author of this medical education blog. That wonderful photo of me is by Chris Stranad; here is his site: http://www.chrisstranadphotography.com/Index.html

Russell Faust, PhD, MD boogordoctor / healthy children
Image: Dr. Faust and friend

Let me know what topics are important to you and your child’s respiratory health. Join the conversation by leaving a comment / reply below, or email me any time. Thanks for visiting, see you here later. In invite you to subscribe to this blog (it’s FREE). Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email. It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time. Stay informed. Stay healthy. Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

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Comments

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  2. My 5 yr old daughter has just been diagnosed with “severe sinusitis” following an MRI. They have us doing daily nasal rinses followed by Flonase and Cefdanir. We are also supposed to see an ENT in two weeks. I have several questions and really appreciate your blog posts I have read. Thank you. How “serious” is ” serious”? Is there a chance this might become a chronic issue (and how will we know when it gets to “serious” status? Also, the Flonase gives her headaches. Might we consider upping the nasal rinses instead? Thank you again.

    • Russell A. Faust, PhD, MD says:

      Thank you for your kind comments.

      Please note that MRI is NOT (!) the appropriate imaging study to diagnose sinusitis. Don’t be surprised if your ENT says the same thing, and may want a CT scan. My question for you: does your 5-year-old daughter fall into a “high risk” category as described in this article? If so, you must already have a team of specialists who can answer your questions. If not, a visit with your ENT doc in a couple weeks is a good place to start.

      Thanks for taking the time to share, and please keep me updated.

  3. My 13 year old son gets headaches. He had a ct done to check his sinus cavity. He has been reading about sinusitis and is afraid it can b life threatening. What do I tell him. I am clueless.

    • Russell A. Faust, PhD, MD says:

      Tell him that “life-threatening” complications of sinusitis are extremely rare. Tell him that if he eats his vegetables, studies hard, and does well at school, he has nothing to worry about :)

  4. Gerard-Nasodren says:

    Hi Dr. Russell,

    From your personal experience, could you tell me what sinusitis complications are common in non-high risk children?

    Thank you and congratulations for your blog!

    • Russell A. Faust, PhD, MD says:

      In fact, NONE of the complications of sinusitis are common in non-high-risk children – fortunately. The most common “risk” of chronic sinusitis, really a risk of chronic inflammation (as from allergic rhinitis), is sino-nasal polyp disease.
      Thank you for visiting, and for your kind comments.

  5. Gerard-Nasodren says:

    Thanks for your comment, Dr. Russell!

    Yet, I meant sinusitis complications in non-high-risk children referred to ‘acute’ sinusitis. Are there any?

    Regards

    • Russell A. Faust, PhD, MD says:

      There ARE potential complications of acute sinusitis, even in “non-high-risk, normal” children. They are all the same risks, but much much much lower risk. I have managed all of them over the past thirty years or so, but they are fortunately very rare!

  6. Gerard-Nasodren says:

    Ok, thank you so much for your answer, Dr. Russell! It’s good to know that such complications are very rare.

    Regards

  7. Sandra Hodge says:

    Dr, my 13 year old Grandson had sinusitis with headaches & vomiting all summer. He had sinus surgery the end of the summer, but the headaches changed from sinus to constant migraine with vomiting, & bloody noses that are more like hemorrhages. I know the sinuses area is close to the brain & if the separation is “knicked” this can cause problems. An mri ruled out tumors. Is it possible this separation could if damaged cause these symptoms, or could some other sinus related problem cause them. ( he’s been thru months of testing thru out the body..all negative results)

    • Russell A. Faust, PhD, MD says:

      Hi Sandra:
      I wish I could give you detailed reassurance, but that’s simply impossible without a complete medical history, review of all the medical data and images, and a complete exam. In other words, if he isn’t my patient I can’t comment. My advice: if you are concerned that he is not receiving excellent medical advice and care, obtain another opinion (and yet another if necessary).
      Thank you for asking…I am flattered. Thank you for sharing, and please keep me pdated.

  8. Dawn Renee says:

    Hi Doctor,I am worried about my 14 year old daughter,she has been getting sinus infections for as long as I remember,but this last one was awful,for a week she had temp up to 104 and vomited up mucus and headaches,went on antibiotics and I took her to er and they tested her blood and took flu test and said it was definitely a sinus infection…She had severe reflux from baby until about 10.I have an appointment with a natural pathic Dr in a couple of weeks but until then what can I do…Tests,food elimination,any suggestions,Thankyou so much and Thankyou for this Website! Much appreciated :))

    • Russell A. Faust, PhD, MD says:

      Hi Dawn,
      Sorry I didn’t get to you comment earlier.
      I hope that you found help with your Naturopath. You might want to take your daughter to an ENT doc, too.
      Please let me know what you learn, and how things work out for you.
      Thank you for visiting, and for sharing.

  9. Kevin Glover says:

    After battling a sinus infection and living on Afrin since November, I finally broke down and went to a Doctor immediately following waking up in the middle of the night from a sensation of drowning. I was prescribed a double supply of Methylprednisolone as well as a 30 day supply of Cephalexin for Ethmoidal Sinusitis(?), I think is what it was called. My nasal passages were surprisingly clear with an abnormally low “booger” count prior to the doctor visit, unfortunately my nasal passages were constantly dry and inflamed, which was why I was living on Afrin. The night of the drowning sensation, I tried using a Breathe Right strip to see if that would help my sinuses finally break free and drain. Since finishing both doses of Methylprednisolone, I have woken up once with the drowning sensation and what feels like a loosened, hardened “something” in my right Ethmoidal sinus cavity. It definitely moves or at least gives me the sensation of moving because when I tried to blow it out, it felt like it got lodged and the drowning sensation returned. I have been unsuccessful in removing it and am wondering if the antibiotic will help remove this mass, if it will leave on its own or if it will require another doctor visit. It’s amazing the thoughts that run through your head at 4am… is it caused by a bug that flew up my nose? Is it the remnants of a bug carcass? Can this get stuck in the passageway and need emergency attention?
    Thanks in advance for any insight you may be able to give and I just want to say that I was shocked and impressed when I read all of your responses to questions on here. It’s rare to find someone, nowadays it seems, who takes the time to actually address comments by fans :)

    • Russell A. Faust, PhD, MD says:

      Hi Kevin:
      Sounds like quite a struggle. My only comment is that, if you feel that there is something in your nose or sinuses, an ENT doc can easily do nasal endoscopy in their office to find out exactly what is bothering you. That would be my recommendation.
      Thanks for visiting and sharing, and best success.

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