A cold: Better let your doctor decide

By Donya Betancourt

SANUR, Bali (JP): A sore throat, stuffy nose, fever and cough are often the symptoms of a cold. But the common cold typically improves within a week and is all gone within two weeks, and does not require special medical attention.

What if a cold gets worse in the second week, or lasts for months? If a cold will not go away, it may not be a cold at all. It could be sinusitis, infection or inflammation of the sinuses, which are the air-filled hollow spaces within the bones of the face and connected to the nose.

There are four sinuses: the ethmoid sinuses located between the eyes; maxillary sinuses located on either side of the nose; frontal sinuses located between the forehead bones; and the sphenoid sinuses, which are located behind and above the nasal (nose) cavity.

The sinuses develop mainly after birth. The maxillary and ethmoid cells are usually the ones that are prone to infection in infancy, while frontal sinuses are rarely a site of infection until the sixth to 10th year of life. The sphenoid sinuses do not generally become infected until the third to fifth year of life.

What does a sinus do? Sinuses warm and humidify the air that we breathe as well as producing mucus, which cleans and moisturizes nasal passages. They also help the sense of smell and improve the sound of the voice.

The growth of paranasal sinuses is important in changing the shape of the face during infancy and childhood, and in adding resonance to the voice during puberty. That is why a young infant who suffers repeated upper respiratory infections or allergic rhinitis may have a long face from underdeveloped sinuses.

The sinuses that develop from the nasal cavity have a small opening area that connects to the nose and throat by cilia -- tiny hairs that sweep mucus out of the sinus and into the nose and throat. Two things can go wrong. One, these cilia break down and do not drain the mucus. Or two, the opening between the sinuses and the nasal passage becomes blocked, the sinuses become infected and you get sinusitis.

Sometimes during upper respiratory tract infections and some allergies, the nasal mucosa (membrane) becomes swollen and inflamed (rhinitis). The swelling of this membrane, with the accompanying increase in mucus secretion, causes the common "stopped-up nose" or "runny nose", which may spread to one or more of the sinuses.

Sinusitis is sometimes difficult to diagnose because its symptoms mimic an upper respiratory tract infection (URI). It might be in the form of a blocked or runny nose, thick yellowish and green nasal discharge, a cough mostly in the daytime and a decrease or lost sense of smell and taste.

But sinusitis should be suspected if a "cold" seems more severe than usual -- such as a fever higher than 39 degree Celsius, facial pain, swollen eyes (periorbital edema) or if the cold lingers for more than 10 days.

In infants and young children -- if left untreated -- sinusitis can lead to serious complications, such as periorbital cellulitis with edema of soft tissues and redness of the skin around the eye; meningitis, which is a brain infection; cavernous sinus thrombosis, a blood clot in blood vessels around the sinuses that can affect the brain like a stroke; or osteomyelitis, an infection of the bones. Fortunately these complications are rare.

To treat sinusitis, the doctor may prescribe antibiotics for a bacterial infection. There are many other antibiotics that help to treat sinusitis. After 72 hours of effective antibiotics, your child should feel better within the course of 10 to 14 days.

Decongestants may relieve the stuffy nose and help your sinuses drain, but antihistamines may cause thicker secretion and more blockage, and are normally not recommended unless there is a history of allergic rhinitis. Sometimes the doctor may prescribe mucolytic, a medication that thins your mucus and helps it drain even when swelling or obstruction narrows sinus openings. At home you may use a syringe to rinse the nose with a mild solution (1/4 teaspoon of salt and a 1/4 teaspoon of baking soda in 240 milliliters of water), or run a vaporizer or humidifier while sleeping.

My recommendation is if your child shows any of these symptoms or suffers from prolonged colds, consider the possibility of sinusitis and take him to a doctor.

The writer is a pediatrician based in Sanur, Bali. If you have any questions, please feel free to write to her. Her e-mail address is drdonya@hotmail.com or you can reach her at features@thejakartapost.com.