A cold: Better let your doctor decide

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.