Why Does Acute Sinusitis Recur After Stopping Medication?

Q: Why Does Acute Sinusitis Recur After Stopping Medication?

To Cloudia： Bacterial sinusitis in children is a common condition that can easily be confused with viral upper respiratory infections and allergic rhinitis, as the initial symptoms are similar and nonspecific. <br>However, if symptoms persist for more than 7 days, there is a high

Why does acute sinusitis relapse two to three days after stopping medication?

Hello Dr.
Hu: My daughter is three and a half years old and has been attending preschool.
Since she started school, she has been experiencing frequent colds.
We have switched from pediatrics to otolaryngology, and each time she presents with cold symptoms, including yellow nasal discharge, but without fever.
She has a slight cough that is more pronounced in the mornings.
Despite taking medication for a month, there has been no improvement; as soon as we stop the medication, her symptoms return within two to three days.
The otolaryngologist mentioned that her previous cold was not fully resolved, which led to acute sinusitis.
After three visits, she seemed to improve, but then her symptoms returned two days later (yellow nasal discharge, but no fever).
What could be the cause? Given this situation, should I take her to a larger hospital for further examination of her nasal passages, such as checking for a deviated septum, etc.? A puzzled mother.

cloudia, 30~39 year old female. Ask Date: 2003/04/14

Dr. Hu Kexin reply Otolaryngology

To Cloudia: Bacterial sinusitis in children is a common condition that can easily be confused with viral upper respiratory infections and allergic rhinitis, as the initial symptoms are similar and nonspecific.
However, if symptoms persist for more than 7 days, there is a high suspicion of acute bacterial sinusitis, characterized primarily by yellow nasal discharge, nasal congestion, and cough, particularly in the morning and evening; fever and headache are less common.
Generally, children aged 2-5 years experience about 6-8 upper respiratory infections annually, with approximately 5-10% developing acute bacterial sinusitis.
Based on your description, it seems to be chronic sinusitis.
Pediatric chronic sinusitis is mainly associated with (1) increased opportunities for recurrent upper respiratory infections when starting preschool, and incomplete antibiotic treatment leading to bacterial persistence and the development of antibiotic-resistant strains, causing recurrence once medication is stopped; (2) nasal obstruction due to adenoid hypertrophy, nasal polyps, foreign bodies, and other congenital abnormalities; (3) systemic diseases such as immunodeficiency and cystic fibrosis; (4) long-term nasal mucosal irritation, such as from secondhand smoke; (5) barotrauma from flying; (6) gastroesophageal reflux, among others.
Therefore, I recommend taking your daughter to our ENT department for a detailed examination and symptomatic treatment.
If chronic sinusitis is confirmed, it is advisable to use broad-spectrum second or third-line antibiotics for 4-6 weeks and to address any other potential causes of sinusitis.
Wishing you health, peace, and joy.
Director Hu Ke-Hsin, ENT Department, Taoyuan Hospital, Department of Health, April 18, 2003.

Reply Date: 2003/04/14

More Info

Acute sinusitis, particularly in young children, can be a challenging condition to manage, especially when it recurs after stopping medication. Your daughter's situation, where she experiences persistent symptoms of yellow nasal discharge and cough without fever, suggests that there may be underlying factors contributing to the recurrence of her sinusitis.

Reasons for Recurrence of Acute Sinusitis
1. Incomplete Treatment: One of the most common reasons for the recurrence of acute sinusitis is that the initial infection was not fully resolved. This can happen if the prescribed antibiotics were not effective against the specific bacteria causing the infection or if the treatment duration was insufficient. In children, the immune system is still developing, making them more susceptible to infections.

2. Underlying Allergies or Irritants: Children often have allergies that can lead to chronic nasal congestion and sinusitis. Allergens such as pollen, dust mites, or pet dander can cause inflammation in the nasal passages, making them more prone to infections. Environmental irritants, such as smoke or strong odors, can also exacerbate symptoms.

3. Anatomical Issues: Structural abnormalities in the nasal passages, such as a deviated septum or enlarged adenoids, can impede proper drainage of the sinuses. This can lead to a buildup of mucus and create an environment conducive to bacterial growth.

4. Viral Infections: Viral infections are a common trigger for sinusitis. If your daughter is frequently exposed to viruses, especially in a school setting, she may develop recurrent sinusitis following these infections.

5. Immune System Factors: Some children may have an underlying immune deficiency that makes them more susceptible to recurrent infections. If your daughter continues to experience frequent infections, it may be worth discussing this with her pediatrician.

Recommendations for Management
1. Follow-Up with an ENT Specialist: Given the recurrent nature of your daughter's symptoms, it would be prudent to consult with an Ear, Nose, and Throat (ENT) specialist. They can perform a thorough examination, which may include imaging studies like a CT scan of the sinuses, to assess for any anatomical issues or chronic sinusitis.

2. Allergy Testing: If allergies are suspected, allergy testing may be beneficial. Identifying and managing allergies can significantly reduce the frequency of sinusitis episodes.

3. Nasal Irrigation: Saline nasal irrigation can help clear mucus and allergens from the nasal passages. This can be particularly helpful in managing symptoms and preventing infections.

4. Medication Review: Discuss with your healthcare provider the possibility of using a longer course of antibiotics if a bacterial infection is suspected. Additionally, consider whether a nasal corticosteroid spray might be appropriate to reduce inflammation.

5. Monitoring Symptoms: Keep a detailed record of your daughter's symptoms, including when they occur and any potential triggers. This information can be valuable for her healthcare provider in determining the best course of action.

6. Preventive Measures: Encourage good hygiene practices, such as frequent handwashing, to reduce the risk of infections. Additionally, ensuring that she stays hydrated and has a balanced diet can support her immune system.

In conclusion, the recurrence of acute sinusitis in your daughter may be due to a combination of factors, including incomplete treatment, allergies, anatomical issues, or frequent viral infections. A comprehensive evaluation by an ENT specialist can provide insights into the underlying causes and guide appropriate management strategies. Your proactive approach in seeking further evaluation is commendable and can lead to better health outcomes for your daughter.

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