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Sinus Pain or Congestion

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Definition

  • Fullness, pressure or pain on the face over a sinus
  • Sinus pain occurs above the eyebrow, behind the eye, and under the cheekbone
  • Other common symptoms can be a blocked nose, nasal discharge, or postnasal drip

Symptoms

  • Most often, the pain or pressure is just on one side of the face.
  • Swelling around just one eye.
  • Other common symptoms are a stuffy or blocked nose or nasal discharge. Your child may also have a nasal drip down the back of the throat. This is called a postnasal drip.
  • Less common symptoms are bad breath or mouth breathing. Also, may have a sore throat and throat clearing from postnasal drip.
  • Age Limit. sinus pain is not a common symptom before 5 years of age.

Causes of Sinus Congestion

  • Viral Sinus Infection. Part of the common cold. A cold infects the lining of the nose. It also involves the lining of all the sinuses.
  • Bacterial Sinus Infection. A problem when the sinus becomes infected with bacteria. (Occurs in 5% of colds.) It starts as a viral sinus infection. Main symptoms are increased sinus pain or return of fever. The skin around the eyelids or cheeks may become red or swollen. Thick nasal secretions that last over 14 days may point to a sinus infection. This can occur in younger children.
  • Allergic Sinus Reaction. Sinus congestion often occurs with nasal allergies (such as from pollen). Sneezing, itchy nose and clear nasal discharge point to this cause.

Treatment of Sinus Congestion

  • Viral Sinus Infection. Nasal washes with saline. Antibiotics are not helpful.
  • Bacterial Sinus Infection. Antibiotics by mouth.
  • Allergic Sinus Reaction. Treatment of the nasal allergy with allergy medicines also often helps the sinus symptoms.
  • All Thick Nasal Drainage. Nasal secretions need treatment with nasal saline when they block the nose. Also, treat if they make breathing through the nose hard. If breathing is noisy, it may mean the dried mucus is farther back. Nasal saline rinses can remove it.

Color of Nasal Discharge with Colds

  • The nasal discharge changes color during different stages of a cold. This is normal.
  • It starts as a clear discharge and later becomes cloudy.
  • Sometimes it becomes yellow or green colored for a few days. This is still normal.
  • Colored discharge is common after sleep, with allergy medicines or with low humidity. Reason: all of these events decrease the amount of normal nasal secretions.

Bacterial Sinus Infections: When to Suspect

  • Yellow or green nasal discharge is seen with both viral and bacterial sinus infections. Suspect a bacterial infection if the discharge becomes thick (like pus). But, it also needs one or more of these symptoms:
  • Sinus Pain, not just normal sinus congestion. Pain occurs mainly behind the cheekbone or eye or
  • Swelling or redness of the skin over any sinus or
  • Fever lasts more than 3 days or
  • Fever returns after it's been gone for over 24 hours or
  • Nasal discharge and post-nasal drip lasts over 14 days without improvement
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When To Call

Call 911 Now

  • Not moving or too weak to stand
  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • You think your child has a life-threatening emergency

Go to ER Now

  • Acts or talks confused

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe. Exception: gone after cleaning out the nose.
  • Redness or swelling on the cheek, forehead or around the eye
  • Severe headache and getting worse
  • Severe pain and not better after using care advice
  • Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
  • Fever higher than 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Headache lasts more than 48 hours
  • Fever lasts more than 3 days
  • Fever returns after being gone more than 24 hours
  • Earache
  • Sinus pain (not just pressure) and fever
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Sinus pain (not just pressure or fullness) lasts more than 24 hours, after using nasal washes
  • Thick yellow or green pus draining from nose and not improved by nasal washes. Exception: yellow or green tinged secretions are normal.
  • Sinus congestion and fullness lasts more than 14 days
  • Runny nose lasts more than 14 days
  • You have other questions or concerns

Self Care at Home

  • Normal sinus congestion as part of a cold
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Care Advice

What You Should Know About Sinus Congestion:

  • Sinus congestion is a normal part of a cold.
  • Nasal discharge normally changes color during different stages of a cold. It starts as clear, then cloudy, turns yellow-green tinged, then dries up.
  • Yellow or green-tinged discharge. This is more common with sleep, antihistamines or low humidity. Reason: decrease the amount of normal nasal secretions.
  • Usually, nasal washes can prevent a bacterial sinus infection.
  • Antibiotics are not helpful for the sinus congestion that occurs with colds.
  • Here is some care advice that should help.

Nasal Saline to Open a Blocked Nose:

  • Use saline (salt water) nose spray (such as store brand). This helps to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use bottled water, distilled water or boiled tap water. Teens can just splash a little water in the nose and then blow.
  • Step 1: put 3 drops in each nostril.
  • Step 2: blow each nostril out while closing off the other nostril. Then, do the other side.
  • Step 3: repeat nose drops and blowing until the discharge is clear.
  • How often: do saline rinses when your child can't breathe through the nose.
  • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
  • Reason for nose drops: suction or blowing alone can't remove dried or sticky mucus.
  • Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.

Fluids - Offer More:

  • Try to get your child to drink lots of fluids.
  • Goal: keep your child well hydrated.
  • It also will thin out the mucus discharge from the nose.
  • It also loosens up any phlegm in the lungs. Then it's easier to cough up.

Humidifier:

  • If the air in your home is dry, use a humidifier. Reason: dry air makes nasal mucus thicker.

Decongestant Nose Spray (Age 12 years or Older):

  • Use this only if the sinus still seems blocked up after nasal washes. Use the long-acting type (such as Afrin).
  • Dose: 1 spray on each side. Do this 2 times per day.
  • Always clean out the nose with saline before using.
  • Use for 1 day. After that, use only for symptoms.
  • Don't use for more than 3 days. Reason: can cause rebound congestion.
  • Decongestants given by mouth (such as Sudafed) are another choice. They can also open a stuffy nose and ears. Side effects: They may make a person feel nervous or dizzy. Follow the package directions.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Use as needed.
  • Try saline first. Sometimes it alone relieves the pain.

Cold Pack for Pain:

  • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
  • Put it over the sinus for 20 minutes.
  • Caution: Avoid frostbite.

Allergy Medicine:

  • If the child also has nasal allergies, give an allergy medicine.
  • Long-acting allergy medicines (such as Zyrtec) are best. Reason: these meds do not cause your child to act sleepy. Age limit: 2 and older.
  • A single dose of Benadryl can be given for any breakthrough symptoms.
  • No prescription is needed. Age limit: 1 and older.

What to Expect:

  • With this advice, the viral sinus blockage goes away in 7 to 14 days.
  • The main problem is a sinus infection from bacteria. This can occur if bacteria multiply within the blocked sinus. This leads to a fever and increased pain. It needs antibiotics. Once on treatment, the symptoms will improve in a few days.

Return to School:

  • Sinus infections cannot be spread to others.
  • Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.

Call Your Doctor If:

  • Sinus pain lasts more than 24 hours after starting treatment
  • Sinus congestion lasts more than 2 weeks
  • Fever lasts more than 3 days
  • You think your child needs to be seen
  • Your child becomes worse

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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