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Sinus Pain or Congestion

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. Sometimes, a fever returns.
  • Allergic Sinusitis. Sinus congestion often occurs with nasal allergies (such as from pollen).  Sneezing, itchy nose and clear nasal discharge point to this cause.

Treatment of Sinusitis

  • Viral Sinus Infection. Nasal washes with saline.  Antibiotics are not helpful.
  • Bacterial Sinus Infection. Antibiotics by mouth.
  • Allergic Sinus Infection. Treatment of the nasal allergy with allergy medicines also often helps the sinus symptoms. 

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.)
  • Yellow or green nasal secretions can also be seen with a bacterial infection. Colored discharge points to a bacterial infection ONLY if it occurs with other symptoms. These are:
  • [1] sinus pain OR
  • [2] swelling or redness over any sinus OR
  • [3] the return of a fever after it has been gone for over 24 hours OR
  • [4] nasal discharge lasts over 14 days without improvement.
  • Nasal secretions need treatment with nasal washes 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 washes can remove it.

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.

When to Call for Sinus Pain or Congestion

Call 911 Now (your child may need an ambulance) If

  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Call Us Now (night or day) If

  • Your child looks or acts very sick
  • Acts or talks confused
  • Trouble breathing not gone after cleaning out the nose
  • Redness or swelling on the cheek, forehead or around the eye
  • Severe pain and not better after using care advice
  • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
  • Fever over 104° F (40° C)
  • You think your child needs to be seen urgently

Call Us Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen, but not urgently
  • Headache lasts more than 48 hours
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
  • Earache occurs
  • Sinus pain with fever

Call Us During Weekday Office Hours If

  • You have other questions or concerns
  • Sinus pain still there after using nasal washes and pain medicine for 24 hours
  • Sinus congestion and fullness lasts more than 2 weeks
  • Nasal discharge lasts more than 2 weeks

Parent Care at Home If

  • Normal sinus congestion as part of a cold

Call 911 Now (your child may need an ambulance) If

  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Call Us Now (night or day) If

  • Your child looks or acts very sick
  • Acts or talks confused
  • Trouble breathing not gone after cleaning out the nose
  • Redness or swelling on the cheek, forehead or around the eye
  • Severe pain and not better after using care advice
  • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
  • Fever over 104° F (40° C)
  • You think your child needs to be seen urgently

Call Us Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen, but not urgently
  • Headache lasts more than 48 hours
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
  • Earache occurs
  • Sinus pain with fever

Call Us During Weekday Office Hours If

  • You have other questions or concerns
  • Sinus pain still there after using nasal washes and pain medicine for 24 hours
  • Sinus congestion and fullness lasts more than 2 weeks
  • Nasal discharge lasts more than 2 weeks

Parent Care at Home If

  • Normal sinus congestion as part of a cold

CARE ADVICE FOR SINUS CONGESTION

What You Should Know:
  • Sinus congestion is a normal part of a cold.
  • 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 Washes to Open a Blocked Nose:
  • Use saline nose drops or spray to loosen up the dried mucus. If you don't have saline, you can use warm tap water. Teens can just splash warm tap 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 nasal washes when your child can't breathe through the nose.
  • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
  • Saline nose drops can also be made at home. Use 1/2 teaspoon (2 ml) of table salt. Stir the salt into 1 cup (8 ounces or 240 ml) of warm water.
  • 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:
  • 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 (No prescription needed):
  • Use this only if the sinus still seems blocked up after nasal washes. Also, only use for age 12 years or older. 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 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).
  • Oral decongestants (such as Sudafed) are not advised. They may lessen nose and ear congestion in some children. But, they also can have side effects.
Pain Medicine:
  • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
Cold Pack:
  • 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.
  • An example of this type of drug is Benadryl. No prescription is needed. See Dose Table.
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
  • Your child becomes worse

And remember, contact us if your child develops any of the "Call Us" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


HouseCalls/Symptom Checker by Dr. Bart Schmitt
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Last Reviewed: 9/1/2012 12:00:00 AM
Last Revised: 12/15/2012 12:00:00 AM

Copyright 1994-2013 Barton D. Schmitt, M.D.