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Medical Forum / Diseases and Disorders / Sinusitis / December 2006Is this a sinus infection?
I've never posted here before, but I am so confused. My daughter, (9 years old) has had a fever for the past 11 days. It has gone up and down between 99-103. She has a constant, unproductive cough, a stomach ache, headache, little appetite, sore throat and no energy. She does not have a runny or unusually stuffy nose, although she's seen a a little bit of blood on the tissue a couple times when she's blown her nose. She's been in to the doctor four times now. The first two times were walk-in clinics, beacause we thought it might be ear infection. The cough got worse and she wasn't getting better, so we took her into her regular physician. She told us it was a virus, and that she'd have it for four or five more days. It's been six, and there's no end in sight, so we took her back in. Her regular doctor wasn't in today, so another pediatrician at the office saw her. The doctor paid no attention to her stomach complaints, felt her lymph nodes which weren't tender, her face which was, looked at her nose, and diagnosed her with a sinus infection and prescribed amoxicillan. Does this sound like a sinus infection? I just got over a sinus infection, and you could hear it in my voice, and I was going for the kleenex constantly. I was definitely congested. Can someone have a sinus infection without sounding stuffy or complaining of congestion? Why didn't any of the other three doctors even mention this as a possibility? Do you think this doctor was just trying to pacify us? Also, she didn't say anything about nasal spray, or cough medicine. I just want my daughter to get better, so if amoxicillan helps, then great. But this doesn't match with my understanding of a sinus infection. Thanks for replying. Ginni > I've never posted here before, but I am so confused. My daughter, (9 > years old) has had a fever for the past 11 days. It has gone up and [quoted text clipped - 4 lines] > nose. She's been in to the doctor four times now. The first two times > were walk-in clinics, beacause we thought it might be ear infection. Does she have ear pain? Dizziness? > The cough got worse and she wasn't getting better, so we took her into > her regular physician. She told us it was a virus, and that she'd have [quoted text clipped - 5 lines] > a sinus infection and prescribed amoxicillan. Does this sound like a > sinus infection? I just got over a sinus infection, It could be a sinus infection, if her face is tender enough to be detected by the physician. In which case, it sounds like she may have caught her infection from you. The symptoms of sinus infections vary tremendously--some folks get terrible pain, some folks get a bad cough, some folks get terrible runny noses, some folks get terrible post nasal drip, some folks even get psychiatric symptoms. Unfortunately, sinusitis doesn't seem to have a standard treatment protocol. You can go to ten different doctors and get ten different recommended treatment options, including some doctors who won't even believe it's a sinus infection at all. The latest thinking is that acute sinus infections will eventually clear spontaneously in two or three weeks if they're not too severe--the most the antibiotic can do is shorten the duration. Which is good, because many sinus infections are viral rather than bacterial, in which case antibiotics won't help at all. If your daughter caught it from you, that suggests it's viral all right. Of course her cough will worsen because of all the post nasal drip that is building up in her airway. There are plenty of ways to deal with that, the best being nasal irrigation (nasal spray is NOT sufficient), and inhaling steam thru her mouth. Kids are more susceptible to respiratory infections than adults, for a variety of reasons. So if you have a bug, your child can easily catch it from you. When I was a young kid, whenever my mom caught a cold, she *always* wore a surgical mask when she was around me. The next time you catch something, wear a surgical mask and gloves when you're around your daughter. Take care and tell your daughter to hang in there. Hope this helps.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > The latest thinking is that acute sinus infections will eventually clear > spontaneously in two or three weeks if they're not too severe--the most > the antibiotic can do is shorten the duration. Which is good, because > many sinus infections are viral rather than bacterial, in which case > antibiotics won't help at all. If your daughter caught it from you, > that suggests it's viral all right The fact that she had a fever for 11 days suggests a secondary bacterial infection. The arguement to withhold antibiotics for sinusitis is not new, but the studies are flawed. Clearly many people will resolve their sinusitis on their own, but likely most those who resolve without treatment aren't ill enough to seek medical care. Here's a review I wrote about the flawed Cochrane Review that suggested that it was unclear if antibiotics treat acute bacterial sinusitis. http://www.aafp.org/afp/20010901/cochrane.html It was written in 2001--so the "latest thinking" is just a rehash of an ongoing debate. As my ENT says, considering that the majority of antibiotics in the US are used in raising animals for consumption, the push to withhold antibiotics in humans has some validity, but the antimicrobial resistance is likely coming from agriculture to a large extent. If you've ever seen a child with a brain abscess/periorbital cellulitis, I don't think you'd be so cavalier about suggesting that this is viral. (I have, and it was the child of one of my medical assistants, and I had to admit her.) The key here is that the child had a prolonged, persistant fever--a viral infection is unlikely in that case, even if the sinusitis was a secondary complication of a inital virus. Secondary sickening is the hallmark of a bacterial sinusitis that follows a virus. Antibiotics need to prescribed judiciously, but they do have a place in the treatment of bacterial sinusitis. I'm a doctor, and I would never give a diagnosis over the internet--I'd just try and share information. Judy > > I've never posted here before, but I am so confused. My daughter, (9 > > years old) has had a fever for the past 11 days. It has gone up and [quoted text clipped - 57 lines] > Email: sdlitvin@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. Thank you for your reply. I just wanted to add that after talking to my husband who took my daughter to her appointment, I'm even less confident in this doctor. He told me that my daughter told the Dr. that it didn't hurt when she touched her face. The Dr. replied that she had "used a baby touch". She also didn't feel the lymph nodes in the right place for a mono check,asked leading questions, and flat-out refused to do a monospot. I'm taking my daughter into her regular Dr. tomorrow and getting a monospot. If it's not mono, it could be bronchitis or the flu. I guess if it's bacterial, amoxicillan should help. I hope it helps. I just don't see this as a sinus infection because there's no green or yellow phlegm. There's no phlegm, period. That's why I wrote to this group. Maybe I still don't understand what a sinus infection is. For the record, I'm not against antibiotics. I took them myself when I recently had a sinus infection and ear infection. I just want an accurate diagnosis and treatment plan for my daughter. The poor girl is miserable, and I don't want her to be sick at Christmas. Thanks for listening, Ginni > > The latest thinking is that acute sinus infections will eventually clear > > spontaneously in two or three weeks if they're not too severe--the most [quoted text clipped - 98 lines] > > Email: sdlitvin@earthlinkNOSPAM.net > > Remove the NOSPAM before replying to me. > Thank you for your reply. I just wanted to add that after talking to > my husband who took my daughter to her appointment, I'm even less [quoted text clipped - 5 lines] > tomorrow and getting a monospot. If it's not mono, it could be > bronchitis or the flu. [Disclaimer: I'm no doctor, just a patient who's caught nearly every bug by now] First of all, I still don't think the fact that your daughter got sick just after you did is a coincidence. Be sure to tell your physician that you have been sick too, because that may help pinpoint the nature of the bug. Did your symptoms resemble your daughter's, in kind if not in degree? Her symptoms don't sound like bronchitis. When your daughter coughs, if the "tickle" making her cough is higher up in her windpipe (ask her), that's more like an upper respiratory problem with post nasal drip. A deep cough way down in the chest, often productive, is more indicative of bronchitis. Mono and sinusitis sound more plausible. Flu I'm not sure about. Flu tends to have a sudden onset, and the first days are extremely severe. Whereas your daughter is having *fluctuating* symptoms (fever rising and falling) over a longer period. Similar to what you had yourself? Sinusitis will do that; it feels like a cold that seems to go away and then relapses, goes away again and relapses again, on and on. Because without adequate drainage, the infection can't clear. > I just don't see this as a sinus infection > because there's no green or yellow phlegm. There's no phlegm, period. Are you sure? That's why I suggested nasal irrigation and steam inhalation. When I get a sinus infection, the infected post nasal drip goes right into my windpipe causing a cough. I don't cough up the phlegm because it's too thick, and I don't get any mucus coming out of my nose either. So it stays hidden, invisible. But after about 45 minutes of mucolytics and steam inhalation, the phlegm in my airway breaks up and then it's amazing how much green-yellow gunk comes flying out of there. That's what sinusitis has been for me. I know the phlegm is down there because of my scratchy throat, laryngitis, and the "tickle" is making me cough frequently. But without taking specific measures to loosen the phlegm, it remains down there, hidden. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > Thank you for your reply. I just wanted to add that after talking to > my husband who took my daughter to her appointment, I'm even less [quoted text clipped - 15 lines] > Thanks for listening, > Ginni With my first sinus infection many years ago, I ran a high fever, and was dizzy, and had NO other signs of a sinus infection, but since my fever was so high and I was out of town, I went to the ER and was diagnosed with a sinus infection. AFTER starting on the antibiotic, I blew all kinds of colored junk out of my nose. Getting the test for mono is a good idea, but if it were me I would start on the antibiotic ASAP. Even though I don't think amoxicillin is the best choice, it is better than nothing. When my granddaughter was 5, she ran a high fever; we took her to the ER and they did NOTHING; a few days later, she couldn't walk. We rushed her to the ER again, where thankfully her pediatrician was astute enough to order an MRI which showed that she had an infection in one of her vertebrae that had apparently spread from her sinuses. She also had had mono a few weeks earlier, so it possibly was a complication from it combined with the sinus infection. I don't think she was having any of the typical sinusitis symptoms either. She was immediately placed on IV antibitoics for a week and had to continue oral antibitoics for several weeks after that. She seems to keep a low grade chronic sinus infection now (mainly with PND and cough) and it scares me that they just keep putting her back on amoxicillin. I don't want to scare you, but if she is still running a fever after this length of time, then I think it is more than viral, unless it is mono, but again I wouldn't take that chance. If she does take the antibiotic, make sure that she finishes it all, even if she starts to feel better. Kathyw Thank you everyone for your advice. I tried nasal irrigation and steam inhalation for my daughter tonight. She was very reluctant to try, but she said it helped her feel better while we were in the bathroom breathing in the steam from the shower. Yea! Afterwards she coughed a lot and spit something out, but I didn't see anything. I asked her to show me if she blew her nose or sneezed, but she didn't have to do either very much before bed. When I asked her, she did say she was dizzy. She also complained more tonight about her ear and head. These complaints didn't go away after the steam and nasal irrigation. I'd like to get a better irrigation system tomorrow at the pharmacy. (We only had saline drops on hand.) Any suggestions? Also, she is taking the antibiotic. So far she's the same. She still has fever (although it didn't get as high today), bad cough, headache, and stomache ache and upset. I know it can take a few days for the antibiotic to work, so I'm hoping tomorrow or the next day she will be feeling better. I'm starting to think maybe the doctor was right about her having a sinus infection. I still don't care for the cursory exam and leading questions, but if the amoxicillan works, GREAT! Reading this newsgroup has been very enlightening. My daughter was recently diagnosed with acid reflux and has been on prevacid for a month. Right now she's on a generic medicine called omeprazole because our insurance won't pay for prevacid until we see if this one will work. She's also sleeping in the recliner in the living room because she's closer to us if she needs us in the night, and she is not lying flat. (Her loft bed doesn't leave room for her to elevate her head at all.) Anyway, It was interesting to me to see that several people here were discussing GERD, which I understand to be similar to acid reflux. Are acid reflux and sinusitis related? Do people commonly have both conditions? I ask because my daughter is sick a lot, both with stomachahes and nausea as well as colds and ear infections. She's been this way her whole life. I've talked to her pd about allergies and been told repeatedly that's not it. We even tried eliminating dairy for two weeks. It didn't seem to help. I think I might try that again after the holidays. She had her adenoids taken out and tubes put in her ears when she was five. It just seems whenever anything is going around, she gets it. I was like that as a kid and missed lots of school. I guess I passed my poor immune system on to her. I feel like the acid reflux diagnosis is one piece of this puzzle. Now I'm wondering if sinusitis is another. Sorry this is so long. I just want to say one more thing. I told every doctor we've seen that I was sick the week before her. None of them until this one said anything about sinusitis. Maybe they should have, but again, our symptoms are so different. I'll mention it again when we see her regular physician tomorrow. Thanks again, Ginni :-) On Dec 21, 7:48 pm, kathywb2...@yahoo.com wrote: > vlbar...@gmail.com wrote: > > Thank you for your reply. I just wanted to add that after talking to [quoted text clipped - 44 lines] > > Kathyw- Hide quoted text -- Show quoted text - Well, this is such a difficult situation. As you can see, you get 10 people with sinus infections and each has a different constellation of symptoms!! I NEVER have breathing problems. But I DO get a severe sore throat and feel just awful. I feel very weak, lethargic and feverish although my fever rarely exceeds 99.2. Yet the docs can always see the "tracks" from what apparently is PND. When it gets very bad I get mucous, sometimes yellow but sometimes clear. It is miserable. I found amoxicillan to be useless. Initially it worked but even before I was done with it the infection came back. What finally seems to have worked was a LONG course of biaxin XL (it took SEVEN Weeks). Next infection I will be getting a CT Scan Mel > Thank you everyone for your advice. I tried nasal irrigation and steam > inhalation for my daughter tonight. She was very reluctant to try, but [quoted text clipped - 96 lines] >> >> Kathyw- Hide quoted text -- Show quoted text - More on variety... I recently went through a bout of infection that I held out on for 10 days and then went on 20 days of Avelox. The abx only started to work when I took 7 days of Prednisone. My uneducated guess is that the Prednisone tamped down the swelling enough for the mucuos to move on down. And that's what I think is weird. My throat hurts all the time, I think, from a steady stream of PND. When I had my infection, my throat didn't hurt. I think it was because the mucous wasn't moving. So no sore throat, but terrible headaches, nausea in the morning (after drinking hot tea), dizziness, etc. Those symptoms are mostly gone, but guess what's back every morning? Yep, sore throat. This happened last year and the ENT was convinced it was LPR and not sinus-related. She put me on PPI for nearly six months. What a waste! I think I do get acid reflux every now and then, especially when under stress, but the diagnosis towards the tummy and away from the sinuses was flawed IMHO. The current ENT first prescribed abx and when that didn't work, he extended it with Prednisone to help. It worked. I can't believe the previous ENT never even suggested this! She spent months giving me different sprays for the inflammation, repeatedly asking me if I had contact with cats, and insisting on PPI's for LPR. Then her final diagnosis was that my nasal inflammation was something I have always had and that it wasn't that big of a deal and that I should live it. But that my real problem was LPR. The only good thing I can say about the first ENT is that she did convince me to give irrigation a second try. What is: LPR, PPI??? Mel > More on variety... > [quoted text clipped - 25 lines] > the first ENT is that she did convince me to give irrigation a second > try. > What is: LPR, PPI??? > > Mel Sorry, was in a rush: Laryngopharyngeal Reflux (LPR) proton pump inhibitor (PPI) Hi everyone. I'm the mom that started this thread. Thank you all so much for caring about my little girl and me. I feel so blessed to find a group of people to talk to about all this. When she's healthy again, I will get her checked out for immune deficiencies. Thanks for the advice. I just wanted to let you all know that we saw her regular pediatrician today. She listened to Katie's (my daughter's)chest and sent her right down for an x-ray. It showed that Katie has pneumonia in the lower lobe of the right lung. She said the amoxicillan probably wouldn't take care of it and prescribed zythromax (sp?). She said she should take the amoxicillan throughout the weekend as well. Katie seems a little better already, so I'm hopeful that she'll feel well for Christmas. We're of course taking it slowly. If she still has a fever on Sun., I'm supposed to bring her back in. Thanks again, Ginni :-) > > What is: LPR, PPI??? > > [quoted text clipped - 5 lines] > > proton pump inhibitor (PPI) I'm so glad you got an answer: you knew something wasn't right--both in the diagnosis and treatment. Azithromycin will cover the "atypicals": mycoplasma, chlymidia--and is a good lung drug as it is also anti-inflammatory as well as anti-microbial. I hope she gets better quickly. Just goes to show that as her mother, your instincts were so right. Judy > Hi everyone. I'm the mom that started this thread. Thank you all so > much for caring about my little girl and me. I feel so blessed to find [quoted text clipped - 20 lines] > > > > proton pump inhibitor (PPI) > Hi everyone. I'm the mom that started this thread. Thank you all so > much for caring about my little girl and me. I feel so blessed to find [quoted text clipped - 11 lines] > Thanks again, > Ginni :-) Ginni, I'm really glad you found us (especially Judy!) and that your daughter is going to be better for her holidays and school vacation. Susan You're right that you'll get a lot of different opinions, but you will get information. Steven, you're right that mono--either EBV or CMV, or even adenovirus can cause a prolonged fever in a child. A CBC, monospot,EBV, CMV acute/convalescent titers will help clarify that situation. For GERD: generic omeprazole is generic prilosec, and it works as well as prevacid--just cheaper. GERD and sinusitis are linked--it's rought to diagnose GERD in a 9 year old: the symptoms can be subtle--just a sore throat and cough, and the only true way to diagnose is a pH probe, which is tough for a child to handle. I completely agree with you that a cursory exam is extremely upsetting: my daughter just had an important follow up appointment and we were literally in the room for 3 minutes--and this is a colleague, and my daughter had previously been very ill. He charged for a 99213--an intermediate visit, I usually spend around 20 minutes for those visits... It's rough to have an ill child and not have a clear diagnosis. Lately will all the resistance out there, the trend is to prescribe higher dose amoxicillin-80-90mg/kg, rather than the "old" 40mg/kg. Sinusitis can present variably: I usually get nauseated and dizzy. Here's a web site with some signs/symptoms of sinusitis--because it's a clinical diagnosis. http://www.entnet.org/healthinfo/sinus/sinusitis.cfm The lead article is about how antibiotics are worthless, but that's controversial. I hope she's better soon. Judy > Thank you everyone for your advice. I tried nasal irrigation and steam > inhalation for my daughter tonight. She was very reluctant to try, but [quoted text clipped - 95 lines] > > > > Kathyw- Hide quoted text -- Show quoted text - Judy: Amazing that a colleague would treat you in such a perfunctory manner!!! Was this an ENT person?? Mel > You're right that you'll get a lot of different opinions, but you will > get information. [quoted text clipped - 138 lines] >> > >> > Kathyw- Hide quoted text -- Show quoted text - No, our ENT is a wonderful person,and literally spends hours with us.(And calls me at home and talks some more, and emails me and calls in scripts for my older daughter at college, and stays late to see her on a Friday when she drives down from college--he's exceptional--and he treats all his patients this way.) This was my younger daughter's neurologist: she developed severe migraines and was hospitalized and sort of lost about 18 months of her life to them--her junior and senior years of high school. Pertinent to this group: rather than headache, she predominantly gets vertigo. Which our ENT valiently tried to treat. I have a great otologist at Mass Eye and Ear, Steven Rauch, and he saw her to validate that she had a severe case of migraine associated vertigo. Here's a good article on the subject of migraine associated vertigo--very common and completely unknown in the medical world. http://www.emedicine.com/ent/topic727.htm She has stabilized and was checking in after her first semester at college, and the visit was literally 3 minutes long. She's actually okay with that--she hates doctors after her horrible experiences in the hospital, and seeing some "world experts" who were not very helpful. He just said hello, did a quick exam, said "don't change anything", didn't write any scripts, and told her he'd see her in a year. Fine with her. I was livid. Judy > Judy: > [quoted text clipped - 145 lines] > >> > > >> > Kathyw- Hide quoted text -- Show quoted text - Have you and your daughter had your immune system checked for immune deficiency such as subclass IgG, complement, etc.? Kathw Kathy, I read an article that most immunodeficiencies can be diagnosed by a CBC and quantitative immunoglobulins: We discovered that my older daughter has low IgA, and I have two low subclasses of IgG (both tests were ordered by allergists). It made sense of why we catch everything and get so many infections. I've ordered complement levels when the rheumatologists ask me for them, for autoimmune diseases. I check immunoglobulins a lot more often now. Judy > Have you and your daughter had your immune system checked for immune > deficiency such as subclass IgG, complement, etc.? > > Kathw > The key here is that the child had a prolonged, persistant fever--a > viral infection is unlikely in that case, even if the sinusitis was a > secondary complication of a inital virus. Secondary sickening is the > hallmark of a bacterial sinusitis that follows a virus. With children, a low-grade fever can occur for all kinds of reasons, viral infections included. I often ran fevers when I was a young child, even though the symptoms pointed to viral onset (sudden onset and rapid spiking of fever). And I was unusually susceptible; I caught everything that was out there. Plus back then, there were no vaccines against measles, mumps and chicken pox and I caught those too. When I was a young child, my mom and our doctor went the route of shoving antibiotics down my throat every time I got a persistent low-grade fever (no higher than 103). The results were disastrous: Bizarre allergic reactions no one had ever seen before, and bacterial resistance. And even though the antibiotics were discontinued following allergic reaction, eventually the fever "broke" anyway and I recovered spontaneously. Obviously if the fever keeps rising and rising, and the systemic symptoms keep worsening steadily, then the infection is getting out of control and may need antibiotics. But I learned the hard way that a) even a kid's immune system is better than parents give it credit for; and b) antibiotics can cause more problems than they solve. > Antibiotics need to prescribed judiciously, but they do have a place > in the treatment of bacterial sinusitis. The proper treatment of bacterial sinusitis is to investigate and correct the cause of the sinusitis. If the cause isn't fixed, the patient is likely to get another sinus infection sooner or later. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me.
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