Sinus infections are a fairly common, but uncomfortable, childhood ailment occurring in about 5 to 10 percent of upper respiratory infections. Sinus infections in kids usually resolve with medication and time, but in some cases, surgery is the best option to keep sinus infections at bay for the long haul.

Pediatric sinus surgery involves a procedure called nasal endoscopy, in which an otolaryngologist (also called an ear, nose and throat doctor, or ENT) inserts a thin instrument into a child’s nostrils to remove blockages. Children may need sinus surgery if they:

• Suffer from recurrent or chronic sinus infections (also known as chronic sinusitis).
• Develop complications from a sinus infection.
• Develop nasal polyps from allergies.
• Have cystic fibrosis.

“Patients who have recurring sinus infections that don’t get better with antibiotics, steroids, and nasal saline spray may require surgery,” says Sean Evans, MD, a pediatric otolaryngologist at Children’s Healthcare of Atlanta. Younger children typically don’t need sinus surgery, since the sinuses develop throughout childhood.

Let’s back up and look at sinuses themselves. Located in a person’s cheeks, between and above the eyes, and deep in the back of the nose, sinuses are air-filled, mucus-lined cavities that help trap foreign objects and bacteria. (We tend to only notice them when they’re causing problems.)

The sinus cavities are large but drain through very small openings. “When the drainage pathway becomes obstructed, or blocked, fluid can build up and create the perfect environment for bacteria to flourish in, resulting in a sinus infection,” says Dr. Evans.

Allergies and sinusitis in kids

If your little one constantly has an inflamed nose without being sick, schedule a visit with an allergist. Allergies are a common cause of chronic sinusitis in kids, but sinus surgery for allergies is not effective if exposure to an allergen goes unchecked.

During endoscopic sinus surgery, the ENT inserts special fiber-optic cameras and instruments into the child’s nasal passages while the child sleeps under anesthesia. The physician removes any infection, trapped mucus, or other obstruction (such as nasal polyps), allowing fluid to escape the sinuses as it should. No external incisions are required, and the procedure typically takes one to three hours.

Recovery from sinus surgery

Pain after pediatric sinus surgery is usually mild and short-lived, says Dr. Evans. Kids may experience the following:

• Small amounts of blood or crusting may come out the nose as part of the natural healing process.
• Most patients will be started on saline “irrigation,” in which they flush out their nose with a saltwater solution to help heal the inflamed sinus.
• The child may be prescribed brief courses of antibiotics or steroids.
• As with any surgery, scarring is possible, which could result in less effective sinus drainage. This typically happens in less than 10 to 15 percent of cases.

After sinus surgery, children can suffer from sinus infections again, notes Dr. Evans. The patients most at risk for developing sinus infections after sinus surgery are those with chronic conditions such as cystic fibrosis or severe allergies.