Q: My 6-year-old has sinusitis with full sinuses on a CT scan despite 3 weeks of antibiotics, but no symptoms. Should we go to a major hospital?

Medically reviewed by Sang Hyun Ahn, MD

Content edited by Myeongchan Kim, MD

This post is a dramatization of a question and answer session experienced by our actual medical reviewers. Please note that this content is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

Question:

My 6-year-old child was initially treated for a cold at a local pediatric clinic and started taking antibiotics. When the condition seemed to worsen, an X-ray confirmed sinusitis. We later switched to an ENT specialist because the improvement was very slow. A CT scan there showed that all eight sinus cavities, including more than half of the sphenoid sinus, are almost completely full.

By the end of this week, my child will have been on antibiotics for four weeks. The confusing part is that my child currently has absolutely no symptoms—no cough, no headache, and no runny nose. The only thing we notice is a very small amount of light green mucus that comes out during a nasal wash in the morning, but nothing in the evening. The ENT doctor mentioned that a running nose would be a sign of improvement, but my child’s nose isn't running at all.

Should we continue monitoring the situation with our current ENT, or should we immediately take my child to a larger university hospital?

Answer:

It is completely understandable that you are worried, especially after hearing that your child's sinuses are full on the CT scan despite weeks of antibiotic treatment.

Here is an assessment of your child's current situation:

• No outward symptoms (no cough, headache, or runny nose): This is actually a very positive sign.

• Small amount of green mucus during nasal wash: This indicates that the sinuses are actively draining, which is what you want to happen.

• Sphenoid sinus involvement: This specific area does require careful observation.

Recommendations for your next steps:

1. Observe for one more week at your current ENT: Because your child has no symptoms, the physical inflammation shown on the CT scan may just be resolving slowly. A 4-week course of antibiotics is actually the standard treatment duration for chronic pediatric sinusitis.

2. Home Care: Continue doing nasal washes 2-3 times a day. Use a humidifier to maintain indoor humidity between 40-60%, encourage your child to drink plenty of fluids, and elevate their head slightly with a pillow while they sleep to help with drainage.

When to visit a university hospital immediately:

Please seek immediate medical care at a major hospital or emergency room if your child develops any of the following warning signs:

• Sudden, severe headache

• Swelling around the eyes

• Vision problems, such as blurred or double vision

• High fever

• Facial swelling or severe pain on one side of the face

Re-evaluation plan:

Pediatric chronic sinusitis can take longer to fully resolve compared to adults. Since the lack of physical symptoms is a highly encouraging sign, it is reasonable to finish the current course of treatment. Have your child re-evaluated by your doctor in one week. If symptoms worsen, if new symptoms appear, or if a follow-up assessment shows absolutely no improvement after the full 4 weeks of antibiotics, you should then discuss a referral to a university hospital with your doctor.

For extra peace of mind and clear guidance when tracking your child's symptoms, the FeverCoach app is always there to help.

https://fevercoach.us