What are the sphenoid sinuses?

The main function of sinuses is to produce a mucus that moisturizes the inside of the nose. This layer protects the nose from pollutants and other small particles. Both air and mucus flow through the sinuses and drain through small openings the nasal passages and then down the back of the throat to be swallowed. A sinus infection causes swelling within the sinus, which can block normal drainage. If the fluid cannot drain, it builds up and leads to the growth of bacteria or fungi. These bacterial or fungal infection cause more swelling and pain. When this happens, the sinus appears opacified on a CT imaging study.

There are four pairs of paranasal sinuses: (1) maxillary sinuses (the largest); (2) frontal sinuses; (3) ethmoid sinuses; and (4) sphenoid sinuses.

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The maxillary and ethmoid sinuses are the most likely to become infected and swollen. This is the typical, run-of-the-mill sinus infection that either resolves on its own or requires a basic antibiotic.

How is sphenoid sinusitis different?

The sphenoid sinuses lie at the base of the brain behind the nose and between the eyes. Due to their location near the base of the brain, if the sphenoid sinuses cannot properly drain, the bacteria or fungus can extend through the thin barrier to the brain and cause an abscess. For this reason, treating sphenoid sinusitis is not the same as a common sinus infection. With a typical sinus infection, multiple rounds of oral antibiotics can be administered without fear that the child will take a turn for the worse. That is not the case with a sphenoidal infection.

How do you treat sphenoid sinusitis in the emergency department?

Treatment for sphenoid sinusitis depends on how long the child has had it for and how it has responded to antibiotic therapy. If the child has already been given one or two rounds of oral antibiotics, the doctor, nurse practitioner, or PA must consult with an ENT or infectious disease specialist to determine the best IV antibiotic to give the child. This is because IV antibiotics are much stronger and work faster to eradicate the infection. If a third (or fourth) round of oral antibiotics is given, the infection will continue to fester. This can cause the bacteria to go into the brain and cause an abscess. For this reason, it is critically important for the emergency room provider to contact a specialist.