Sinusitis in Children — Symptoms, Diagnosis and Treatment

What is sinusitis in children?

Sinusitis (rhinosinusitis) is the inflammation of the mucosa lining the paranasal sinuses. In children, the sinuses develop gradually: the ethmoidal and maxillary sinuses are present from birth, the sphenoid sinus develops around the age of 5, and the frontal sinus after 7-8 years of age.

It is estimated that 5-10% of viral nasopharyngitis cases in children are complicated by bacterial sinusitis. The differential diagnosis from a common cold is essential for proper treatment.

Symptoms

Acute sinusitis

• Purulent rhinorrhea — yellowish-green nasal discharge, persisting for more than 10 days
• Nasal congestion — bilateral nasal obstruction
• Cough — predominantly nocturnal or upon waking, caused by postnasal drip
• Facial pain — less commonly expressed in young children, sometimes headache
• Fever — may be present, especially in bacterial sinusitis
• Halitosis — foul-smelling breath
• Periorbital edema — a warning sign that may indicate a complication

Chronic sinusitis

Symptoms persist for more than 12 weeks and include:

• Chronic anterior and posterior rhinorrhea
• Persistent nasal obstruction
• Chronic cough, especially nocturnal
• Reduced sense of smell (hyposmia)

Causes

Sinusitis in children occurs through:

• Viral infections — the common cold (rhinoviruses, respiratory syncytial virus) — the main cause
• Bacterial superinfection — Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
• Allergic rhinitis — allergic inflammation predisposes to blockage of the sinus ostia
• Adenoid hypertrophy — adenoid vegetations can obstruct sinus drainage
• Nasal septum deviation
• Immunodeficiencies — in children with recurrent or severe sinusitis
• Gastroesophageal reflux — a contributing factor to chronic sinus inflammation

Diagnosis

• Medical history and clinical examination — the temporal criterion is essential (symptoms lasting more than 10 days or worsening after day 5-7)
• Nasal endoscopy — reveals purulent secretions at the level of the middle meatus, mucosal edema
• Sinus computed tomography (CT) — indicated only in chronic sinusitis or suspicion of complications, not in uncomplicated acute forms
• Allergy testing — in children with recurrent sinusitis on an allergic background

Sinus X-ray is not routinely recommended in children under 6 years of age due to low specificity. Nasal endoscopy provides much more precise information.

Treatment

Acute sinusitis

• Antibiotic therapy — amoxicillin or amoxicillin-clavulanate, 10-14 days, for bacterial forms
• Saline nasal irrigation — essential for clearing secretions and improving drainage
• Nasal corticosteroids — reduce mucosal inflammation and facilitate drainage
• Analgesics-antipyretics — paracetamol or ibuprofen for pain and fever
• Nasal decongestants — only for short periods (3-5 days) in children over 6 years old

Chronic sinusitis

• Prolonged courses of antibiotic therapy (3-6 weeks)
• Long-term nasal corticosteroids
• Treatment of associated causes (allergy, adenoid vegetations)
• Adenoidectomy — when adenoid hypertrophy contributes to chronic sinusitis
• Endoscopic sinus surgery — reserved for cases refractory to conservative treatment

When to see a doctor

• Purulent nasal discharge persisting for more than 10 days without improvement
• High fever (above 39°C) with purulent nasal discharge from the onset of illness
• Worsening of symptoms after initial improvement (biphasic pattern)
• Periorbital swelling or redness — requires urgent evaluation
• Severe headache, neck stiffness, or deterioration of general condition
• Recurrent sinusitis (more than 4 episodes per year)

Complications

Although sinusitis is usually a benign condition, it can develop serious complications:

• Orbital complications — periorbital and orbital cellulitis, subperiosteal abscess — surgical emergencies
• Intracranial complications — meningitis, epidural abscess, cavernous sinus thrombophlebitis — rare but very serious
• Frontal osteomyelitis — in adolescents, with frontal swelling (Pott's puffy tumor)
• Asthma exacerbation — in children with associated asthma
• Otitis media — through spread of infection via the Eustachian tube