Pediatric sinusitis is a common and significant health concern, particularly in children aged 4 to 7 years. Studies show that children experience upper respiratory tract infections (URTIs) 6 to 8 times per year, and 5-10% of these infections can lead to acute sinusitis. The condition often develops following a viral URTI or in association with allergic rhinitis, leading to inflammation and blockage of the sinus drainage pathways.
Key symptoms of pediatric sinusitis include persistent nasal congestion, purulent nasal discharge, facial pain or pressure, cough (especially at night), and sometimes fever. It is important to differentiate sinusitis from prolonged viral infections, as bacterial sinusitis may require targeted treatment. Diagnosis is typically clinical, based on symptom duration and severity, though imaging is sometimes used in complex cases.
Initial treatment focuses on symptom relief and infection control. For uncomplicated cases, supportive care with nasal saline irrigation, intranasal corticosteroids, hydration, and analgesics is recommended. Antibiotics are reserved for cases where bacterial infection is suspected, indicated by high fever, purulent nasal discharge, and worsening symptoms after initial improvement.
Chronic rhinosinusitis in children (lasting more than 12 weeks) poses additional challenges. Underlying factors such as allergic rhinitis, adenoid hypertrophy, or gastroesophageal reflux may contribute to persistent symptoms. Clinical guidelines recommend a stepwise approach: starting with medical therapy including nasal corticosteroids, antihistamines (if allergic component is present), and saline rinses. Evaluation for other contributing conditions is crucial in treatment-resistant cases.
In recent years, some families have explored complementary and alternative medicine (CAM) approaches to support sinusitis management, including herbal remedies, steam inhalation, and essential oils. While certain measures like saline nasal irrigation and humidified air are supported by evidence, other CAM therapies lack robust data for efficacy and safety in children. Parents should consult healthcare providers before using such treatments to avoid potential risks or interactions.
For children who do not respond to medical therapy, surgical options are considered. Adenoidectomy is often the first-line surgical intervention, especially in younger children with enlarged adenoids contributing to nasal obstruction and infection. If symptoms persist despite adenoidectomy and medical management, endoscopic sinus surgery (ESS) may be performed to improve sinus drainage and ventilation. Surgical decisions should be individualized, taking into account the child’s age, underlying conditions, and response to prior treatments.
In managing pediatric sinusitis, a comprehensive, evidence-based approach combining medical, surgical, and supportive care strategies offers the best outcomes for children and their families.
