Sinusitis in children is often confused with a simple cold or runny nose. However, if this condition is not recognized and treated, it can lead to significant health problems in children. Early recognition of sinusitis symptoms by parents and directing them to appropriate treatment both prevents the disease from becoming chronic and improves the child’s quality of life. In this article, we will discuss in detail what sinusitis is in children, its symptoms, diagnostic methods, treatment, and prevention methods.

What is Sinusitis? Anatomy and Function of the Sinuses

Sinuses are small, air-filled cavities located within our facial bones. The main sinuses are: maxillary (cheek), frontal (forehead), ethmoid (nasal root), and sphenoid (behind the nose) sinuses. These cavities are lined with nasal mucosa and open into the nasal cavity. The functions of the sinuses include:

• Warming and humidifying air
• Contributing to voice resonance
• Reducing the weight of the head
• Filtering and cleaning mucus

In children, the sinuses are not fully developed at birth. While the maxillary and ethmoid sinuses grow in early childhood, the development of the frontal and sphenoid sinuses continues until puberty. This developmental process causes sinusitis symptoms in children to be different from adults and sometimes more difficult to understand.

Sinusitis is the inflammation of the sinus mucosa due to infection or allergy. This inflammation leads to blockage of the channels that open the sinuses to the nasal cavity, mucus accumulation, and increased pressure. As a result, symptoms such as headache, nasal congestion, and facial pain occur.

Causes of Sinusitis in Children

Many factors play a role in the development of sinusitis. The causes of sinusitis in children can be listed as follows:

1 – Infections

Viral upper respiratory tract infections are the most common cause of sinusitis. If sinus drainage is impaired, especially after a cold, bacterial infection may develop. Rarely, fungal infections can also cause sinusitis, but this is very rare in children.

2 – Allergic Rhinitis

Allergic rhinitis causes swelling of the nose and sinuses through the reaction of the nasal mucosa to allergens. This swelling blocks sinus drainage and prepares the ground for sinusitis.

3 – Anatomical Factors

Deviation in the nasal septum, nasal polyps, and adenoid hypertrophy (enlarged adenoids) can cause sinusitis development by blocking sinus channels. Adenoid enlargement is a common condition in children and increases the risk of sinusitis.

4 – Environmental Factors

Exposure to cigarette smoke, air pollution, and cold air prepare the ground for irritation and infection in the sinus mucosa. These factors increase the frequency of sinusitis in children.

5 – Immune System Problems

In children with weak immune systems, sinus infections spread more easily and can become chronic. Recurrent infections may be a harbinger of immune deficiencies.

Sinusitis Symptoms in Children: 7 Critical Signs Parents Must Know

Sinusitis symptoms in children can be more subtle and different compared to adults. The 7 most important signs that parents should pay attention to are:

1 – Nasal Discharge Lasting More Than 10 Days

In normal colds, nasal discharge usually improves within 7-10 days. However, nasal discharge lasting more than 10 days, especially dark yellow or green in color, is an important sign of sinusitis.

2 – Morning Cough

Mucus accumulated in the sinuses flows toward the throat while lying down at night. This condition causes cough to increase, especially in the mornings, and can disrupt the child’s sleep.

3 – Post-Nasal Drip and Voice Changes

Inflammatory mucus flowing from the nose to the throat irritates the throat. A different voice from the throat or hoarse speech may be heard in children.

4 – Dark Circles Under the Eyes (Sinusitis Mask)

When sinusitis is particularly effective in the maxillary and ethmoid sinuses, dark circles may form around the eyes. These circles are seen in the child along with fatigue and weakness.

5 – Mouth Breathing

Nasal congestion prevents the child from breathing through the nose. The child frequently breathes through the mouth, which can lead to dry mouth and sore throat.

6 – Persistent Tonsil Inflammation

Upper respiratory tract infections are also common with sinusitis. Frequent inflammation of the tonsils may be an accompanying symptom of sinusitis.

7 – Changes in Behavior and Sleep Patterns

Due to nasal congestion and cough, restlessness, loss of appetite, sleep problems, and general weakness can be observed in children.

Types of Sinusitis: Acute, Subacute, and Chronic

Sinusitis in children is seen in three basic clinical types:

• Acute Sinusitis: Symptoms last less than 4 weeks. It usually develops after viral infection and improves with antibiotics or supportive treatment.
• Subacute Sinusitis: Symptoms last between 4-12 weeks. If not treated, there is a risk of chronicity.
• Chronic Sinusitis: Symptoms last longer than 12 weeks. In this type of sinusitis, permanent inflammation and structural changes occur in the sinus mucosa. Treatment is difficult and surgical intervention may be required.

Acute sinusitis is most common in children. However, chronic cases require more careful follow-up.

How is Sinusitis Diagnosed?

Sinusitis diagnosis is mostly made through clinical evaluation and physical examination. However, in some cases, additional imaging methods are used.

1 – Clinical Evaluation

The doctor takes a detailed history of the child’s complaints, duration of illness, and previous medical history.

2 – Physical Examination and Nasal Examination

Through nasal examination, swelling, inflammation, or discharge in the mucosa is evaluated. Whether there is adenoid hypertrophy is checked.

3 – Imaging Methods

• Sinus X-ray: Simple and low-cost. However, it provides limited information.
• Endoscopy: Difficult to apply in children, rarely preferred.
• Computed Tomography (CT): It is the gold standard for showing sinus anatomy and disease spread, especially in chronic and recurrent cases.

4 – Laboratory Tests

Generally not necessary for diagnosis. However, blood tests and allergy tests may be performed in suspicious cases.

Treatment Methods for Sinusitis in Children

Sinusitis treatment is planned according to the severity, duration of the disease, and the child’s general health condition.

1 – Medical Treatment

• Antibiotics: Antibiotics recommended by your doctor are used in case of suspected bacterial sinusitis. Treatment duration is usually 10-14 days.
• Nasal Sprays: Decongestant sprays can be used for short periods. Saline (physiological serum) sprays help clean mucus and are safe.
• Antihistamines and Corticosteroids: If allergic rhinitis is present, allergy treatment contributes to the improvement of sinusitis.

2 – Nasal Irrigation and Humidification

Nasal irrigation with saline helps clean mucus and reduce congestion. Room humidification reduces mucosal irritation caused by dry air.

3 – Surgical Treatment

• Adenoidectomy: If adenoid enlargement causes sinusitis, it can be surgically removed.
• Sinus Surgery: Endoscopic sinus surgery may be required in chronic and treatment-resistant cases.

4 – Supportive Measures

Measures such as adequate fluid intake, sufficient rest, and staying away from cigarette smoke support treatment.

Complications and Risks of Sinusitis

If sinusitis is not treated or treatment is delayed, it can lead to serious complications:

• Orbital (Eye Area) Infections: Abscess and cellulitis may develop around the eyes.
• Intracranial Complications: It carries vital risks such as meningitis and brain abscess.
• Chronic Sinusitis: Constantly recurring sinusitis reduces the child’s quality of life and negatively affects school success.

Protection and Prevention Methods from Sinusitis

With some measures taken by parents, the risk of sinusitis in children can be reduced:

• Keeping away from cigarette smoke and air pollution
• Controlling allergy triggers (dust, pollen, animal hair) as much as possible
• Providing balanced nutrition and adequate sleep to support the child’s immune system
• Encouraging frequent hand washing
• Early treatment and follow-up in upper respiratory tract infections
• Maintaining the humidity balance of the home environment

Special Clinical Recommendations and Experiences from Dr. Gediz Murat Serin

With my over 20 years of rhinology experience, I would like to share some important points I frequently encounter in the diagnosis and treatment of sinusitis in children:

• Early Diagnosis is Very Important: Nasal congestion and prolonged nasal discharge should definitely be taken seriously.
• Adenoid Enlargement Must Be Evaluated: Adenoid enlargement must be reviewed, especially in recurrent sinusitis.
• Antibiotic Use Should Be Careful: Unnecessary antibiotic use both leads to resistance development and reduces treatment success.
• Nasal Irrigation Habit Should Be Developed: Teaching children nasal hygiene is very beneficial in terms of treatment and preventive measures.
• Multidisciplinary Approach: Should be followed up with cooperation of allergy, immunology, and ear, nose, and throat specialists.
• Careful Evaluation When Deciding on Surgery: If surgical intervention is necessary, modern endoscopic techniques should be preferred.

Conclusion and Summary

Sinusitis in children is often confused with a simple runny nose, but it is an important disease that requires correct diagnosis and treatment. Parents should observe symptoms such as nasal discharge, cough, and mouth breathing in their children and definitely consult a specialist physician for persistent complaints. With early diagnosis and appropriate treatment, chronicity and complications of sinusitis can be prevented.

Being conscious about this issue makes a big difference for your child’s healthy breathing, improved quality of life, and supporting school success.