Chronic sinusitis symptoms in children are ascribed to a number of factors including oversized adenoid pads, anatomic defects and a broad array of respiratory pathogens. However, with advancements in medical science the symptoms, the factors and the treatment are viewed in different light. Difference of opinion occurs in medical community about different aspects of the disease.

The adenoid pad, a lymphoid tissue located in the nasal region, produces antibodies required to protect the body against infections. The pads expand in all human beings but when the size becomes too big, the pads obstruct the nasal airway and Eustachian tube. Then the problem begins and sinusitis-like conditions may develop, requiring removal of the pad. 

 Especially, abnormal growth and subsequent oversized adenoid pads may trigger sinusitis symptoms in children. Removal of these pads ensures healthy nasal cavity. A number of research studies concluded that adenoidectomy resolves the symptoms and signs to some extend. More work is however required to analyze efficacy of the surgery.

Anatomic defects (abnormalities) leading to pediatric sinusitis is shrouded in controversies. Firstly, some medical professionals opine that differences in anatomy should not be referred to as abnormality; the differences should be considered as a variation in anatomy. It is an interesting issue requiring further investigation because if the variations neither cause nor increase sinusitis signs and symptoms, and systemic factors cause sinusitis, ­ it can be managed with medicines. Alternatively, only conservative operations may be sufficient in case of systemic sinusitis.

Sinusitis in children, particularly in infants, was generally not considered as a separate entity prior to the 1980s. In fact, sinus symptoms were equated with cold or allergy signs. Antihistamines and / or decongestants were administered to resolve the symptoms. Now-a-days sinusitis in children is very common and considered as an individual entity by clinicians.

In the beginning of the 1990s when endoscopic sinus surgery was introduced, the surgery was performed on scores of pediatric patients with sinusitis. However, later on, the surgery was not advocated and the number of surgeries fell. Today, endoscopic sinus surgery is generally recommended for the children having more than one sinus infections or chronic sinusitis symptoms.

Viral rhinosinusitis has been ignored in the past for two reasons: lack of an effective treatment method and the uncomplicated disease resolved spontaneously. Today viral rhinosinustits is considered as a separate entity and treated accordingly.