<p>Sinusitis in children is a common condition encountered in our practice but many times the diagnosis becomes challenging due to its similarity and/or association with adenoid hypertrophy, allergic rhinitis and upper respiratory infections. Although many guidelines have been formulated this condition is either undertreated or overtreated. Striking a balance between these two is essential for effective management. Hence we intended to study the burden of pediatric sinusitis, its clinical presentation, diagnostic tools, management strategies adapted at our center and analyze the outcome. Most common surgery performed in our study was adenoidectomy (50%) followed by Mini Endoscopic Sinus Surgery (43%). Total of 39 children were involved in study. Male to female ratio was 1.6:1. Chronic sinusitis was seen in 49% cases and acute in 41%, of which 75% were with complication. Most common causative association was with adenoid hypertrophy (40%). 66% of these children were managed medically which included adjuvant and antimicrobial therapy and 44% required surgical intervention. By the end of 6 months follow up 65% of our children had achieved complete recovery. Retrospective observational study involving children &lt; 18 years diagnosed as sinusitis at our specialty pediatric ENT center over a period of 1 year. Acute sinusitis is very common in children and etiopathogenesis commonly involves adenoid hypertrophy. Appropriate medical management with efficient use of adjuvant therapies and limited surgical management in indicated cases gives good results. Adapting these strategies in practice can help us effectively manage the condition with less intervention on the growing nasal structures.</p>