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Objectives: To analyse the incidence, microbiology and rate of complications to sinusitis in hospitalized children under five years old in Stockholm County after the introduction of the pneumococcal conjugate vaccine (PCV) in 2007.Methods: This was a population-based, descriptive observational cohort study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Tertiary care admissions of children with a discharge diagnosis of sinusitis and related complications were reviewed and compared to the four years prior to the introduction of PCV.Results: 215 children were admitted, resulting in a risk ratio of 0.43 (95% CI 0.35-0.52) for admission in comparison to the four years prior to vaccine introduction. CT-verified postseptal orbital complications (orbital cellulitis, subperiostal abscess or orbital abscess) occurred in 29 children (13%) and surgery was necessary in nine (4%), five girls and four boys. There were 53 positive bacterial cultures from blood, nose or surgical site in 37 children. Streptococcus pneumoniae was found in two blood and 12 nasal cultures, but in none of the children with postseptal complication or surgery, where Streptococcus pyogenes (n=4), Haemophilus influenzae (n=3) and Staphylococcus aureus (n=1) was found.Conclusion: This study confirmed a significant decrease of hospital admissions for children with sinusitis compared to the four years preceding the introduction of PCV in Stockholm County. The number of postseptal complications and surgery was still low although increased in relation to number of admissions. Other pathogens than Streptococcus pneumoniae was found in the most severe cases in the PCV era.