Complications of acute sinusitis in children

Abstract

Objectives: To review the demographic, microbiologic, and outcome data for children with complications of acute sinusitis. Methods: Retrospective review of admissions for complications of acute sinusitis from January 1995 to July 2002 at a tertiary children’s hospital. Results: A total of 104 patients with 95 intraorbital complications, 18 intracranial complications, and 3 Pott’s puffy tumors were identified. Sixty-six percent were males ( P < 0.001), and 64.4% presented from November to March ( P < 0.001). Patients with orbital complications were younger than patients with intracranial complications, (5.3 vs 12.3 years), had a shorter stay (4.2 vs 17.1 days), and shorter duration of symptoms (4.8 vs 14.9 days, all P <0.01). Intraorbital complications included 51 cellulitises and 44 abscesses. Complete resolution was documented for 51/55 patients with decreased ocular motility, 7/8 with visual loss, and 3/3 patients with abnormal pupils. Intracranial complications included 7 epidural empyemas, 6 subdural empyemas, 2 intracerebral abscesses, 2 meningitis, and 1 cavernous sinus thrombosis. Seven of 14 patients with intracranial complications presented with neurological deficits and 4/14 presented with seizures. All neurological deficits resolved. Three Pott’s puffy tumors fully recovered. Positive cultures were obtained for 35 patients. The most common organism was Streptococcus milleri (11 patients). Conclusions: Complications of acute pediatric sinusitis most commonly occur in males in the winter. Patients with orbital complications were younger and had a shorter stay and shorter duration of prodromal symptoms. Despite presenting with significant deficits, permanent morbidity was extremely low following adequate treatment. The emergence of Streptococcus milleri as the most common isolated bacteria significantly differed from previous studies.