Complications Of Rhinosinusitis Research Articles

Clinical Outcomes of Severe Rhinosinusitis Complicated with Cavernous Sinus Syndrome.

Background: Various diseases involving the cavernous sinus can cause a condition called cavernous sinus syndrome (CSS), which is characterized by ophthalmoplegia or sensory deficits over the face resulting from the compression effect of internal structure. While tumor compression is the most reported cause of CSS, statistical data on CSS caused by infections are limited. Its risk factors, treatment methods, and clinical outcomes are not well-documented. Methods: In this retrospective study, we reviewed the data of patients admitted to a tertiary medical center from 2015 to 2022 with a diagnosis of acute and chronic sinusitis and at least one diagnostic code for CSS symptoms. We manually reviewed whether patients were involved in two or more of the following cranial nerves (CN): CN III, CN IV, CN V, or CN VI, or at least one of these nerves with a neuroimaging-confirmed lesion in the cavernous sinus. Results: Nine patients were diagnosed with rhinosinusitis-related CSS. The most common comorbidity was type 2 diabetes, and the most common clinical manifestations were diplopia and blurred vision. The sphenoid sinus was the most affected sinus. One patient expired due to a severe brain abscess infection without surgery. The remaining patients underwent functional endoscopic sinus surgery, and 50% of the pathology reports indicated fungal infections. Staphylococcus spp. was the most cultured bacteria, and Amoxycillin/Clavulanate was the most used antibiotic. Only four patients had total recovery during the follow-up one year later. Conclusions: CSS is a rare but serious complication of rhinosinusitis. Patients with diabetes and the elderly may be at a higher risk for this complication. Even after treatment, some patients may still have neurological symptoms.

Pott’s puffy tumor a subdurální absces jako komplikace akutní rinosinusitidy – kazuistika

Summary Rhinogenic inflammatory intracranial complications are relatively rare, but they are very serious and can be fatal. The diagnosis is mainly based on anamnesis, objective examination, imaging methods and laboratory findings. Our case study is devoted to an intracranial complication of sinusitis of a 17-year-old patient. It was a subperiosteal abscess with simultaneous subdural abscess in the frontal region and osteomyelitis of the frontal bone. The patient came to the otorhinolaryngology clinic at Jičín Regional Hospital with prolonged rhinosinusitis, after already receiving primary therapy of oral aminopenicillin with a temporary effect. An objective examination revealed slight swelling in the area of the root of the nose and eyelids, rhinoendoscopic swelling of the mucous membranes with mucopurulent secretion in the middle nasal passage on the left. The original suspicion of an orbital complication of rhinosinusitis was ruled out by a CT scan. The patient was hospitalized and treated with intravenous antibiotics, corticoids and the nasal cavity was treated locally and the inflammatory parameters decreased gradually. During hospitalization, swelling of soft tissues progressed frontally, without neurological symptoms. Due to the suspicion that there was an intracranial complication of rhinosinusitis, a CT scan of the paranasal sinuses and brain was performed. The radiologist diagnosed subdural empyema and osteomyelitis of the frontal bones. An acute transfer to the neurosurgery clinic of the University Hospital in Hradec Králové for intravenous antibiotic therapy and surgical intervention by a neurosurgeon and otorhinolaryngologist was arranged. Postoperative healing was favourable. Key worlds paranasal sinuses – sinusitis – subdural abscess – osteomyelitis

Surgical treatment of multiple bilateral brain abscesses and subdural empyas in a 6-year-old child with purulent rhinosinusitis

Introduction. Bacterial brain abscesses and subdural empyema are often rare complications of rhinosinusitis, which is especially important in pediatric practice. Intracranial purulent clusters are life-threatening diseases which require urgent, and as a rule, surgical management.
 Purpose. To illustrate successful surgical treatment of a patient with multiple bilateral brain abscesses and subdural empyemas as a result of purulent inflammation - paranasal sinusitis, which had not been diagnosed at the prehospital stage.
 Material and methods. A case of a 6-year-old boy with multiple bilateral brain abscesses and subdural empyemas is described in the article. The patient had antibacterial therapy; paranasal sinuses were sanitized; all intracranial purulent foci were removed with minimally invasive approaches and accurate calculations based on findings of MRI examination.
 Results. It had been confirmed that abscesses and subdural empyemas in the described patient was a complication of purulent inflammation in paranasal sinuses. To control treated foci and to exclude development of new purulent intracranial clusters in dynamics, multiple MRI examinations of the brain were performed. For successful management of purulent foci, the technique of incision, drainage, sanitation with antiseptic solutions and intraoperative exudate aspiration was applied.
 Conclusion. Abscesses and empyemas of children’s brain are serious, life-threatening pathologies that always require hospitalization and emergency measures. Multiple abscesses and subdural empyemas is, as a rule, complication of rhinosinusitis. Multiple dynamic CT/MRI examinations of the brain is of a key importance, both for controlling removed foci and for excluding development of new purulent intracranial clusters. Active surgical tactics in the combination with antibacterial therapy leads to successful outcomes in patients with intracranial purulent lesions complicating the course of rhinosinusites.

Orbital Cellulitis as a Complication of Acute Rhinosinusitis

Orbital Cellulitis as a Complication of Acute Rhinosinusitis

838. The Role of Surgery in the Management of Invasive Fungal Rhinosinusitis Complicated by Orbitocranial Extension in the Era of Azole Antifungals

Abstract Background Orbitocranial fungal infection (OCFI) is a potentially lethal complication of fungal rhinosinusitis, historically requiring aggressive surgery despite its significant morbidity. Over the past two decades, early use of azole agents has been introduced to support amphotericin B formulations as first-line treatment followed by step down therapy with azoles, demonstrating promising outcomes. To date, there is no data regarding the contribution of surgery in the “azole era” to patients’ survival. We aimed to provide real-life data on azole treatment outcomes and the role of surgery in the current management of OCFI. Methods Data was collected retrospectively from a chart review of the four tertiary participating centers in Israel and Australia between January 1, 2009 and January 1 2020, as well as additional cases identified through a systematic literature review (Fig. 1). The study group included patients with OCFI treated with azole antifungals. Control cases were all treated with amphotericin B. The cranial and orbital involvement was staged based on imaging (Fig. 2). The extent of surgical resection was also classified to allow for inter-group comparison. Flowchart for identification, screening, eligibility, and inclusion for the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Staging of orbitocranial fungal infection used in the study and T1 contrast-enhanced magnetic resonance images illustrating each stage I. Orbital extent: orA - periorbit, lacrimal apparatus; orB - orbital fat; orC - oculomotor muscles; orD – optic nerve, eyeball. II. Cranial extent: crA - pterygopalatine fossa, nasopharynx; crB – temporal/infratemporal fossa; crC – cavernous sinus, dura; crD – brain, spinal cord. Results There were 125 patients in the azole anti-fungal (AAF) group and 153 in the control group (Table 1). Mucorales and Aspergillus were identified in 28% and 72% of AAF cases, respectively, and 67% and 33% of control cases, respectively (p< 0.001). Among patients with cranial extension, 22.6% were operated on in the AAF group and 18.4% in the control group (Table 2). However, meninges and brain resection were performed only in the controls (10.5%) and never in the azole antifungals group (p=0.045). Orbital involvement required surgery in 25.9% of AAF cases and 38.6% of controls (p=0.12). Despite a more aggressive cranial involvement, azole-treated patients’ 3-year mortality was significantly lower than controls (21% vs. 52%, HR 0.27, p< 0.001, Fig. 4). Comparison of the study groups according to the orbitocranial fungal infection extent a. cranial extent; b. orbital extent Kaplan Meier curve on the orbitocranial fungal infection specific survival during up to 3 years of follow-up *Categorical variables are presented in n (%); **Continuous variables are represented as mean (±SD); ªAcquired immunodeficiency syndrome; bHematologic disease leading to immune compromised status; *Including 6 patients with both Mucorales and Aspergillus Univariate analysis of the study groups' main characteristics Conclusion Despite less aggressive surgical intervention for cranial involvement, OCFI patients treated with azoles had a higher survival rate, suggesting we may improve morbidity with a more conservative surgical approach in conjunction with azole treatment. The same trend is emerging for orbital involvement. Surgery for rhino-orbital-cerebral mycosis patients. Disclosures Sharon C. Chen, PhD MBBS, F2G PTy LTd: Advisor/Consultant|F2G PTy LTd: Grant/Research Support

Revisiting the orbital complications of acute rhinosinusitis

ObjectiveThe present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. MethodsClinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. Results143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler’s and Mortimore & Wormald’s classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001). Complications were present at higher rates in the OA group compared to the other three groups. ConclusionsARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima’s classification system proved valid, simple, and effective for categorizing orbital complications of ARS. Level of evidence3.

Orbital and Intracranial Complications of Acute Rhinosinusitis in a Tertiary Center, Saudi Arabia.

Background Rhinosinusitis is an inflammatory condition affecting the nasal cavity's mucosa and paranasal sinuses. In rare cases, acute rhinosinusitis (ARS) might lead to significant orbital and intracranial complications. This study aims to review the patients who presented with orbital or intracranial complications of ARS and to identify the main outcomes of these complications and their prognosis. Methods In this study, aretrospective chart review of patients with orbital or intracranial complications of ARS who presented to the otolaryngology department at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 2016 to 2022 was conducted. Results A total of 43 patients with orbital, intracranial, or both (orbital and intracranial) complications of ARS were included. The most involved sinuses were maxillary sinuses. The most reported orbital complications were subperiosteal abscesses, and the most reported intracranial complications were epidural abscesses. Conclusion Orbital and intracranial complications of ARS are serious and life-threatening if not recognized early and treated effectively. The majority of ARS complications in this study were orbital complications. Fortunately, most of the cases carry a favorable outcome.

Systemic corticosteroids for orbital complications of pediatric rhinosinusitis: A systematic review.

Determine if systemic corticosteroids administration is associated with reduced length of stay, surgical intervention, and abscess formation in pediatric patients with orbital complications of rhinosinusitis. Systematic review and meta-analysis were performed utilizing the PubMed and MEDLINE databases to identify articles published between January 1990 and April 2020. Retrospective cohort study of the same patient population over the same time period at our institution. Eight studies, 477 individuals, met criteria for inclusion in the systematic review. 144 patients (30.2%) received systemic corticosteroids, while 333 patients (69.8%) did not. Meta-analyses of frequency of surgical intervention and subperiosteal abscess showed no difference between those who did and did not receive systemic steroids ([OR=1.06; 95% CI: 0.46 to 2.48] and [OR=1.08; 95% CI: 0.43 to 2.76], respectively). 6 articles evaluated hospital length of stay (LOS). 3 of these reported enough data to perform meta-analysis, which showed patients with orbital complications who received systemic corticosteroids had shorter mean hospital LOS when compared with those who did not receive systemic steroids (SMD=-2.92, 95% CI: 5.65 to -0.19). While available literature was limited, systematic review and meta-analysis suggests systemic corticosteroids decrease length of stay for hospitalized pediatric patients with orbital complications of sinusitis. Further research is needed to more clearly define the role of systemic corticosteroids as an adjunctive treatment.

Orbital cellulitis - complication of an untreated rhinosinusitis: Case report

AbstractSinusitis not properly treated can generate multiple complications. Among these complications, oculo-orbital manifestations can be difficult to treat and can lead to vision loss, despite modern antibiotic therapy.In this paper, we aimed to discuss the orbital complications of rhinosinusitis, especially orbital cellulitis, and the method of treatment, highlighted by the presentation of a clinical case diagnosed and treated medically and surgically in the ENT and Ophthalmology Departments, within the Braila County Emergency Clinical Hospital.

Concurrent Pansinusitis and Orbital Cellulitis Complicated by Extensive Head and Neck Venous Thrombosis in an Unvaccinated Adolescent Patient with COVID-19: A Case Report

BackgroundOrbital cellulitis is an infrequent but serious infectious complication of rhinosinusitis, most commonly seen in the pediatric population. Extension into the cavernous sinus, leading to further infection and thrombosis, is a rare but life-threatening complication. Although COVID-19 has been linked to an increased risk of venous thromboembolism, most cases involve extremity deep venous thrombosis or pulmonary embolism; reports of intracranial or jugular system thrombosis are rare. Case ReportWe describe a case of a 17-year-old female patient with no significant medical history or thrombotic risk factors found to have orbital cellulitis and severe pansinusitis, complicated by multiple venous thromboses in the head and neck requiring emergent surgical intervention and pediatric intensive care admission. Why Should an Emergency Physician Be Aware of This?Extensive head and neck venous thrombosis and intracranial abscesses are rare complications of pansinusitis and orbital cellulitis, and the thrombotic complications of COVID-19 are well documented. A delay in diagnosis and treatment can lead to potentially devastating consequences.

Complications of Acute Bacterial Rhinosinusitis in Contemporary Practice: Lessons Learnt and the Way Ahead.

There are variable presentations of complications of rhinosinusitis, which may be subtle especially due to use of antibiotics. Thus the classical picture as described by Chandler is rarely seen and threshold for diagnosing and treating a complication should be low. To identify possible risk factors for development of complications in acute bacterial rhinosinusitis (ABRS) and suggest a new method of reporting/classifying the complications. We conducted a retrospective study and observed the clinical presentation and risk factors of 9 patients who presented with complications of ABRS in our OPD during a period of 6years, and then tried to formulate a reporting method based on the risk factors. We identified certain risk factors which include age, gender, sinus involved, extension beyond sinus, history of trauma, anatomical variations, and duration of symptoms. There are possible risk factors for development of complications. These factors can be studied in further details to ascertain their causal relationship in causing these complications. We also suggest a new method of reporting the complications. Such a reporting system would help in accurately identifying the exact severity of the disease, prognosticating the disease and guide treatment.

Predictors for surgical intervention in orbital complications of pediatric rhinosinusitis.

Orbital complications are the most common complication of acute rhinosinusitis, especially among pediatric patients. While most cases are treated with antibiotics alone, severe presentation may demand surgical intervention. Our goal was to determine which factors predict the need for surgery and to investigate the role of computerized tomography in the decision process. A retrospective review of all children hospitalized between 2001-2018 with orbital complications of acute rhinosinusitis in a university-affiliated children's hospital. A total of 156 children were included. Mean age was 7.9 years (1-18 years). Twenty-three children (14.7%) were surgically treated, and the rest were conservatively treated. High fever, ophthalmoplegia and diplopia in association with minimal or no response to conservative treatment were predictive for surgical intervention, as well as higher inflammatory indices. Eighty-nine children (57%) underwent imaging during hospitalization. Presence of a subperiosteal abscess, as well as its size and its location were not found to be predictors for surgery. Clinical and laboratory findings in association with minimal or no response to conservative treatment predict the need for surgical intervention in cases of orbital complications of acute rhinosinusitis. As Computerized Tomography scans can have long-term implications in the pediatric population, caution and patience should be practiced when deciding on the timing of imaging in this population. Thus, close clinical and laboratory monitoring should lead the decision-making process in these cases and imaging should be reserved for when the decision for surgery has been made.

Diagnosis and management of orbital and cranial complications of pediatric acute rhinosinusitis

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.

Varied presentations of complicated rhinosinusitis in COVID era: a rational approach to management

AimTo study the various presentations and manifestations of complicated rhinosinusitis in COVID era- ranging from bacterial rhino sinusitis to invasive fungal rhino sinusitis.MethodsDesign-A retrospective observational study was carried out from March 2020 to May 2021. Setting-Tertiary care hospital subjects—all COVID-positive patients who had paranasal sinus involvement. Methods-Patients were evaluated based on their symptomatology profile. Fungal stains and culture were carried out for all. They underwent Magnetic resonance Imaging and Computed Tomography scan on case-to-case basis, apart from routine nasal endoscopy. All were managed both medically and surgically depending upon their diagnosis. The natural course including outcomes, was studied, documented and analyzed.ResultsOut of 496 patients presenting with sinonasal disease, 126 were COVID-positive, 16 patients had complicated rhino sinusitis, of which 4 patients had complicated rhinosinusitis with intraorbital, intracranial or combined complications. All patients were managed successfully with combined medical and surgical approach. Twelve patients had invasive mucormycosis with overall mortality rate of 37%.ConclusionComplicated sinusitis was encountered in COVID-positive patients either when they were being actively treated for COVID-19 or as part of post-COVID sequalae. Though rhino-orbito-cerebral mucormycosis constituted the major disease burden in such patients but the possibility of bacterial rhino sinusitis with or without complications must also be kept in mind while evaluating such patients. We must remember every complicated rhinosinusitis in COVID-positive patient may not be mucor and manage appropriately.

Interdisciplinary care in orbital complications of acute rhinosinusitis in children.

Orbital cellulitis is a serious condition with potentially severe complications. Treatment requires interdisciplinary care and early introduction of antimicrobial therapy. In our tertiary center, a team of pediatricians, pediatric ophthalmologists, and otorhinolaryngologists successfully participated in the management of pediatric periorbital/orbital cellulitis. This study aimed to demonstrate our interdisciplinary approach and to investigate clinical profile and management of pediatric periorbital/orbital cellulitis. A retrospective chart review was performed of all pediatric patients hospitalized for periorbital and orbital cellulitis in a tertiary hospital center from September 15, 2016, to March 15, 2020. A total of 26 children-median age 2.7 years (range 0.5-12)-were treated during the study period. Disease presentation was unilateral, mainly during winter (n = 12) and autumn (n = 12), without ophthalmoplegia/proptosis. Seven patients had orbital cellulitis (Chandler classification of ≥III) and were older (6.5 years, P = 0.011) with sinusitis (P < 0.001), required surgery (P = 0.004), underwent longer antimicrobial treatment (13 days, P < 0.001), and had a longer length of hospital stay (13.43 days, P = 0.001). Orbital cellulitis occurred in a median of three days (range 1-12) of acute rhinosinusitis. Radiological survey was performed in 11 patients, whereas six patients were treated surgically. All intraoperatively collected cultures (sinus swabs) were positive, whereas Streptococcus pyogenes and Peptostreptococcus were isolated in five cases. All patients fully recovered. No recurrence was documented. Sinusitis is associated with severe orbital cellulitis and surgical management. Orbital cellulitis occurred early in the course of acute rhinosinusitis, as a distinctive presentation of rhinosinusitis. Interdisciplinary care and early management are crucial in treatment of pediatric periorbital/orbital cellulitis.

Rhinosinusitis among children and adolescents in Southwestern Nigeria

Worldwide, rhinosinusitis is a common sinus and nasal condition. The purpose of this study was to determine the prevalence and clinical characteristics of rhinosinusitis among children and adolescents in Ekiti, in the southwest of Nigeria. This two-year retrospective hospital study included 161 children and adolescents who had rhinosinusitis at the Ekiti State University Teaching Hospital in Ado Ekiti, southwest Nigeria. SPSS version 18 was used to analyze the data. There were 161 participants, ages 2 to 17, mean ± SD = 6.8 ± 4.5. 101 (62.7%) of them were males, making the male to female ratio 1.5:1. 9.2% of the participants in this study had rhinosinusitis. Recurrent rhinosinusitis (41) and chronic rhinosinusitis (61) were the two most prevalent types of rhinosinusitis. According to the etiology, 81 (50.3%) cases of infective rhinosinusitis were the main clinical pattern, followed by 67 (41.6%) cases of allergic rhinosinusitis and 13 (8.1%) cases of vasomotor rhinitis. There were 127 cases of nasal stuffiness (78.9%), 108 cases of rhinorrhea (67.1%), 92 cases of snoring (57.1%), and 86 cases of coughing (53.4%). Adeno-tonsillar hypertrophy, nasal foreign body impaction, and asthma were the three main comorbid conditions with rhinosinusitis in children, with 96 (59.6%), 46 (28.6%), and 12 (7.5%) cases each. In this study, the most common complications of rhinosinusitis were tonsillitis (26.7%), otitis media (33.5%), orbital complications (36.6%), and pneumonia (8.1%). In Ado Ekiti, southwest Nigeria, rhinosinusitis was a common sino-nasal condition affecting children and adolescents. Due to the delayed presentation, chronic rhinosinusitis was the most frequent type.

Unusual complications of acute frontal rhinosinusitis. Two clinical cases

Introduction: Acute frontal rhinosinusitis is defined as an acute infection of the frontal sinus. Spreading of this infection to surrounding structures is uncommon but, when present, carries significant morbidity and mortality. Description: In this case report, we present two unusual cases of frontal rhinosinusitis complications. Firstly, we describe a case of acute rhinosinusitis with orbital complications caused by a frontoethmoidal osteoma. In the second case, the infection extended to the underlying bone and through the skull causing osteomyelitis and focal meningitis complicated with an abscess. After appropriate treatment, both patients were free of infection at follow-up, without complications. Discussion: In the first case we presented, a frontoethmoidal osteoma gave rise to rhinosinusitis with orbital complications. These benign tumors rarely cause symptoms, but when large enough, sinus outflow can be blocked, making the osteoma clinically relevant. Osteomas can induce frontal rhinosinusitis, giving rise, among other conditions, to the development of orbital complications like periorbital cellulitis or the formation of a periorbital abscess. Diagnosis of osteoma is usually straightforward on computed tomography and surgical treatment is only indicated for large tumors, rapid growth, intracranial or orbitary extension. In the second clinical case, the infection extended to the underlying bone and through the skull causing osteomyelitis and focal meningitis with abscess formation. In this patient, a Draf Type IIa procedure was performed for the frontal abscess drainage, followed by proper antibiotic and anti-inflammatory therapy. Conclusions: Complications of frontal rhinosinusitis are uncommon but require immediate attention and aggressive treatment to avoid morbidity and mortality. In these cases, our patients were properly treated with good outcomes, avoiding potentially more dangerous complications.

Approach to paediatric nasal obstruction.

Paediatric patients with nasal obstruction are frequently encountered in general practice. The differential diagnosis is distinct from that of adult nasal obstruction and necessitates more judicious use of radiological and invasive investigations. Most cases of nasal obstruction in children result from benign disease, although there is a significant quality of life impact that must be addressed with prompt diagnosis andsymptomatic management. The aim of this article is to outline the workup and management of paediatric nasal obstruction in primary care and suggest where referral to a relevant specialist is warranted. Although the differential for paediatric nasal obstruction is broad, a thorough history and physical examination yields the diagnosis in most cases. Diagnoses not to be missed include nasal foreign body, lesions suspicious for neoplasia and intracranial complications of severe rhinosinusitis. Further investigation and ear, nose and throat referral should be considered when there are surgical targets for nasal obstruction, red flag signs or symptoms or failure of conservative therapy.

Clinical Markers of Need for Surgery in Orbital Complication of Acute Rhinosinusitis in Children: Overview and Systematic Review.

Background: Although they can occur at all ages, orbital (OC) and periorbital cellulitis (POC) prevail in the pediatric population. Acute rhinosinusitis (ARS) is the most frequent predisposing factor of OC. Recent literature has suggested a medical management approach for OC and POC, with surgery reserved only for more severe cases. However, there is still a lack of consensus on the clinical markers of a need for surgery. The aim of this systematic review was to identify clinical markers of a need for surgery in children with OC. Our systematic review, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process, yielded 1289 articles finally screened. This resulted in 31 full texts that were included in a qualitative analysis. The results of this review suggest that in children aged over 9 years, large subperiosteal orbital abscesses (SPOAs), impaired vision, ophthalmoplegia, proptosis, elevated C-reactive protein (CRP) and absolute neutrophil counts (ANC), hemodynamic compromise, no clinical improvement after 48/72 h of antibiotic therapy, and a Chandler III score or higher are clinical markers of the need for surgery. However, most of the studies are observational and retrospective, and further studies are needed to identify reliable and repeatable clinical markers of the need for surgery.

THE IMPORTANCE OF RECOGNIZING THE ACUTE COMPLICATIONS OF RHINOSINUSITIS: A CASE REPORT

The difficulty in establishing an early diagnosis in the face of intracranial complications of rhinosinusitis can cause significant clinical changes and irreversible sequelae.