Complications Of Acute Sinusitis Research Articles

Complications of endoscopic sinus surgery for chronic rhinosinusitis in a tertiary care teaching hospital in Saudi Arabia

To aimed to determine the incidence of complications of endoscopic sinus surgery (ESS) and to investigate the factors associated with the occurrence of complications.In this retrospective study, we reviewed the medical records of all patients who had undergone ESS at King Saud University Medical City (KSUMC) between January 2015 and March 2022. Patients who underwent ESS for complicated acute sinusitis, sinonasal malignancy, and cerebrospinal fluid leak repair, and those who underwent extended ESS for indications other than chronic rhinosinusitis were excluded. This study was approved by the KSUMC Institutional Review Board.We included 1395 patients, 3 of whom had major complications and 28 had minor complications, resulting in an overall major complication rate of 0.2% and a minor complication rate of 2%. The most common major complication was orbital hematoma, and the most common minor complication was synechia. Moreover, the duration of surgery and laterality increased the risk of complications, whereas the use of image guidance had no effect.The ESS is a safe procedure. The operative start time and laterality were associated with an increased risk of complications and warrant further investigation.

Evolution in the incidence of infectious diseases in the pediatric ENT area during the COVID-19 pandemic

IntroductionSARS COV-2 infection is an emerging disease that has become a global pandemic since the beginning of 2020. To reduce transmission, measures have been imposed by governments such as home confinement, the use of masks, social distancing or promotion of hand hygiene. The aim of this study is to determine if the measures adopted to reduce the COVID-19 pandemic have produced a decrease in the incidence of infectious diseases and their complications in the ENT area in our center. Material and methodsA retrospective descriptive study was carried out in a tertiary hospital of patients aged between 0 and 15 years who required admission due to deep cervical infections, complications derived from acute otitis media (mastoiditis or facial paralysis) or complicated acute sinusitis. ResultsThere is a notable decrease in the number of global admissions in the COVID period (9) compared to the average of the previous 5 years (20.1). Likewise, there are statistically significant differences in the number of admissions for cervical infections (p value=0.027) and complications derived from acute otitis media (p value=0.029). Discussion/conclusionA decrease in the number of admissions caused by complications of infections in the ENT area in paediatric patients has been observed after the start of the COVID-19 pandemic in our environment, this fact could be explained by a global decrease in the number of infections of the upper respiratory tract due to the hygienic measures taken by the COVID-19 pandemic.

Evolución de la incidencia de las enfermedades infecciosas del área ORL en edad pediátrica durante la pandemia COVID-19

IntroductionSARS COV-2 infection is an emerging disease that has become a global pandemic since the beginning of 2020. To reduce transmission, measures have been imposed by governments such as home confinement, the use of masks, social distancing or promotion of hand hygiene. The aim of this study is to determine if the measures adopted to reduce the COVID-19 pandemic have produced a decrease in the incidence of infectious diseases and their complications in the ENT area in our center. Material and methodsA retrospective descriptive study was carried out in a tertiary hospital of patients aged between 0 and 15 years who required admission due to deep cervical infections, complications derived from acute otitis media (mastoiditis or facial paralysis) or complicated acute sinusitis. ResultsThere is a notable decrease in the number of global admissions in the COVID period (9) compared to the average of the previous 5 years (20.1). Likewise, there are statistically significant differences in the number of admissions for cervical infections (P = .027) and complications derived from acute otitis media (P = .029). Discussion/conclusionA decrease in the number of admissions caused by complications of infections in the ENT area in paediatric patients has been observed after the start of the COVID-19 pandemic in our environment, this fact could be explained by a global decrease in the number of infections of the upper respiratory tract due to the hygienic measures taken by the COVID-19 pandemic.

Topical Nasal Decongestant Oxymetazoline: Safety Considerations for Perioperative Pediatric Use.

The over-the-counter nasal decongestant oxymetazoline (eg, Afrin) is used in the pediatric population for a variety of conditions in the operating room setting. Given its vasoconstrictive properties, it can have cardiovascular adverse effects when systemically absorbed. There have been several reports of cardiac and respiratory complications related to use of oxymetazoline in the pediatric population. Current US Food and Drug Administration approval for oxymetazoline is for patients ≥6 years of age, but medical professionals may elect to use it short-term and off label for younger children in particular clinical scenarios in which the potential benefit may outweigh risks (eg, active bleeding, acute respiratory distress from nasal obstruction, acute complicated sinusitis, improved surgical visualization, nasal decongestion for scope examination, other conditions, etc). To date, there have not been adequate pediatric pharmacokinetic studies of oxymetazoline, so caution should be exercised with both the quantity of dosing and the technique of administration. In the urgent care setting, emergency department, or inpatient setting, to avoid excessive administration of the medication, medical professionals should use the spray bottle in an upright position with the child upright. In addition, in the operating room setting, both monitoring the quantity used and effective communication between the surgeon and anesthesia team are important. Further studies are needed to understand the systemic absorption and effects in children in both nonsurgical and surgical nasal use of oxymetazoline.

Children’s head and neck infections caused by Streptococcus intermedius in the Pediatric Otolaryngology Department of Warsaw Medical University

Introduction. Streptococci are commonly known pathogens of the normal bacterial flora of the mouth, pharynx, gastrointestinal tract and genitourinary system. The most common infections are beta-hemolyzing streptococci causing pharyngitis, streptococcal angina, otitis and paranasal sinusitis. But not all streptococcal infections are easy to treat. They are those that forming abscesses in the deep tissues of the body and caused life-treating complications. Aim. The aim of the study is to draw attention to the pathogen of the Streptococcus viridans group, i.e. Streptococcus intermedius, which, being a saprophyte of the upper respiratory tract, may cause life-threatening complications during an infection. Material and methods. The age, sex of children, underlying disease, complications, conservative and surgical treatment of children treated in the Pediatric Otolaryngology Department of the Medical University of Warsaw due Streptococcus intermedius infections were analyzed. Results. 6 children in age from 14 months to 15 years were treated in the ENT Department of Warsaw Medical University due to Streptococcus intermedius infections. There were 5 boys and 1 girl. All children were diagnosed with abscesses in deep tissue as a complication of acute sinusitis in 4 children, pharyngitis in 1 and post trauma nasal bone in 1 child. All children were immunocompetent. The treatment of choice was antibiotic therapy and drainage of abscesses. All children were successfully treated. Conclusions. The isolation of Streptococcus intermedius in cultures taken from infection’s site in the upper respiratory tract is associated with the risk of complications in the form of deep head and neck and central nervous system abscesses. Each patient with an infection of Streptococcus intermedius etiology requires CT or MRI imaging of the craniofacial and brain due to the possibility of deep abscesses. The treatment of choice is antibiotic therapy with ceftriaxone, clindamycin and together with surgical drainage of the abscess. The sensitivity of Streptococcus intermedius to popular antibiotics is the reason for effective treatment despite serious complications.

Frontal Sinus Drainage in Acute Pediatric Sinusitis With Intracranial Complications.

The indication for frontal sinus drainage is uncertain when managing pediatric acute sinusitis with intracranial complications. The primary objective was to determine if addressing the frontal sinus reduced need for subsequent surgical procedures in children presenting with acute sinusitis complicated by intracranial abscess. A case series with chart review was performed at a tertiary children's hospital between 2007 and 2019. Children under 18 years of age requiring surgery for complicated acute sinusitis that included the frontal sinus with noncontiguous intracranial abscess were included. Outcomes were compared among children for whom the frontal sinus was drained endoscopically, opened intracranially, or left undrained. Thirty-five children with a mean age of 11.1 years (95% CI: 9.9-12.3) met inclusion. Most presented with epidural abscess (37%). Hospitalizations lasted 12.9 days (95% CI: 10.2-15.5), 46% required a second surgery, 11% required three or more surgeries, and 31% were readmitted within 60 days. Initial surgery for 29% included endoscopic frontal sinusotomy, 34% had a frontal sinus cranialization and 37% did not have any initial drainage of the frontal sinus. Groups were similar with respect to demographics, severity of infection, need for repeat surgery, length of stay, and readmissions (p > .05). Further, persistence of cranial neuropathies, seizures, or major neurological sequelae after discharge were no different among groups (p > .05). Drainage of the frontal sinus, when technically feasible, was not associated with reduced surgical procedures or increased complications and there is unclear benefit on measured clinical outcomes.

Complications of Acute Sinusitis: A Review and Case Series

Complications of Acute Sinusitis: A Review and Case Series

The Role of Endoscopic Sinus Surgery in Children Undergoing External Drainage of Non-Medial Subperiosteal Orbital Abscess.

The extent of surgery required in the management of pediatric non-medial subperiosteal orbital abscess (SPOA) due to medically refractory complicated acute sinusitis is unknown. The primary objective is to compare operative outcomes of children treated with combined endoscopic sinus surgery (ESS) and external orbital drainage (EOD) versus those treated with EOD alone. Retrospective case series from a tertiary children's hospital analyzing outcomes in children requiring surgical management for acute sinusitis complicated by non-medial SPOA between November 2007 and September 2019. Sixteen children with a mean age of 9.4 years (95% CI: 7.3-11.4) met inclusion. Eleven (68.8%) underwent combined EOD and ESS, while five (31.2%) underwent EOD alone. Groups were similar in age, symptom duration, white blood cell count, C-reactive protein level, intraocular pressure, Lund-Mackay score, and abscess volume. There was no significant difference in median length of stay between patients treated with a combined approach versus those treated by EOD alone. Cultures identified non-beta-hemolytic Streptococcus species in 56.3% of patients, with Streptococcus intermedius representing the most common organism in 37.5%. In one case, ESS identified a pathogen not acquired via concomitant EOD, which did influence management. No child required a subsequent surgical procedure and there were no operative complications. The addition of ESS in the management of pediatric non-medial SPOA was not associated with a statistically different duration of hospitalization. Cultures from concomitant ESS rarely aided in diagnosis or antibiotic therapy. Further study should delineate the indications for ESS in these cases.

Les complications oculo-orbitaires des sinusites aigues chez l’enfant. A propos de 3 cas

Introduction. Les complications oculo-orbitaires des sinusites chez l'enfant sont fréquentes et peuvent engager le pronostic visuel et même vital. Leur prise en charge doit être urgente, médicale et parfois chirurgicale. Le but de ce travail est d’étudier à travers trois observations, les différents tableaux cliniques et para cliniques des complications oculo-orbitaires des sinusites chez l’enfant ainsi que leur traitement. Patients & méthodes. Nous rapportons les observations de trois enfants, deux filles et un garçon, âgés entre 6 et 12 ans, hospitalisés dans le cadre de l’urgence. Deux patients présentaient un syndrome inflammatoire orbitaire unilatéral avec exophtalmie importante et le 3ème cas un état de cécité avec céphalée et vomissement chez qui l’examen ophtalmologique a révélé une névrite optique bilatérale œdémateuse. L’imagerie (scanner et IRM) a montré une sinusite antérieure dans les deux premiers cas et une sinusite sphénoïdale isolée dans le dernier cas. L’examen ORL a confirmé la sinusite dans les deux premiers cas et était normal dans le dernier cas. Tous les patients ont bénéficié d’une tri- antibiothérapie générale associée secondairement à une corticothérapie systémique. Un patient a nécessité un drainage chirurgical. Résultats. L’évolution à trois mois était bonne pour les trois patients : réduction presque complète de l’exophtalmie et récupération de l’acuité visuelle chez le dernier cas. Discussion et conclusion. Les complications orbitaires des sinusites sont assez fréquentes. Chez l’enfant, la complication de l’atteinte des sinus antérieurs (ethmoïdal et frontal) sont responsables d’un tableau clinique bruyant avec une cellulite orbitaire. Cependant, la complication de la sinusite sphénoïdale est rare mais grave, ses manifestations cliniques sont pauvres et trompeuses. Le diagnostic et le traitement doivent être précoces pour éviter la complication redoutée qui est la thrombophlébite du sinus caverneux.

Incidence and Clinical Outcomes of Streptococcus anginosus in Acute Complicated Sinusitis: A Pediatric Cohort.

We conducted a retrospective cohort study of 160 hospitalized children admitted for acute complicated sinusitis and compared children with S anginosus-associated infection to children with other or no pathogens identified. The incidence of S anginosus-associated infections increased 12% per year, and infections with S anginosus are associated with increased morbidity.

Pediatric intraorbital abscess: Early recognition and management.

Key Clinical MessageOrbital involvement occurs in 85% of complicated acute sinusitis and is more prevalent in children. Prompt differentiation between the more common periorbital (preseptal) cellulitis and infections, posterior to the orbital septum (including orbital cellulitis/abscess), is essential due to the latter's risk of irreversible optic neuropathy, intracranial spread and death.

The Microbiology of Complicated Acute Sinusitis among Pediatric Patients: A Case Series.

The microbiology of pediatric complicated acute rhinosinusitis (ARS) has evolved, and our current understanding of pathogenic organisms is limited. The objectives of this study are to describe the incidence of pathogens causing complicated ARS requiring surgical intervention at our institution over a 10-year period as well as their associated treatment outcomes. Retrospective cohort study. A single tertiary care children's hospital. Data were reviewed from all patients who underwent surgery for complicated ARS and had positive culture data from 2006 to 2016. Associations among pathogens, complications, and outcomes were analyzed with Pearson χ2 and Wilcoxon rank-sum tests. Eighty-nine patients met criteria. Complications included orbital infections (78%), intracranial infections (48%), Pott's puffy tumor (13%), and cavernous sinus thrombosis (9.0%). Bacterial isolates were majority polymicrobial (55%) and included Streptococcus species (58%), Staphylococcus species (49%; including methicillin-resistant S aureus [MRSA], 11%), and anaerobic bacteria (35%). S pneumoniae (9.0%), Haemophilus species (4.5%), and Moraxella catarrhalis (1.1%) were relatively uncommon. Bacterial isolates were similar among patients with all types of complications. Among a large cohort of pediatric patients with complicated ARS, most bacterial isolates were polymicrobial, with Streptococcus and Staphylococcus species contributing to the majority of cases. S aureus species, including MRSA and anaerobic pathogens, were common. The pattern of bacterial isolates was similar among patients with all types of complications of ARS. We suggest treatment for complicated ARS with broad-spectrum antibiotics with coverage for Streptococcus species, Staphylococcus species including MRSA, and anaerobic bacteria.

331. Vascular Complications Among Children and Adolescents With Acute Complicated Sinusitis

BackgroundThe characteristics of intracranial vascular complications in children from bacterial sinusitis is not well known. The objectives of the study were to describe the types of vascular complications and pathogens in acute complicated sinusitis and identify the proportion of vascular complications due to Streptococcus anginosus vs. other pathogens. MethodsWe conducted a retrospective cohort study by identifying hospitalized patients with ICD 9/10 codes of acute sinusitis at Children’s Hospital Colorado from 2010–2016. After identifying patients with complicated sinusitis (bacterial meningitis, intracranial abscess/empyema, venous thrombosis, stroke, or orbital cellulitis/abscess based on ICD 9, ICD 10, or imaging findings), we reviewed patient demographics, clinical characteristics, and clinical outcomes. Patients with cultures positive for S. anginosus were compared with other patients who met inclusion criteria. Bivariable relationships were examined using χ2 tests and t-tests or Wilcoxon rank-sum tests.ResultsAmong 416 inpatients with acute sinusitis, 235 had acute complicated sinusitis. Of these, 75 were excluded due to immunocompromised status, cystic fibrosis, craniofacial abnormality, and fungal disease. The most common pathogen was S. anginosus, identified in 64/160 (40%) cases. Vascular complications were observed in 21/160 (13%) children (Figure 1). The rate of vascular complications was higher in the S. anginosus group, compared with the non-S. anginosus group, although not reaching a statistical difference (18% vs. 9%, P = 0.085) The most common vascular complication was dural venous sinus thrombosis (30%). Children with S. anginosus infection were older (11.8 vs. 7.2 years), had an abnormal MRI (97% vs. 68%) and neurological deficit (56% vs. 35%), and required surgery (98% vs. 35%), longer antibiotic duration (42 vs. 16 days), and ICU admission (34% vs. 11%), P < 0.01 unless otherwise mentioned.ConclusionVascular complications among children with complicated sinusitis are common, with a high proportion due to S. anginosus. There is a greater burden of disease from S. anginosus compared with other bacterial pathogens as demonstrated by worse neurologic and radiographic outcomes in this group.Disclosures All authors: No reported disclosures.

Perioperative Risk Factors Associated With Morbidity and Mortality Following Pediatric Inpatient Sinus Surgery.

Pediatric sinus surgery is indicated for a wide range of sinonasal and skull base pathologies, but it is most commonly performed for recalcitrant chronic rhinosinusitis or complicated acute sinusitis. The authors aim to report medical risk factors of morbidity and mortality following inpatient sinus surgery in the pediatric population. Using data from the Kids' Inpatient Database from 2003 to 2012, patients with International Classification of Diseases, Ninth Revision, procedure codes for primary sinus surgery were identified. Mixed-effect multivariable logistic regression was used to identify risk factors of inpatient postoperative morbidity and mortality. The final sample included a weighted estimate of 4965 pediatric patients. The rates of inpatient morbidity and mortality were 6% and 1%, respectively. Respiratory complications (2.5%) were the most prevalent postoperative adverse events. The most prevalent comorbidities were chronic sinusitis (59.8%), acute sinusitis (27.8%), and cystic fibrosis (26.4%). Compared with patients who did not experience any morbidity, patients with inpatient morbidity had higher rates of pneumonia, mycoses, and nasal or paranasal benign neoplasm ( P < .05). The odds of inpatient morbidity and mortality were highest for patients with leukemia (odds ratio, 2.74; 95% confidence interval, 1.59-4.72; P < .001) and mycoses (odds ratio, 15.84; 95% confidence interval, 6.45-38.89; P < .001), respectively. This study is the first to report the national comorbidity burden and risk factors for postoperative adverse events following inpatient sinus surgery. Knowledge of the comorbidities and independent factors associated with morbidity and mortality will help in directing preoperative optimization and counseling. 2c.

Management of Intracranial Complications of Acute Sinusitis: Our Experience Regarding a Series of Clinical Cases

Sinusitis is a common ear, nose and throat disease which develops from viral or bacterial upper respiratory airway infection. Complications of rhinosinusitis vary from relatively benign to fatal and severe and have been classified into local (5-10%), orbital (60- 75%) and intracranial (15-20%) complications [1]. Intracranial complications consist of meningitis, epidural abscess, subdural abscess, intracerebral abscess, cavernous sinus thrombosis and superior sagittal sinus thrombosis. We present a series of 3 cases of intracranial complications of acute paranasal sinusitis treated in our department of oto-rhino-laryngology from January to December 2015 and review the literature.

Chapter 31 - Imaging of orbital disorders

Diseases of the orbit can be categorized in many ways, but in this chapter we shall group them according to etiology. Inflammatory diseases of the orbits may be infectious or noninfectious. Of the infections, orbital cellulitis is the most common and typically arises as a complication of acute sinusitis. Of the noninfectious, inflammatory conditions, thyroid orbitopathy is the most common and results in enlargement of the extraocular muscles and proliferation of the orbital fat. Idiopathic orbital inflammatory syndrome is another cause of inflammation in the orbit, which may mimic thyroid orbitopathy or even neoplasm, but typically presents with pain. Masses in the orbit may be benign or malignant and the differential diagnosis primarily depends on the location of the mass lesion, and on the age of the patient. Lacrimal gland tumors may be lymphomas or epithelial lesions of salivary origin. Extraocular muscle tumors may represent lymphoma or metastases. Tumors of the intraconal fat are often benign, typically hemangiomas or schwannomas. Finally, globe tumors may be retinoblastomas (in children), or choroidal melanomas or metastases in adults.

Oculo Orbital Complications of Sinusitis

The ocular-orbital complications of sinusitis constitute a diagnostic and therapeutic urgency that requires a correct multidisciplinary assumption. Objectives: The description of clinical and therapeutic data of the orbital complications of acute sinusitis. Methods: Our work is based on a retrospective study of 86 cases of ocular-orbital complications of sinusitis hospitalized at the ENTdepartment of Hassan II Hospital in Fes (Morocco), between the years of 2006 and 2014. Results: It is about 56 men and 30 women. The average age was 24 years, with the extremes of 3 years and 65 years. The average time of consultation was 13 dates. The achievement was frontal-ethmoido in 26 cases, and it is about a pan sinusitis in 24 cases. About 13% and 7% of cases were classified respectively in the stage III and the stage IV of chandler. The surgery was done for 24 cases. Bacteriological sample was performed among 24 patients and allowed to isolate a streptococcus (3.5%), and a staphylococcus (5.8%), and a poly microbial flora for 15.1% of patients. A death in sepsis panel was noted for a patient who presented a thrombosis of cavernous sinus. And we have noted a persistent left exophthalmia without the diminution of visual acuity for another patient. Conclusion: The orbital complications of sinusitis require a multi-disciplinary medical approach associated to ear specialist, ophthalmologist, and neuro-radiology. A precocious diagnosis, an appropriate anti-biotic therapy, and sometimes an associated surgical treatment, can significantly diminish the mortality and the morbidity related to this pathology.

Hospital cost of pediatric patients with complicated acute sinusitis

ObjectiveReview costs for pediatric patients with complicated acute sinusitis. MethodsA retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. ResultsThe study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. ConclusionAlthough complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients.

English

English

Imaging in Sinonasal Inflammatory Disease.

While most patients with inflammatory rhinosinusitis are successfully diagnosed clinically, imaging is indicated in patients with recurrent or chronic sinusitis, atypical symptoms and complicated acute sinusitis. Non-enhanced high resolution, thin section computed tomography (CT) is the reference standard in evaluating such patients. It provides superb anatomical details and enables a fairly accurate diagnosis and delineation of the disease, addressing all concerns of the endoscopic surgeon prior to intervention. Contrast MR imaging is preferred for assessing intraorbital or intracranial complications. The radiologist must have a systematic approach to sinonasal CT and generate a clinically relevant report that impacts patient management.