Complications Of Acute Rhinosinusitis Research Articles

Orbital Cellulitis as a Complication of Acute Rhinosinusitis

Orbital Cellulitis as a Complication of Acute Rhinosinusitis

Complications of primary pediatric endoscopic sinus surgery for chronic rhinosinusitis: A 25-year single surgeon experience.

ObjectiveTo report our experience on the complications of primary pediatric endoscopic sinus surgery (ESS).MethodsCase series of pediatric ESS performed from 1991 to 2016 on children who failed maximal medical therapy and/or adenoidectomy. Inclusion criteria were children (age <12 years old) who underwent primary ESS with or without adenoidectomy for chronic rhinosinusitis (CRS) after failed maximal medical therapy and/or adenoidectomy. All patients underwent maxillary antrostomy ± partial or total ethmoidectomy. Patients with complicated acute rhinosinusitis were excluded. Complications reviewed included: skull base injury and CSF leak, orbital injuries (blindness, orbital hemorrhage, emphysema, periorbital swelling and bruising, fat exposure), and bleeding requiring intervention.ResultsA total of 352 patients underwent ESS between 1991 and 2016. There were no blindness or orbital hematoma reported, and no major nasal bleeding requiring intervention. The total number of complications was 31 (8.8%): 1 (0.3%) CSF leak, 3 (0.85%) orbital emphysema, 5 (1.4%) periorbital ecchymosis, and 22 (6.3%) lamina papyracea violation with orbital fat exposure.ConclusionsComplications of primary pediatric ESS can be rare dependent on surgeon's experience, the most common being orbital injury.Level of evidence: 4.

Effectiveness of superior eyelid endoscopic-assisted approach in the management of selected orbital abscess: considerations on 4 cases.

SUMMARYOrbital abscess is one of the most serious complications of acute rhinosinusitis and requires surgical management to avoid further complications such as visual loss and intracranial extension of the infectious process. Endoscopic sinus surgery is the most frequently used procedure in such cases, even if its use may be insufficient in some cases. The aim of the present study is to present our experience on the management of selected orbital abscesses through a superior eyelid endoscopic approach in combination with endonasal surgery. Personal considerations on four cases and lessons learned are described.

Abscess of the clivus in an adolescent with complicated acute rhinosinusitis: a case report

BackgroundComplications of acute sinusitis affecting multiple sites are very uncommon, and generally develop for a delayed diagnosis of the primary infection, with possible severe and life-threatening evolution. Patients can have variable presentations according to the site and extent of the infection. Multiple forms generally include the coexistence of orbital manifestations and intracranial infections. We here present a case with unusual multiple sites locations (i.e.: intraorbital intraconic abscess, sigmoid sinus thrombosis, preclival abscess, multiple splanchnocranium osteomyelitic processes).Case presentationA 13-year-old male presented at our hospital with right progressive orbital oedema with eyesight worsening and signs of meningitis. Computed tomography and magnetic resonance (MRI) demonstrated right intraorbital intraconic abscess, left sphenoidal sinusitis, transverse and sigmoid sinus thrombosis. Ophthalmologic evaluation documented a right optic nerve sufferance. Endoscopic and superior right trans-palpebral surgical decompression was performed, and the abscess was drained. Microbiological analysis revealed the presence of multi-sensitive Streptococcus Intermedius. Subsequent prolonged antibiotic and anti-thrombotic treatments were started. In the following two-weeks the sinusal and ophthalmologic clinical conditions improved, whereas the patients complained of mild to moderate cervical pain and suffered from intermittent pyrexia. Control MRI documented clival abscess extending up to preclival soft tissues posterior to the nasopharynx, associated with mandible osteomyelitis, occipital condyles and anterior part of the temporal bone hyper intensity. Endoscopic trans-nasal surgical approach to the clival compartment with neurosurgery navigation-guided achieved preclival abscess drainage. Complete clinical and radiological recovery was achieved after 45 days of medical treatment.ConclusionsMultiple sites complicated rhinosinusitis is uncommon, and its management is challenging. A proper history and thorough clinical examination along with a radiological evaluation are key factors in the final diagnosis of patients with complicated multiple sites acute rhinosinusitis. A quick multidisciplinary approach is always necessary to avoid unwanted life-threatening complications.

Isolated Unilateral Ptosis Presenting as a Complication of Acute Rhinosinusitis: Case Report

Isolated Unilateral Ptosis Presenting as a Complication of Acute Rhinosinusitis: Case Report

A rare case of rhinosinusitis: Three different complications in a patient

The aim of this study is to describe the management of three different complications associated with rhinosinusitis which developed simultaneously in the same patient. A 27-year-old man visited the emergency department with complaints of headache and swelling of the left eye. He had sustained a blunt head injury 1 month earlier. He was diagnosed with preseptal cellulitis, subdural abscess, and Pott’s puffy tumor which was shown to be a result of rhinosinusitis after physical examination and imaging. After surgical and medical treatment, he was followed up without further complications. Complications of acute rhinosinusitis are very uncommon in the antibiotic era. Patients may suffer life-threatening outcomes if complications develop. A prompt multidisciplinary approach must be immediately established by otorhinolaryngologists, ophthalmologists and other specialists of relevance in order to diagnose and treat life-threatening complications.

Trends in complications of pediatric rhinosinusitis in the United States from 2006 to 2016

Objectives1) Evaluate the changing prevalence of complications from pediatric acute bacterial rhinosinusitis and 2) elucidate factors associated with the development of complicated acute rhinosinusitis in this population. Study Design/SettingCross-sectional analyses of the Kids’ Inpatient Database. Subjects and methodsChildren <20 years with a diagnosis of acute rhinosinusitis were included. Diagnosis codes pertaining to acute rhinosinusitis-related complications were then queried for each subject. All patients were ultimately categorized into one of four groups: uncomplicated acute rhinosinusitis, orbital complications, intracranial complications, or both orbital and intracranial complications. Weighted measures were applied to provide national estimates. ResultsOver the decade studied, national estimates for children admitted with acute rhinosinusitis decreased from 8,312 cases in 2006 to 5,592 in 2016. There was an increase in the rate of orbital complications from 8.9% to 19.3% and intracranial complications from 2.2% to 4.3%. Children with both complications increased from 0.5% to 1.0% of cases. Children with orbital complications were significantly younger (8.6 years) compared to those with intracranial complications (12.4 years) and both complication types (12.2 years) (p < 0.001). ConclusionDespite an overall decrease in cases of acute rhinosinusitis, rates of orbital and intracranial complications continued to increase over a ten-year period. Antibiotic prescribing patterns, vaccination effects, and evolving practice patterns may help explain these observations. Further studies warrant investigation into the cause of these trends. Level of evidence4.

Orbital complications of acute rhinosinusitis: a study on clinical profile, surgical management and outcome

Objectives1. Evaluate the clinical signs and their correlation to Computed Tomography(CT) findings2. Assess the correlation between CT and intra-operative findings.3. To identify implicated micro-organisms.4. Evaluate the current practice in surgical management. MethodologyA descriptive retrospective study conducted at Lady Ridgeway Hospital (LRH) on 19 patients who underwent endoscopic sinus surgery, drainage of pus and orbital decompression for radiologically suspected orbital complications of acute rhinosinusitis from 01/01/2015 to 31/12/2018. ResultsClinical features were fever (73.7%), peri-orbital swelling (100%), chemosis(68.4%), proptosis(57.9%) and ophthalmoplegia(42.1%). Chemosis and ophthalmoplegia were found in 62% and 37% of the patients with intra-orbital abscesses, with only chemosis showing a statistically significant association. CT was suggestive of subperiosteal abscess or inflammation in all. Intra-operatively abscesses were found in 16 (84.2%). Of these 6 had both subperiosteal and intra-orbital abscesses. Eight had subperiosteal abscesses. Two had only intra-orbital abscesses. The CT scan failed to predict the presence of abscess within the orbital fat in 3 out of 8. The positive predictive value was 89.4% for CT to detect orbital abscesses. An Intra-operative bony defect was noted in 15.8%. The mean surgery duration was 2.04 hours. Cultures revealed MRSA(21.1%), MSSA(15.8%), Pseudomonas(10.5%), mixed growth(10.6%) and Streptococcus viridans(5.3%). ConclusionThe commonest presentations were peri-orbital swelling, fever, chemosis. MRSA and pseudomonas being the commonest organism, the appropriate empirical therapy needs further discussion. Endoscopic surgery is safe, reliable and cosmetic. As patients with intra-orbital abscesses may not be detected clinically or radiologically, we recommend routine incision of the orbital periosteum for suspected orbital complications of acute rhinosinusitis when undergoing endoscopic surgery.

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.

Infection rates of MRSA in complicated pediatric rhinosinusitis: An up to date review

IntroductionPublished studies have reported a rise in MRSA isolates in head and neck infections, but the microbiology of complicated pediatric rhinosinusitis is unclear. One study of such patients showed that MRSA isolates were seen only in the last three years of data collection, suggesting a possible recent increased prevalence. Given the public health concerns of increasing rates of antimicrobial resistance, the goal of this study was to investigate the microbiologic patterns and outcomes of complicated pediatric rhinosinusitis. MethodsRetrospective cohort of pediatric patients admitted to our children's hospital with complicated acute rhinosinusitis from 2004 to 2014. ResultsThe mean age of 250 hospitalized children with complicated rhinosinusitis was 7.6 ± 4.9 years; 109 of these (43%) underwent surgical procedures. Although MRSA prevalence was highest in 2014, no significant trend in overall MRSA prevalence occurred when considering the entire study period. No significant relationship was identified between MRSA and intra-orbital versus intra-cranial complications. Interestingly, 22.7% of patients with anaerobes detected by culture had persistent abnormal physical examination (PE) findings versus 6.1% of patients without anaerobes (p = 0.025). Furthermore, multivariate analysis also revealed that detection of anaerobes or MRSA was associated with persistent PE findings being 21.8 and 14.8 times more likely, respectively, when compared to other detected pathogens. DiscussionOur data indicate modest variability in the annual rates of MRSA associated pediatric rhinosinusitis, however there was no statistically significant pattern of change in MRSA prevalence during 2004–2014. Although detection of MRSA was not significantly associated with either intraorbital or intracranial complications of sinusitis, a significant association with a poorer outcome was observed by multivariate analysis for patients from whom MRSA or anaerobes were detected. These data raise the question as to whether clindamycin is adequate for MRSA and anaerobic coverage.

Rhinology-specific priority setting for quality improvement: a modified Delphi study from the Quality Improvement Committee of the American Rhinologic Society.

Improving the quality of healthcare is a complex and resource intensive process. To optimize the allocation of scarce resources, quality improvement (QI) should focus on high-value diseases that will produce the largest improvement in health system performance. Given the breadth and multidisciplinary nature of sinonasal disease management, the purpose of this study was to transparently develop a prioritized list of sinonasal diseases for QI from the perspective of the specialty of rhinology and the American Rhinologic Society (ARS). The RAND modified Delphi methodology was used to rank the priority of nine sinonasal disease categories from 1 (lowest priority) to 9 (highest priority). Two rounds of ranking along with a teleconference meeting was performed by a panel of 9 experts from the ARS Quality Improvement Committee. The final QI-prioritized list of sinonasal diseases are as follows: chronic rhinosinusitis (CRS) (mean score = 8.9), recurrent acute rhinosinusitis (RARS) (mean score = 7.9), sinonasal neoplasms (mean score = 7.0), anatomic nasal obstruction (mean score = 5.9), refractory epistaxis (mean score = 5.2), complicated acute rhinosinusitis (mean score = 5.2), chronic nonallergic rhinitis (mean score = 4.4), orbital disease (mean score = 4.3), uncomplicated acute rhinosinusitis (mean score = 4.1), and allergy/allergic rhinitis (mean score = 3.7). The three most important disease categories for QI from the perspective of the specialty of rhinology were CRS, RARS, and sinonasal neoplasms. Future studies need to define and validate quality metrics for each of these important disease categories in order to facilitate appropriate measurement and improvement initiatives.

Acute Rhinosinusitis in Children

Acute rhinosinusitis in children is a common disorder that is characterized by some or all of the following symptoms: fever, rhinorrhea, nasal congestion, cough, postnasal drainage, and facial pain/headache. It often starts as an upper respiratory tract infection that is complicated by a bacterial infection in which the symptoms worsen, persist, or are particularly severe. The accurate diagnosis of acute rhinosinusitis is challenging because of the overlap of symptoms with other common diseases, heavy reliance on subjective reporting of symptoms by the parents, and difficulties related to the physical examination of the child. Antibiotics are the mainstay of treatment. There is no strong evidence for the use of ancillary therapy. Orbital and intracranial complications may occur and are best treated early and aggressively. This article reviews the diagnosis, pathophysiology, bacteriology, treatment, and complications of acute rhinosinusitis in children.

Complications of acute rhinosinusitis in The Netherlands

Despite the evidence demonstrating that antibiotics are of little benefit in acute rhinosinusitis (ARS), GPs continue to prescribe them, possibly in an attempt to prevent potentially dangerous complications. In this study, we present epidemiological data about the incidence, course and severity of such complications in the Netherlands. This retrospective cohort study included all patients hospitalized in The Netherlands in 2004 with a complication of ARS. Records were made of the symptoms of ARS and the complication, demographics, medical history, medical treatment preceding hospitalization, diagnostic techniques, therapeutic management, course and outcome. Forty-seven patients with 48 complications (16 intracranial and 32 orbital) were included. In the intracranial group (mean age 35.9 years), six patients had been treated with oral antibiotics prior to hospitalization. While hospitalized, all patients were treated with intravenous antibiotics and 15 underwent surgery. Eight patients recovered fully after treatment, three patients had residual symptoms and three patients died (missing data: 2). Of the 31 patients with orbital complications (mean age 17.4 years), 14 received oral antibiotics before admission. While hospitalized, all patients were treated with intravenous antibiotics and 13 underwent surgery. Twenty-seven patients recovered fully and two had residual symptoms (missing data: 2). Severe ARS complications occur in an otherwise healthy population in an estimated 1:12,000 paediatric and 1:32,000 adult cases in the Netherlands. Our study suggests that antibiotic treatment of ARS in general practice does not play a role in preventing complications.

Orbital complications of rhinosinusitis.

Suppurative extension of rhinosinusitis to the orbit is a complication that often results from delay in diagnosis and, or inadequate treatment. These complications may range from preseptal cellulitis, orbital cellulitis, orbital abscesses, and subperiosteal abscesses to intracranial extension with a threat to both vision and life. This study aims to review the clinical profile, treatment modalities and outcome of orbital complications of rhinosinusitis in Ibadan, Nigeria. A retrospective review of the charts of patients with orbital complications of rhinosinusitis managed in the departments of Otorhinolaryngology and Ophthalmology, University College Hospital, Ibadan over a five year period (Feb 2002- Jan 2007) was carried out .The diagnosis of rhinosinusitis was based on history, physical examination, plain x ray and CT scan findings and antral puncture. Demographic data, clinical presentation and treatment were evaluated. A total of 24 patients were reviewed in the study. There were 13males and 11females (M/F, 1:1). The age range was 8months to 75years, 14 (58.3%) patients were children and while 10 (41.7%) patients were adults. 75% of the patients were seen during the dry season (November to February). The duration of symptoms ranged from one day to three weeks. Involvement of one eye occurred in 14 patients (58.3%); right eye (4), left eye (10). Both eyes were involved in 10 patients (41.7%). Non-axial proptosis was seen in 8 patients (33.3%). It was infero-lateral in 6 patients (25%) and infero-nasal in two (8.3%) patients. Orbital cellulitis was seen in 10 (41.7%) patients, 6 (25%) patients had preseptal cellulitis while 8 (33%) patients had orbital abscess. Cavernous sinus thrombosis was seen in 3 (12.5%) patients. The cases with preseptal and orbital cellulitis were effectively managed by intravenous antibiotics. Orbital abscesses were drained surgically with complete resolution. Sinus surgical procedures were done in 10(41.7%) patients. This group of patients had preoperative visual acuity of between 6/6 and 6/60. They all had complete resolution of proptosis and good visual outcome. Orbital complications of acute rhinosinusitis are common in children. Surgical drainage and aggressive medical management remain the standard to achieve a good prognosis and visual outcome.

Orbital and intracranial complications after acute rhinosinusitis

Background/objectives: Nowadays, intracranial abscess is a rare complication of acute rhinosinusitis. The consequent orbital and intracranial complications of acute rhinosinusitis are rare but must be mutually excluded in complicated rhinosinusitis even when proper surgical and medical treatment tend to efficiently heal the orbital complication. Methods: We report a case of a patient who primarily revealed symptoms of orbitocellulitis as a complication of odontogenous rhinosinusitis. Proper diagnostic and therapeutical measures were undertaken to manage the disease immediately after stationary admission. Results: Two weeks after an inconspicuous healing period, hemiparesis due to formation of an intracranial abscess developed. An emergent situation reveals which was unusual to the clinical situation. Conclusion: The possible role of underlying mechanisms of intracranial abscess formation is discussed and review of literature concerning orbital and intracranial rhinosinusitis complications is performed. The correct indication of imaging methods and accurate evaluation of diminutive symptoms are essential. We assume that performance of a complementary CT of the brain or MRI even when previous CT scan of the orbit/paranasal sinuses reveals no cerebral pathology should be done to avoid or minimize future patients with consecutive orbital and intracranial complications of acute rhinosinusitis.

British Rhinological Society audit of the role of antibiotics in complications of acute rhinosinusitis: a national prospective audit

Nowadays, intracranial abscess is a rare complication of acute rhinosinusitis. The consequent orbital and intracranial complications of acute rhinosinusitis are rare but must be mutually excluded in complicated rhinosinusitis even when proper surgical and medical treatment tend to efficiently heal the orbital complication. We report a case of a patient who primarily revealed symptoms of orbitocellulitis as a complication of odontogenous rhinosinusitis. Proper diagnostic and therapeutical measures were undertaken to manage the disease immediately after stationary admission. Two weeks after an inconspicuous healing period, hemiparesis due to formation of an intracranial abscess developed. An emergent situation reveals which was unusual to the clinical situation. The possible role of underlying mechanisms of intracranial abscess formation is discussed and review of literature concerning orbital and intracranial rhinosinusitis complications is performed. The correct indication of imaging methods and accurate evaluation of diminutive symptoms are essential. We assume that performance of a complementary CT of the brain or MRI even when previous CT scan of the orbit/paranasal sinuses reveals no cerebral pathology should be done to avoid or minimize future patients with consecutive orbital and intracranial complications of acute rhinosinusitis.

British Rhinological Society audit of the role of antibiotics in complications of acute rhinosinusitis: a national prospective audit

Acute rhinosinusitis (ARS) is one of the most common presenting conditions to Primary Care physicians. Over-prescription of antibiotics has led to wide debate and divided expert opinion regarding the resulting increasing bacterial resistance or the merits of prevention of more serious complications of ARS. A national prospective audit was undertaken in the UK to evaluate use of antibiotics for ARS in Primary Care. British Rhinological Society members were asked to contribute patients admitted with complications of ARS, between Feb 2008–Feb 2009 to a national prospective audit via an on-line survey. Seventy-eight patients were admitted with complications of ARS. The majority of patients were started on antibiotics (59%) prior to admission, with penicillin/amoxicillin being most frequently (64%) prescribed. Similar complication rates were seen in patients treated with and without prior antibiotics. Despite prior antibiotic treatment, complications of ARS seem to occur sporadically. Our study has shown that the complications which require surgical treatment are similar in both the prior antibiotic treated group and the no prior antibiotic group, suggesting limited benefit of oral antibiotics in the Primary Care setting. Early recognition with CT scanning and appropriate hospital management is essential to reduce any subsequent morbidity or mortality.

Rhinosinusitis in children: the role of surgery

Indications and nature of surgery for chronic rhinosinusitis (CRS) have yet to be elucidated in children. After review of the literature and based on their experience, the authors suggest guidelines for the treatment of CRS in children. They suggest grouping children with rhinosinusitis into two groups: those with complicated acute rhinosinusitis and those with CRS. For the first group, the authors suggest an early surgical intervention because of the potential serious consequences and sometimes irreversible damage. For the second group, most agree that maximal medical management should be the first line of treatment with antibiotics, nasal lavage and as a last resort surgery. It is important to realize that surgery should be considered in these cases if medical treatment fails. Once surgery is recommended, the kind of surgery then becomes an issue between adenoidectomy, endoscopic sinus surgery or a combination of the two depending on the age and other conditions.

Our experience with FESS in children

Between 1993 and 1996 we operated on 50 children with one of the following surgical indications: 17 children with a complication of acute rhinosinusitis and the propagation of the process towards the orbit (periorbitis), six children with an ethmoid and sphenoid foreign body (shrapnels shells), 11 children with an antrochoanal polyp, four children with nasal polyposis in cystic fibrosis and l2 children with chronic rhinosinusitis after 2–4 acute reinfections. The surgery was done under endotracheal anesthesia with hypotension. CT axial and coronal tomograms were done during the preoperative treatment. During the 2 weeks preoperative treatment, the patients with polyposis and antrochoanal polyps were treated with 4–8 mg of cortisone per os or i.m., and also with Fluticasone Propionate 100 mg twice a day and antibiotics in chronic and acute rhinosinusitis. The children's age was between 7 and l5 years. In the patients with nasal polyposis and antrochoanal polyps ( n=15) post-operatively, we had four cases of synechiae, recurrent polyposis in two and antrochoanal polyps in two cases.

Die Computertomographie als Standarduntersuchungsverfahren zur Nasennebenhöhlendiagnostik aus der Sicht des Hals-Nasen-Ohren-Arztes

The renaissance of endonasal microsurgery is not only based on a deeper knowledge of the mucociliar clearance and better operation instruments but depends as well as on the improved radiological diagnosis provided by computed tomography. Since 1986, high-resolution computed tomography in two plains has been part of the authors' preoperative routine diagnostic program for paranasal sinus diseases at their clinic. One hundred and fifty-eight computed tomograms of patients with chronic rhinosinusitis, complicated acute rhinosinusitis, and polyposis nasi were reexamined. The involvement of the paranasal sinuses and abnormalities of the lateral nasal wall were analyzed. The anterior ethmoid is the most frequently affected area in all of the diseases. The computed tomogram is most important for the rhinosurgeon. The ethmoid cell system can be visualized without superimposing structures. Therefore even circumscript pathologic mucosa alterations and the extent of the disease can be defined. All this enables the surgeon to put forward an exact diagnosis and to plan a safe operation as regards important physiological structures of the nose and paranasal sinuses.