Complications Of Sinusitis In Children Research Articles

Orbital complications of sinusitis in children - Retrospective analysis of an 8.5 year experience

ObjectiveOrbital complications account for approximately 74–85 % of all complications of acute sinusitis, affect the pediatric population more frequently, and can have devastating consequences.In the years following the COVID-19 pandemic (2022, 2023), a high number of children presented to our clinic with orbital complications.1)Has there been an increase in orbital complications in the post-covid era? 2)To what extent has the use of MRI reduced radiation in pediatric patients? DesignIn our retrospective data analysis, all pediatric patients (age 0–16 years) treated at a university ENT clinic during the period 01/2014-06/2023 who presented with an orbital complication of rhinosinusitis were included. The analysis was descriptive. ResultsForty-four children with orbital complications of rhinosinusitis were treated during the study period, 14 females and 30 males. Most patients (n = 23, 52 %) presented during the years of the waning Covid-19 pandemic (01/2022 to 06/2023). MRI was the initial imaging modality (n = 22,50 %); CT was performed in 17 of 44 cases (39 %) when surgery was indicated. The most common germ detected was of the Streptococcus species, and the predominant antibiotic administered was amipicillin/sulbactam. ConclusionThe standard operating procedure (SOP) established at our hospital in 2014 was followed in 42/44 cases. Except for 2 cases, CT was performed exclusively when surgery was indicated. Imaging-related radiation could be avoided in 27 patients (61 %). There was a 30 % increase in orbital complications related to sinus infections postpandemically.

A 20-Year Study of Intracranial Pyogenic Complications of Sinusitis in Children.

Intracranial pyogenic complications of sinusitis in children can lead to serious sequelae. We characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period. Single-center retrospective chart review. Cases were identified based on International Classification of Diseases diagnostic codes (ICD)-9 and ICD-10 depending on the year and by reviewing all intracranial microbiologic samples. A total of 104 cases of complicated sinusitis were included after review of 1591 charts. Median age was 12 (IQR 9-14); 72 were male (69%). The most frequent complications were epidural empyema (n = 50, 48%), subdural empyema (n = 46, 44%) and Pott's puffy tumor (n = 27, 26%). 52% (n = 54) underwent neurosurgery and 46% (n = 48) underwent otolaryngologic surgery. The predominant pathogen isolated from sterile site specimens was Streptococcus anginosus (n = 40, 63%), but polymicrobial growth was common (n = 24; 38%). The median duration of intravenous antibiotic therapy was 51 days (IQR 42-80). Persistent neurologic sequelae (or death, n = 1) were found in 24% (n = 25) and were associated with the presence of cerebritis and extensive disease on neuroimaging ( P = 0.02 and P = 0.04, respectively). Intracranial complications of sinusitis continue to cause significant morbidity in children. Polymicrobial infections are common, which reinforces the need for broad-spectrum empiric antibiotic therapy and cautious adjustment of the antibiotic regimen based primarily on sterile site cultures. The association of neurologic sequelae with the presence of cerebritis and extensive intracranial involvement on neuroimaging suggest that delayed diagnosis may be a contributor to adverse outcome.

Diagnosis and treatment of orbital complications of acute sinusitis in 51 children

Objective:To analyze the clinical features, diagnosis and treatment of acute sinusitis related orbital cellulitis in children. Methods:The data of 51 cases with acute sinusitis comorbid with orbital cellulitis in Tianjin Children's Hospital from April 2016 to March 2021 were retrospectively analyzed. According to the extent of infection, the patients were divided into two groups:pre-septal orbital cellulitis（7 cases） and post-septal orbital cellulitis（44 cases）. The general clinical characteristics, clinical manifestations, laboratory examination and treatment were compared between the two groups. Among them, 23 cases（6 in pre-septal orbital cellulitis group and 17 in post-septal orbital cellulitis group） were cured by medicine treatment; 28 cases were cured by surgical treatment after failure of medicine treatment. Results:There was no significant difference in age, gender and medical history between the two groups. Redness, swelling, heat and pain in eyelid was the most common clinical manifestations of orbital cellulitis in children, followed by fever, headache, runny nose, eye fixation, and vision loss. WBC count and neutrophils percentage were significantly higher in post-septal orbital cellulitis group. All children were followed up for 3 months to 3 years， 1 case was lost to follow-up， 50 cases had no recurrence and recovered well. Conclusion:Orbital cellulitis is a common and rapid developing complication of sinusitis in children. Early diagnosis and effective anti-infection treatment are very important for prognosis. Orbital CT plays an important role in the determination and evaluation of this complication. When conservative treatment is ineffective, surgical drainage in time can reduce the occurrence of serious ocular sequelae.

264. A 20-year Study of Intracranial Pyogenic Complications of Sinusitis in Children

Abstract Background Intracranial pyogenic complications of sinusitis in children are relatively uncommon but can lead to serious sequelae. The objective of this study was to characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period (2000- 2019). Methods Single-center retrospective chart review. Cases were identified based on International Classification of Diseases (ICD)-10 diagnostic codes (intracranial abscess or granuloma, extradural and subdural abscess, Pott’s puffy tumor, acute or chronic sinusitis) and by reviewing all microbiological samples of intracranial pus, tissue or fluid. Results 108 cases of clinically and/or radiologically diagnosed sinusitis were included after review of 1591 charts. The majority were adolescents (median age 12, IQR 9-14); 72 were male (67%). The most common presenting symptoms were fever (84%), headache (87%) and symptoms of upper respiratory tract infection (57%). Median symptom duration was 10 days (IQR 5-21) and 55 cases (51%) received oral antibiotics prior to admission. The most frequent complications were epidural empyema (n=50, 46%), subdural empyema (n=46, 43%) and Pott’s puffy tumor (n= 31, 29%). 50% (n=54) underwent neurosurgery, of which 20% (n=11) required multiple craniectomies. 38% (n=41) underwent otolaryngological surgery. Microbiological data from sterile specimens demonstrated single organisms in 36 cases (59%) and polymicrobial growth in 25 cases (41%). The most frequently identified pathogens were Streptococcus anginosus (n=40, 66%) followed by Fusobacterium species (n=10, 16%) and Prevotella species (n=10,16%). Most cases were treated with combination antibiotic therapy (n=68, 63%) and 14% (n=15) with a carbapenem. The median duration of intravenous antibiotic therapy was 51 days (IQR 42-80). One child died and 23% (n=25) suffered neurological sequelae (median follow-up 344 days). 48 cases (44%) occurred between 2014-2019. Conclusion Intracranial complications of sinusitis continue to cause significant morbidity in children. The predominant causative pathogen was Streptococcus anginosus. Polymicrobial infections are common, confirming the need for prolonged broad-spectrum antibiotic treatment. Disclosures Sharon Cushing, MD, MSc, FRCSC, Cochlear Corporation (Research Grant or Support)Cochlear Corporation (Speaker’s Bureau)Interacoustics (Speaker’s Bureau)Plural publishing (Other Financial or Material Support, Royalties: editor: manual of pediatric balance disorders)

Adverse Events in Endoscopic Sinus Surgery for Infectious Orbital Complications of Sinusitis: 30-Day NSQIP Pediatric Outcomes.

Objective Identify predictors of adverse events for children who underwent endoscopic sinus surgery for treatment of orbital complications associated with sinusitis. Study Design Cross-sectional analysis of a US national database. Setting American College of Surgeons National Surgical Quality Improvement Program (NSQIP), pediatric version (2012-2015). Subjects and Methods Patients were identified with a combination of codes from the International Classification of Diseases, Ninth Revision and 2014 Current Procedural Terminology. Our primary outcome measure was adverse events, which were compared with clinical risk factors to examine for any associations. Results A total of 57 patients were included for analysis. No significant relationship was identified between 30-day postoperative adverse events and age, sex, race, body mass index, prematurity, history of asthma, steroid use (within 30 days), and preoperative white blood cell count. There was a statistically significant increase in adverse events for those patients who underwent delayed surgery ( P < .0001). No serious adverse events related to death, sepsis, nerve injury (eg, visual loss), or other organ space infections (eg, intracranial infection) were identified. After controlling for age group and race, delayed operative intervention was a significant clinical predictor of adverse events (odds ratio = 25.65; 95% CI, 3.86-170.45; P = .0008). We observed unplanned reoperation and readmission rates of 5.3% and 7%, respectively. Conclusions Endoscopic surgical drainage for infectious orbital complications of sinusitis in children appears to be safe. Serious or significant adverse events were uncommon. Areas for improvement include limiting and reducing unplanned reoperations and readmissions.

Orbital complications of sinusitis in children in Komfo Anokye Teaching Hospital

Orbital complications of sinusitis in children in Komfo Anokye Teaching Hospital

Sinogenic intracranial complications in children - cases report

Background Although uncommon, intracranial suppurative complication of sinusitis in children can occur. The progressive pneumatization of the sinuses after birth and the late appearance of the sphenoid and frontal sinuses explain the predilection for intracranial sinogenic complications in older children and adolescents. Early imaging is crucial to diagnosis and brain MRI is the most useful test. Medical therapy combined with neurosurgical and otolaryngological surgical intervention may improve outcome and reduce the neurological sequelae.

Identifying and Managing Intracranial Complications of Sinusitis in Children

Of patients admitted to hospital with sinusitis, about 3% have an intracranial complication. We describe the clinical features, laboratory data, imaging findings, and outcomes of pediatric patients with intracranial complications of sinusitis. A retrospective chart review of all pediatric patients < 21 years of age admitted for intracranial complications of sinusitis to a tertiary hospital over a 10-year period. A total of 13 patients with a mean age of 13.3 ± 3.7 years presented with headache (92%), fever (85%), nausea/vomiting (62%), sinus tenderness (31%), and lethargy (23%). Physical examination findings included Pott puffy tumor (46%), orbital cellulitis (46%), altered level of consciousness (46%), new-onset seizure (31%), hemiparesis (23%), nuchal rigidity (23%), visual disturbance (23%), and slurred speech (15%). Computed tomography and magnetic resonance imaging demonstrated 16 instances of epidural and subdural empyema, and 1 brain abscess. One child had sagittal sinus thrombosis. Our findings suggest that acute sinusitis in combination with severe intractable headache, varying degrees of altered level of consciousness, focal neurologic deficits, and/or signs of meningeal irritation should raise clinical suspicion for potential intracranial complications of sinusitis. These signs and symptoms should prompt early and aggressive evaluation and management, including neuroimaging studies, neurologic and otolaryngologic consultations, and intravenous antibiotics.

Abcès de la cloison nasale compliquant une pansinusite aiguë

Nasal septal abscess is a rare complication of acute sinusitis in children. We report the case of a 9-year-old girl who presented at the emergency unit with a bilateral eyelid edema evolving over 2 days, associated with bilateral rhinorrhea and nasal obstruction. Clinical examination found a tumefied nasal septum and nasal obstruction. A computed tomography scan of the nose and paranasal sinuses showed pansinusitis with an abscess of the nasal septum. Treatment consisted in the evacuation of the abscess associated with a triple antibiotic therapy. Progression was favorable. Acute sinusitis is seldom complicated by an abscess of the nasal septum, and very few cases are reported in the literature. Early diagnosis and treatment can avoid complications, which engage not only the functional but also the vital prognosis.

External rhinoplasty excision of a nasal tip glioma in a 6-month old infant: Case report and review of the literature

This review describes the microbiology, and medical management of orbital and intracranial complications of sinusitis in children. The most common complications are orbital cellulitis, subperiosteal abscess, orbital abscess, brain abscess, subdural empyema and meningitis. The predominate organisms recovered from these infection are anaerobic, aerobic, and microaerophilic bacteria of oral flora origin. Establishing the microbiology by obtaining appropriate cultures for both aerobic and anaerobic bacteria are essential for proper antimicrobial selection. Early recognition and appropriate surgical and medical therapy are essential to ensure recovery.

Orbital Complications of Sinusitis in Children

Background and Aim: Orbital complications of sinusitis are uncommon but can result in significant morbidity if not appropriately managed. This study was conducted to evaluate the clinical presentation, diagnosis, management, and outcome of orbital complications of sinusitis in children treated at our institution over a 10-year period.

Complications of Acute Bacterial Sinusitis in Children

&lt;P&gt;A 15-year-old male presents to the emergency room with lethargy and frontal headache. He has had two days of intermittent low grade fever and poor appetite. Physical exam reveals that he is afebrile and slightly tachycardic. His neurologic and ophthalmologic examinations are normal. Examination of the nares reveals diffuse bilateral mucosal edema and muco-purulence under the middle turbinates. A computerized tomography (CT) scan of the sinuses and brain are obtained (see Figure 1 and Figure 2).&lt;/P&gt; &lt;H4&gt;ABOUT THE AUTHORS&lt;/H4&gt; &lt;P&gt;Natalie E. Edmondson, MD; and Sanjay R. Parikh, MD, FAAP, FACS, are with the Department of Otorhinolaryngology-Head and Neck Surgery, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, N.Y.&lt;/P&gt; &lt;P&gt;Address correspondence to: Sanjay R. Parikh, MD, Department of Otorhinolaryngology, Head and Neck Surgery, Children’s Hospital at Montefiore, 3400 Bainbridge Ave, 3rd Floor, Bronx, NY 10467.&lt;/P&gt; &lt;P&gt;Dr. Edmondson and Dr. Parikh have disclosed no relevant financial relationships.&lt;/P&gt; &lt;H4&gt;EDUCATIONAL OBJECTIVES&lt;/H4&gt; &lt;OL&gt; &lt;LI&gt;Review the anatomy of the paranasal sinuses in children and the pathogenesis of sinus disease in this population.&lt;/LI&gt; &lt;LI&gt;Provide a classification system for serious complications of sinusitis in children.&lt;/LI&gt; &lt;LI&gt;Discuss the necessity of a team approach to management of serious complications of sinus disease in children.&lt;/LI&gt; &lt;/OL&gt;

Intracranial Complications of Sinusitis in Children and Adolescents and Their Outcomes

Germiller JA, Monin DL, Sparano AM, Tom LWC. Arch Otolaryngol Head Neck Surg. 2006;132:969–976 PURPOSE OF THE STUDY. To evaluate the presentation, imaging, microbiology, treatment, and outcome of intracranial complications of sinusitis in children. STUDY POPULATION. The study included 25 consecutive children and adolescents treated for intracranial complications of sinusitis over a 5-year period. METHODS. This was a retrospective chart review of patients who were identified by screening admission diagnoses for central nervous system infections including intracranial abscesses, meningitis, encephalitis, and dural sinus thrombophlebitis. These records were cross-referenced for both procedure codes for external and endoscopic sinus surgery and diagnosis of acute or chronic sinusitis. RESULTS. Twenty-five consecutive patients were identified, with ages ranging from 4 to 18 years; 19 patients were male and 6 were female. There were 35 intracranial complications: 13 epidural abscesses, 9 subdural empyemas, 6 meningitis, 2 dural sinus thromboses, and 1 middle cerebral artery ischemia. Nine patients (36%) had &amp;gt;1 intracranial complication. Ten patients (44%) also had at least 1 extracranial complication: 5 with orbital cellulites, 4 with orbital/periorbital abscess, 1 with forehead abscess, and 1 with forehead edema. Seventy percent of the patients with extracranial complications had epidural abscess as their intracranial complication. In addition, 12 patients (48%) presented with neurologic signs and symptoms, most commonly change in mental status (9 patients) or hemiparesis (5 patients). Of the 13 who presented without neurologic signs and symptoms, 9 (69%) had epidural abscess as their only intracranial complication. Fifteen patients had computed tomography imaging with contrast, identifying 12 (63%) of 19 complications in those patients. MRI was performed in 19 patients, identifying 26 (93%) of 28 complications in those patients. Cultures grew multiple organisms in more than one half of the patients, 53% of which were Streptococcus species. Outcomes were divided into 3 groups. No patient in group 1 (14 patients) had neurologic deficits or events. All the patients in group 1 underwent endoscopic sinus surgery (100%), and 7 (50%) underwent a neurosurgical procedure. By definition, there were no short-term or long-term sequelae for the children in group 1. Group 2 included 8 patients who experienced short-term neurologic sequelae only. Seven patients of group 2 underwent endoscopic sinus surgery (88%), and 5 (63%) underwent a neurosurgical procedure. Group 3 included 3 patients who experienced permanent neurologic deficits (bilateral sensorineural hearing loss for one and hemiparesis, expressive aphasia, and seizures for the other) or death. Two patients in group 3 underwent endoscopic sinus surgery (67%), and 1 (33%) underwent a neurosurgical procedure. CONCLUSIONS. Intracranial complications of sinusitis in children present diagnostic challenges, because many patients lack a history of sinusitis and present with vague, nonlocalizing signs and symptoms. Aggressive medical and surgical management may limit morbidity and improve outcomes. Early imaging is crucial to diagnosis, and MRI is the most useful test. REVIEWER COMMENTS. Intracranial complications of sinusitis remain uncommon; even in this review from a tertiary pediatric center only 5 patients per year were identified. A high index of clinical suspicion, particularly in adolescent boys, should lead to early imaging for diagnosis. Medical therapy combined with neurosurgical and otolaryngological surgical interventions may improve outcomes and reduce short-term and long-term sequelae.

Intracranial Complications of Sinusitis in Children and Adolescents and Their Outcomes

Intracranial Complications of Sinusitis in Children and Adolescents and Their Outcomes

Orbital complications of sinusitis in children

Orbital complications of sinusitis in children

Intracranial Complications of Sinusitis in Children and Adolescents and Their Outcomes

To gain insight into patterns of presentation, imaging, microbiological aspects, therapy, disease course, and outcome of intracranial complications of sinusitis (ICS), which are challenging conditions with the potential to cause significant morbidity and mortality. We reviewed our experience with ICS in children and adolescents. Consecutive case series with a mean follow-up of 12 months. Tertiary pediatric referral center. Consecutive sample of 25 children and adolescents treated for 35 intracranial complications (mean age, 13.2 years [range, 4-18 years]). Medical and surgical management. Survival and temporary and permanent neurologic sequelae. Most patients were adolescents (n = 19; 76%) and male (n = 19; 76%). Epidural abscess was most common (13 complications), followed by subdural empyema (n = 9), meningitis (n = 6), encephalitis (n = 2), intracerebral abscess (n = 2), and dural sinus thrombophlebitis (n = 2). Abscesses were primarily located in the frontal or frontoparietal regions. Magnetic resonance imaging was extensively used and was superior to contrast computed tomography in diagnosis. All patients received intravenous antibiotics, 21 underwent endoscopic sinus surgery, and 13 underwent neurosurgical drainage. Only 1 death occurred from sepsis secondary to meningitis (mortality, 4%). Overall, neurologic outcome was excellent. Although 10 patients (40%) had neurologic deficits, most resolved within 2 months. Only 2 patients had permanent neurologic sequelae. Among ICS, epidural abscess appeared to be a distinct clinical entity. Epidural abscesses typically presented without specific neurologic symptoms or signs, were more often associated with orbital complications, and had outcomes considerably better than the other ICS. Intracranial complications of sinusitis are challenging, but prognosis can be favorable in children and adolescents by using aggressive medical and surgical management.

Empiema subdural como complicación de sinusitis

Subdural empyema is a rare complication of sinusitis in children. Its clinical presentation represents a neurosurgical emergency and as a scarcely recognized entity a delayed diagnosis rapidly increases its fatal prognosis. We report the clinical and radiological course of an adolescent with a subdural empyema secondary to sinusitis. Clinical and radiological features, laboratory findings and outcome of this condition are discussed based in a review of previously reported cases.

Complications of Acute Sinusitis in Children

To review the demographic, microbiologic, and outcome data for children with complications of acute sinusitis. Retrospective review of children admitted with complications of acute sinusitis from January 1995 to July 2002 to a tertiary care children's hospital. One hundred four patients were reviewed with the following complications: orbital cellulitis (51), orbital abscesses (44), epidural empyemas (7), subdural empyemas (6), intracerebral abscesses (2), meningitis (2), cavernous sinus thrombosis (1), and Pott's puffy tumors (3). Sixty-six percent were males (P < 0.001), and 64.4% presented from November to March (P < 0.001). Patients with isolated orbital complications were younger than patients with intracranial complications (mean, 6.5 versus 12.3 years), had a shorter stay (mean, 4.2 versus 16.6 days), and had shorter duration of symptoms (mean, 5.4 versus 14.3 days; all P < 0.0001). Complete resolution was documented for 54/55 patients with restricted ocular motility, 7/8 with visual loss, 3/3 patients with a nonreactive pupil, 7/7 with neurological deficits, and 2/4 with seizures. The most common organism isolated was Streptococcus milleri (11/36 patients with surgical cultures). No mortalities occurred, and persistent morbidity occurred in 4 patients (3.8%). Despite significant deficits on presentation, permanent morbidity was low. Streptococcus milleri is a common pathogen with complications of sinusitis in children.

Suppurative intracranial complications of sinusitis in children

Objective: A review of suppurative intracranial complications of sinusitis in children. Methods: Case series review over a two-year period from 1998 to 1999 in a children's hospital, Singapore. Results: There were seven cases, all male, and age range 9 to 14. Six had subdural empyemas and one had meningitis. The most common presenting symptoms included fever, headache and vomiting. Sinusitis was suspected as the cause in only one patient initially. The intracranial infections were not apparent from the initial brain CT of two patients and were only confirmed later on repeated imaging. Four patients had lumbar punctures without any adverse effects. All seven children had infections involving the frontal, ethmoid and maxillary sinuses and two also had sphenoid involvements. All were treated with high-dose intravenous antibiotics together with drainage of both the intracranial (n=six) and sinus (n=seven) suppurations. Five needed repeated intracranial drainages. Streptococcus species were isolated in five cases. Three patients developed seizures post-operatively which resolved on follow-up. One patient needed a ventriculo-peritoneal shunt for hydrocephalus. All patients had a good Glasgow Outcome Score. The hospital stay ranged from 30 to 89 days with a median of 43 days. Conclusions: Only males were identified in this review, collaborating the feeling that teenage males are at greatest risk of developing intracranial infections from sinusitis. We recommend that radiologic imaging of the brain for suspected intracranial infection should always include the sinuses as this aids early identification of actual cause. Initial CT imaging may be negative and hence repeated scans are warranted if the index of suspicion is high. The successful outcome of the children in this series supports the opinion that combined aggressive surgical and medical treatment is preferable in this patient population.

Orbital complications of sinusitis in children.

Orbital complications of sinusitis are uncommon but can result in significant morbidity if not appropriately managed. This study was conducted to evaluate the clinical presentation, diagnosis, management, and outcome of orbital complications of sinusitis in children treated at our institution over a 10-year period. The study retrospectively reviewed cases of 139 children with evidence of orbital complications of sinusitis admitted to the Montreal Children's Hospital between January 1990 and March 2000. Factors assessed included the clinical presentation, radiologic findings, management, and outcome (length of admission, complications). Complications were classified as preseptal if they did not penetrate the periorbita. Postseptal complications were defined as those penetrating the periorbita and were further subdivided into cellulitis and abscess categories. Seventy-two percent of patients presented with preseptal cellulitis, 19% with orbital cellulitis, and 9% with subperiosteal abscess. Ophthalmoplegia and proptosis at presentation were found to be predictors of postseptal disease, although computed tomography (CT) was necessary to differentiate between cellulitis and abscess. Preseptal disease resolved with antibiotics in all cases. Postseptal disease was treated medically and in some cases surgically, although surgery did not affect outcome. Preseptal complications of sinusitis can be diagnosed clinically without a CT scan and should be treated with an appropriate course of intravenous antibiotics. Postseptal complications of sinusitis can be diagnosed by the presence of ophthalmoplegia or proptosis and mandate a CT scan to differentiate abscess from orbital cellulitis. Management of these patients should include intravenous antibiotics, reserving surgery for selected cases.