Orbital Complications Of Acute Sinusitis Research Articles

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.

Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients.

BackgroundSurgery is often avoided in the setting of pediatric orbital complications from acute sinusitis unless necessitated by alarming ophthalmological signs. Criteria for surgical intervention are not well-defined.ObjectiveWe aim to review our experiences, management practices and patient outcomes over a ten-year period for Chandler III patients.MethodsA retrospective review was performed from January 1, 2007 through December 31, 2016 of patients treated for orbital symptoms secondary to acute sinusitis at a free-standing tertiary-care pediatric hospital.ResultsOf the 186 patients reviewed, 42 Chandler III patients were included. Average age was 82.6 months (SD 50.6) with a slight male predominance (M to F, 1.8 to 1). 27 patients (64.3%) underwent intervention including endoscopic sinus surgery (ESS) with or without orbitotomy. Late surgical intervention (>48hrs from admission) demonstrated significant increase in overall length of stay (LOS) when compared with early surgical intervention and/or medical management (median, 6.9 vs 3.6 vs 3.7 days; p < 0.01). Postoperative LOS was also higher in the late surgery group compared with patients who had surgery within 48 hours of admission, but this did not reach statistical significance [median, 3.8 vs 2.8 days, p= 0.12]. There was no significant difference in overall abscess volume between patients who underwent intervention and those who did not (1019 mm3 vs 805 mm3, p = 0.5), but abscess width ≥ 1.2 cm was associated with higher rates of intervention. An alarming extraocular exam was the most common factor associated with surgical intervention.ConclusionPediatric subperiosteal orbital abscess may prompt surgical intervention by ESS. An alarming ophthalmologic exam should prompt consideration of early intervention, which may lead to decreased overall and post-operative length of hospital stay.Level of Evidence4Meeting InformationAmerican Rhinologic Society, Fall National Meeting. Chicago, IL, USA. September 8–9, 2017.

Orbital complications of acute sinusitis

In the pre-antibiotic era, orbital complications of acute sinusitis were not infrequent, often leading to severe patient morbidity, including blindness. Today, treatment of orbital complications consists primarily of systemic antibiotic therapy with surgical intervention reserved for large or medically unresponsive orbital or subperiosteal abscesses. Staging systems have been created to assist physicians in management and prognosis of such complications, but do not replace clinical acumen. Although powerful antibiotics have decreased the morbidity associated with orbital complications of acute sinusitis, the physician should remain aware of potential complications and ready to escalate treatment when necessary.

Association of oral flora with orbital complications of acute sinusitis.

Acute and chronic sinusitis in children and adults can spread to the orbit. Oral flora has been seen in orbital infections, but the extent of synergy between pathogens in such infections remains unknown. A retrospective case series of patients with complicated sinusitis that involved the orbit from acute sinusitis who were admitted to a tertiary care hospital from January 2000 to December 2014 and who had surgical cultures obtained. Patients were identified by the International Classification of Diseases, Ninth Revision code for periorbital cellulitis, subperiosteal abscess, or orbital abscess. Sixteen patients underwent surgical drainage via external drainage or endoscopic sinus surgery of an orbital infection associated with sinusitis and had cultures obtained. Nine patients (56%) grew organisms that exist in oral flora, whereas seven patients (44%) grew common respiratory pathogens. The most common organisms recovered were viridans group streptococcus (VGS) (50%), Staphylococcus aureus (31%), Eikenella corrodens (25%), and Prevotella species (19%). Oral flora anaerobes were cultured alongside a VGS species in seven of eight patients (88%) as opposed to the respiratory pathogens, which were less frequently associated with concomitant VGS infection (29%) (p = 0.04). There are two main sources for infectious orbital complications from acute sinusitis: respiratory pathogens and oral flora. The high prevalence of concurrent anaerobic oral flora and VGS infection supports a suspected synergy between VGS and other oral organisms.

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.

Post-septal orbital complications of acute bacterial rhinosinusitis: Endoscopic anatomical considerations

Orbital complication of acute sinusitis is not an uncommon condition, especially in children and young adults. Many cases can be successfully managed medically with antibiotics, but if the condition has not improved or rapidly progressed, it results in catastrophic local sequelae. This study aims to analyze the possible relationship between sinonasal anatomic variation and the incidence of orbital infections complicating acute sinusitis. A management protocol amalgamating both clinical and radiological criteria is presented.The study was carried out on 240 patients suffering from acute rhino-sinusitis with 90 patients suffering from orbital post-septal complicating acute rhino-sinusitis. Eighty-five cases underwent orbital decompression, except 5 cases with orbital cellulitis; they were improved on medical treatment. Visual monitoring by the ophthalmological team on regular basis was performed, until clinical and radiological improvement of the condition. This study proves that there may be a relationship between anatomic variation and orbital infections complicating acute sinusitis or acute on top of chronic sinusitis.

Orbital Complications of Acute Sinusitis: Evaluation, Management, and Results

Introduction Even though orbital complications in acute rhinosinusitis are not very common, they can be very severe complications, with high mortality rates, due to infection spreading to orbital and intracranial tissues (1). Especially due to intracranial complications, acute rhinosinusitis is considered in the life-threatening disease group. As per Chandler et al. (2), orbital complications are classified into five groups according to the severity of complications: preseptal cellulitis, orbital cellulitis, subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis. Although orbital complications are clinically rare, they are more common in children than in adults. Orbital septum acts as a barrier that prevents the spread of inflammation from the preseptal region towards the orbital space. Along with proptosis, limitation of eye movements, and decrease in vision, the presence of redness, edema, and local temperature increase in the eyelids, i.e., infectious pathology of orbital region, suggest intraorbital propagation. Especially in the childhood period, compared to adult age groups, infections in the preseptal region that did not receive proper treatment can spread easily in the orbits and cause serious complications such as brain abscess, meningitis, and cavernous sinus thrombosis (1-4). Although antibiotic use reduces the incidence of sinus infections and complications, acute sinusitis is still the leading cause of orbital inflammation and impaired vision. Particularly after frequent upper respiratory infections during the childhood, the infection that spreads easily to the nose and sinuses sets the ground for orbital complications (4-6). In our study, accompanied by diagnosis, treatment, and follow-up symptoms of 11 patients who developed orbital complications of rhinosinusitis, treatment and follow-up algorithm of orbital complications have been revised with literature data. 131

Transnasal endoscopic treatment of orbital complications of acute sinusitis: the Graz concept.

Orbital complications of acute sinusitis can be severe. Nowadays, surgical drainage of intraorbital abscess formations is performed endoscopically in the majority of cases. This study aims to illustrate the Graz experience in the endoscopic treatment of orbital complications and to present our treatment algorithm. In a retrospective study, 53 patients were examined who were referred to the Department of General Otorhinolaryngology of the ENT-University Hospital Graz from 2000 to 2011. Of 53 patients, men were affected more frequently than women (n=37, 69.81% vs n=16, 30.19%). The following diagnoses were obtained: 9 preseptal cellulitis, 7 orbital cellulitis, 14 subperiosteal abscesses, and 23 orbital abscesses. In 16 patients, a conservative therapy was administered; 37 patients underwent surgery, most of them purely endoscopically (n=31, 83.78%). Two of the patients who underwent conservative treatment and 7 of those who underwent surgery experienced a recurrence (n=9, 16.98%). Based on analysis of our recurrences, we have tried to create the optimal treatment algorithm as a point of reference in the management of orbital complications of acute sinusitis. In this way, 7 of 9 recurrences could have been avoided, equaling a hypothetical recurrence rate of 3.77% instead of 16.98% (hypothetical success rate 96.23%).

Orbital Complications of Acute Sinusitis in Infants

Orbital infections from acute sinusitis are rare in neonates and infants and can lead to devastating complications. To our knowledge, no prior dedicated review exists for evaluation, treatment, and outcomes of orbital complications in this age group. To perform a systematic review over the past 50 years on the diagnosis and treatment of orbital complications secondary to acute sinusitis in neonates and infants and report a case. A systematic review of the literature was performed searching PubMed to collect all the pertinent case reports and series in the English language with subperiosteal orbital abscess (SPOA) or orbital abscess in neonates or infants (date range, 1959-2012). Eleven cases of SPOA in infants were identified, including our current case. Ages ranged from 10 to 74 days. There were 6 female and 5 male infants. The right eye was affected in 5 cases, the left in 5, and both in 1. There was 1 mortality in this series for which surgical drainage was not performed. Staphylococcus aureus was the most common organism isolated in 9 of 11 cases. Seven of the cases had open surgical drainage, 2 had endoscopic procedures (including our case), and 1 had spontaneous rupture of the abscess. An orbital complication due to acute sinusitis is rare in infants and neonates. Drainage in this patient population appears to be paramount, since the only infant in this series who did not receive drainage had died. Modern telescopes and equipment have allowed endoscopic drainage to be a safe and effective surgical treatment in this age group.

Prise en charge des complications oculo-orbitaires des sinusites aiguës

Describe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches. Retrospective study of 29cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012). There were 23men and 6women. The mean age was 15.75years. The average time until consultation was 7.68days. Sinusitis was ethmoido-maxillary in 20cases, ethmoidal in 6cases, and frontal in 3cases. Orbital extension was grouped according to the Chandler classification: stageI (3cases), stageII (3cases), stageIII (15cases), stageIV (8cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22cases. Bacterial cultures revealed streptococcus (2cases), aspergillus fumigatus (1case) and were negative in 8cases. The outcome was favorable in 27cases. In two cases, the outcome was unfavorable with associated intracranial complications. Oculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment.

Managment of orbital complications of sinusitis

Purpose: We reported on the clinical approaches of ophthalmology and otorhinolaryngology departments in the treatment of the orbital complications of sinusitis. We also included an in-depth literature review. Methods: We retrospectively reviewed the medical files of 51 patients from January 2008 to January 2014. The records were evaluated for age, gender, type of orbital complications, symptoms, predisposing factors, imaging studies, medical and surgical management, culture results, and follow-up information. SPSS version 15.0 software (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) was used for the statistical analysis. Results: Fifty-one patients met the criteria, with available medical records, for the study (29 male, 22 female). Thirty-two (62.7%) were diagnosed with preseptal cellulitis and 19 (37.3%) with postseptal cellulitis. After a detailed evaluation, 15 were diagnosed with a subperiosteal abscess (SPA), and 4 were diagnosed with orbital cellulitis. The age and gender was similar for the two groups. Five patients with medial SPA were treated with endoscopic sinus surgery, one patient with inferior SPA was treated with external surgery, and six patients with other localizations were treated with a combination of endoscopic sinus surgery and external surgery. All patients presented with periorbital erythema and edema. The length of hospitalization and duration of symptoms were similar in both groups. Visual acuity was between 1/10 to 10/10 (mean 7/10) and statistically significant for preseptal and postseptal cellulitis groups (p<0.001). All patients received intravenous antibiotics upon the first day of admission. Conclusion: Orbital complications of acute sinusitis required intensive follow-up and a multidisciplinary approach. A contrast-enhanced paranasal sinus computerized tomography (CT) scan can detect the extent of the infection. An initial trial of intravenosus (IV) antibiotics may be appropriate when close monitoring is possible. Surgery may be indicated when there has been no improvement within 48 hours of intravenous treatment, loss of visual acuity (under 8/10), and a non-medial abscess.

Orbital Complications of Acute Sinusitis

The widespread use of the 7-valent pneumococcal conjugate vaccine (PVC7), developed to combat invasive Streptococcus pneumoniae infections, has the potential to influence the prevalence and antibiotic resistance patterns of pathogens associated with orbital complications from acute sinusitis. Given the significant morbidity that may result from inadequate treatment of orbital infections related to acute sinusitis, determining the impact of PCV7 on the bacteriology and drug resistance of the pathogens associated with these infections may provide critical information needed to accurately guide optimal clinical management. To determine if the characteristics of orbital complications from acute sinusitis in children have changed in the post-PCV7 era. Review of clinical data. Tertiary care children's hospital. Patients with a diagnosis of orbital cellulitis and/or subperiosteal abscess from January 1, 1996, to December 31, 2009. Patients with immune deficiency or orbital trauma were excluded. Patients were divided into pre-PCV7 (before 2003 [n = 128]) and post-PCV7 (2003 and after [n = 145]) groups. Statistical analyses were used to compare the 2 groups. Differences in patient demographics, signs and symptoms, laboratory study results, computed tomography scan findings, and microbiological analyses between the pre-PCV7 and post-PCV7 groups. A total of 273 children met the inclusion criteria. The post-PCV7 group was older (71.4 months vs 88.8 months [P = .007]) than the pre-PCV7 group. A significant decrease in S pneumoniae and Streptococcus viridans -positive sinus or blood cultures were observed (22.4% vs 0% [P < .001] and 12.24% vs 0% [P = .005], respectively). An increase in Staphylococcus aureus was seen in the post-PCV7 group (20.4% vs 42.37% [P = .02]). Methicillin-resistant S aureus (MRSA) was isolated only in the post-PCV7 group (P = .002). The pre-PCV7 group had a significantly longer hospital stay than the post-PCV7 group (7.15 days vs 5.47 days [P = .004]). Although universal PCV7 vaccination has eliminated S pneumoniae as an etiologic pathogen in acute sinusitis complications in this series, there has been a parallel and significant increase in S aureus, including an increase in the prevalence of MRSA associated with orbital infections related to acute sinusitis.

Nasennebenhöhlenmetastasen eines Mammakarzinoms

With the symptom diplopia, in addition to an ocular cause, pathology of the paranasal sinuses must always be taken into consideration. A common differential diagnosis is an acute inflammatory process such as an orbital complication of acute sinusitis. We present the rare case of an initial manifestation of metastasis in the paranasal sinuses originating from a primary ductal carcinoma in situ of the breast. In our case, the metastatic manifestation and its clinical symptoms were the first sign of recurrence and transformation into invasive breast cancer.

Powikłania ostrego zapalenia zatok przynosowych u dzieci w materiale własnym

We describe children with orbital complications of acute sinusitis and analyse symptoms, diagnostic procedure and treatment options. We used X-ray and/or CT of paranasal sinuses to make diagnosis. The most frequent presenting orbital and occular symptoms are preseptal cellulitis and orbital cellulitis. Management of these children included intravenous antibiotic and we made maxillary sinus puncture with drainage. Proper recognition and treatment lead to total recovery.

Primary Care Evaluation of the Nose and Paranasal Sinuses

Primary Care Evaluation of the Nose and Paranasal Sinuses

Orbital Complications of Acute Sinusitis in Children

Purpose. Acute sinusitis with orbital complications is an ambiguous disease. Without timely diagnosis and appropriate management, it may lead to ocular squela and even become a life-threatening disease. The purpose of this study was to evaluate the clinical presentation, diagnosis, management and outcome of orbital complications of acute sinusitis in children treated at our hospital over a 10-year period. Methods. We retrospectively reviewed 23 children with orbital complications of acute sinusitis who were admitted to our hospital from January 1995 to July 2004. The clinical presentation, laboratory examination, radiological examination, bacteriology, and treatment method were analyzed. Results. The mean age of the patients was 5.0 years, and 65% of patients were younger than 5 years. The mean hospitalization was 8.0 days. Computerized tomography confirmed medial subperiosteal abscess in six children and orbital abscess in three children. Six children underwent surgical intervention. One child had the same blood and pus results: Staphylococcus haemolyticus. Neither cavernous sinus thrombosis nor intracranial infection was noted. No sequela was found in these 23 patients during a follow-up period of 1 to 2 months. Conclusions. Orbital inflammation is the most common complication of acute sinusitis in children. Computerized tomography is very useful for staging orbital inflammation and guiding surgical intervention.

Clinical analysis of orbital complications of acute sinusitis in children and adults

Objectives: The purpose of this study is to analyze the common types of orbital complication in children and adults and to compare the symptoms, prognosis, and treatment of children with those of adults. Methods: Retrospective review of patients treated for orbital complications from sinusitis at the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea, between March 1998 and July 2003 yielded 34 patiets. Symptoms, duration of treatment, treatment modality, prognosis, and CT findings were analyzed. Results: Twenty-four children were younger than 17 years and 10 were younger than 7. Preseptal cellulites were 8 (33.3%) in children and 16 (60.0%) in adults. Subperiosteal abscess were 10 (41.7%) in children and 2 (20.0%) in adults. Orbital cellulites were 6 (25.0%) in children and 2(20.0%) in adults. Lid swelling, diplopia and limit of motion were observed 24/24(100%), 4/24(16.6%), in children and 10/10(100%), 2/10(20.0%) in adults. Medical treatment was done only 17/22(70.8%) in children, 6/10(60.0%) in adults. Surgical treatment was done 7/24(29.2%) in children and 4/10(40.0%) in adults. Conclusions: Orbital complications of children are more severe than those of adults. Postseptal cellulitis type of orbital complications are much more in children than adults. Orbital complications of children can be more conservatively treated than adults.

The Groote Schuur hospital classification of the orbital complications of sinusitis.

The complications of sinusitis have been well described. The most common classifications used for orbital complications have been that of Chandler et al. (1970) and Moloney et al. (1987). With the ready availability of high-resolution computed tomography (CT) scanners, limitations of these classifications have become apparent. The aims of this study were to determine the relative frequency of the various complications associated with acute sinusitis, to determine which groups of sinuses were most frequently involved and to correlate the orbital signs with a new proposed classification of orbital complications. Over a five-year period, 87 consecutive patients were admitted with acute sinusitis. Sixty-three patients (72.4 per cent) had one or more complications. When orbital complications were classified under the proposed classification, all patients with proptosis and/or decreased eye movement had post-septal infection. Visual impairment occurred only in the post-septal group. Most complications had a combination of sinus involvement with the maxillary/ethmoid/frontal combination being the most common. The authors propose a modification of Moloney's classification for orbital complications of acute sinusitis that allows a clear differentiation between pre- and post-septal infection and a radiological differentiation to be made between cellulitis/phlegmon and abscess formation. The latter is of importance when a decision is made on whether surgical intervention is appropriate or not.

Orbital Complications of Pediatric Sinusitis: Treatment of Periorbital Abscess

Twenty-six children requiring surgical intervention for orbital complications of acute sinusitis were treated at our institutions between 1985 and 1995. Twenty patients were successfully treated surgically utilizing endoscopic/microscopic endonasal surgery, or traditional external ethmoidectomy. However, six patients failed to respond to initial surgical attempts and ultimately required a revision. In one of these six patients the development of an intracranial abscess also necessitated a craniotomy for surgical drainage. Analysis of these six failures was performed with special attention given to the reasons for initial surgical failure and possible means for preventing revision surgeries.

Minimally invasive therapy of otorhinolaryngologic emergencies in infants and children: Indications and limitations

Minimally invasive therapy of otorhinolaryngologic emergencies in infants and children was made possible by the development of improved paediatric endoscopes, telescopes and advances in anaesthetic and laser techniques. Functional endoscopic sinus surgery is a safe and efficacious therapy in children with orbital complications of acute sinusitis requiring surgery. Thus, external ethmoidectomy, which carries a serious risk of late complications like mucoceles, can be avoided. The most demanding emergency, however, is airway obstruction in infants and children. Historically, tracheotomy was the mainstay of treatment. Nowadays, various obstructing proliferations like haemangiomas, papillomas, cysts and granulomas are removed endoscopically. Selected cases of acquired laryngeal and tracheal stenosis may be managed with the CO2 laser.