Management of Orbital Complications of Acute Rhinosinusitis in Pediatric Patients

Abstract

Background: The major clinical dilemma managing acute rhinosinusitis (ARS) in pediatric population is distinguishing uncomplicated rhinosinusitis from a complicated bacterial ARS and orbital complications, the latter requiring antimicrobials and surgical intervention. However, factors associated with severe orbital complications and the optimum management strategy remains controversial. The objectives of this study were to characterize the clinical outcomes of children with orbital complications of ARS and to identify risk factors associated with disease severity. Methods: This retrospective cohort analysis evaluated the clinical outcomes of 61 children admitted for orbital complications between 1 st January 2002 and 31 st December 2017. Descriptive statistics were performed to examine the demographics and clinical findings. We compared groups using Mann-Whitney test for continuous variables and Chi-square for categorical variables. Results: Although two-thirds of children had received pre-hospital antibiotics, half of the cohort presented with post-septal orbital complications. While 83% of isolates obtained from the same patients were susceptible to the pre-hospital antibiotics given, the majority of those who received pre-hospital antibiotics nevertheless required surgical intervention. We observed significant association between the age of presentation and disease severity. Children older than 5 years of age presented with more severe orbital complications despite pre-hospital antibiotics and were more likely to require surgical intervention (p<0.001). Conclusion: In this study, stage II/III orbital complications at presentation and older age were the most important determinants of medical treatment failure. Early referral to ENT should be considered for children >5 years with ARS due to worse orbital complications despite pre-hospital antibiotics. * According to Chi-square test, p<0.05 ** According to Mann-Whitney U test, p<0.05

Preseptal Versus Orbital Cellulitis in Children: An Observational Study

“…Acute rhinosinusitis in the pediatric population has been described as a predisposing factor of PC and OC, which usually surfaces from a direct extension of ethmoid sinusitis. [15][16][17] We found that nonpreviously diagnosed sinusitis involving the ethmoid and maxillary sinuses was mostly associated with the risk of OC, suggesting that underdiagnosis is frequent in pediatrics. As imaging tests were performed only in a small proportion of PC patients in our series, underdiagnosis of sinusitis is probable even among patients included in this study.…”

Ophthalmological Perspective on Pediatric Ear, Nose, and Throat Infections

“…In [35]. While various prevalence rates have been reported, preseptal cellulitis is the most common orbital complication [48][49][50]. Such patients are expected to have palpebral edema, periocular erythema, and increased temperature and pain.…”

Metagenomic sequencing provides evidence of the nasal microbiota’s influence on idiopathic orbital myositis: a case control study

“…In patients with acute rhinosinusitis, orbital involvment accounts for approximately 95% of cases with complications [2]. Systemic antibiotic therapy, along with surgical removable of pathologic tissues, are considered as effective treatments [3]. Apart from infection, the cases with no known causative pathogens are referred to as idiopathic orbital myositis (IOM), and the autoimmune system plays a key role during IOM pathogenesis.…”