Predictors of Surgical Intervention for Pediatric Acute Rhinosinusitis with Periorbital Infection

Abstract

Background: Medical versus surgical management of pediatric periorbital infection secondary to acute bacterial rhinosinusitis (ABRS) can be a dilemma for clinicians. This study aimed to evaluate the prognostic factors related to the need for surgical drainage and to help direct management decisions. Methods: Children admitted for periorbital infection secondary to ABRS between 2001 and 2019 were retrospectively reviewed. Demographics, clinical presentations, laboratory data, comorbidities, and computed tomography results were collected from medical records. Results: A total of 141 pediatric patients were enrolled. Forty-two patients (29.8%) required surgical intervention. Multivariate logistic regression analysis identified that delayed initiation of intravenous antibiotics from the onset of periorbital swelling (odds ratio [OR] = 1.94; p < 0.001) and proptosis at initial presentation (OR = 6.63; p = 0.008) were significantly associated with the need for surgical intervention. A C-reactive protein value of > 55.73 mg/L and initiation of intravenous antibiotic treatment > 2 days from the onset of periorbital swelling showed the best predictive power for surgery. Conclusion: Pediatric patients with delayed initiation of intravenous antibiotic treatment and initial presentation of proptosis had worse outcomes and required surgical intervention.

Clinical Characteristics of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps in Adolescents

“…21 Type 2 inflammation tends to involve the central part of the sinonasal area, including the nasal septum, olfactory cleft, middle turbinates, and ethmoid cells. 31,32 The mechanism responsible for the predominance of ethmoid sinus inflammation in patients with type 2 CRS remains unclear. One possible explanation is that there are regional differences in the expression patterns of type 2 eosinophilic inflammatory molecules in the nasal cavity.…”

Management of complicated acute sinusitis in the setting of concurrent COVID-19

“…This series found that half of patients with COVID-19 and complicated acute sinusitis ultimately required surgical intervention, despite early initiation of antibiotic regimens. This represents an increased need for surgery as opposed to pediatric patients with complicated acute sinusitis before the start of the COVID-19 pandemic [12] . In these cases, COVID-19 precautions may have delayed surgical intervention that was ultimately necessary to manage the patients' complicated sinusitis.…”