Evaluation of Clinical and Laboratory Findings of Sinusitis Complications in Children

Abstract

Objective This retrospective study evaluates the demographic characteristics, clinical symptoms, laboratory results, treatment approaches, and outcomes of children with complications arising from bacterial sinusitis.

Methods Fifty-four pediatric inpatients with sinusitis complications admitted between September 2013 and October 2022 were included in the study. These patients were categorized into two groups: those with preseptal cellulitis (group 1) and those with orbital–intracranial complications (group 2).

Results The median age of the patients was 10.8 years, and 61.1% were males. Maxillary sinusitis (n = 40.74%) was the most common type of sinus involvement. Half of the patients exhibited preseptal cellulitis. The median age of our patients with intracranial complications was 13.7 years, while the median age of patients with orbital complications was 8 years. The predominant orbital–intracranial complication was meningitis, which accounted for 41% of the cases. All patients with a subdural abscess (n = 6) presented with frontal sinusitis, while all cases of cavernous sinus thrombosis (n = 3) involved the sphenoidal sinus. Surgical intervention was undertaken in 37% of cases. Streptococcus pneumoniae was the most frequently isolated microorganism. The median duration of hospital stay was 14 days, with a total median treatment duration of 21 days. There were no fatalities, although neurological sequelae were observed in 7.4% of patients (n = 4).

Conclusion Preseptal cellulitis and meningitis remain the most common complications of sinusitis in children. Adolescents with sinusitis should be monitored closely for intracranial complications. The prevalence of S. pneumoniae as the most frequently detected pathogen underscores the importance of vaccination.

Keywords

sinusitis - cellulitis - meningitis - orbital abscess

Note

This article was produced from the specialty thesis titled “Evaluation of Clinical and Laboratory Findings of Sinusitis Complications in Children.” The thesis was written by Arife Melike Bulut Karakuş under the consultancy of Gülsüm Alkan.

Publication History

Received: 24 May 2024

Accepted: 26 September 2024

Article published online:
04 November 2024

• References

• 1 DeMuri GP, Gern JE, Moyer SC, Lindstrom MJ, Lynch SV, Wald ER. Clinical features, virus identification, and sinusitis as a complication of upper respiratory tract illness in children ages 4-7 years. J Pediatr 2016; 171: 133-9.e1
• 2 Chow AW, Benninger MS, Brook I. et al; Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54 (08) e72-e112
• 3 Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clin Proc 2011; 86 (05) 427-443
• 4 Mulvey CL, Kiell EP, Rizzi MD, Buzi A. The microbiology of complicated acute sinusitis among pediatric patients: a case series. Otolaryngol Head Neck Surg 2019; 160 (04) 712-719
• 5 Aring AM, Chan MM. Current concepts in adult acute sinusitis. Am Fam Physician 2016; 94 (02) 97-105
• 6 Knipping S, Hirt J, Hirt R. Management of orbital complications. Laryngorhinootologie 2015; 94 (12) 819-826
• 7 Hytönen M, Atula T, Pitkäranta A. Complications of acute sinusitis in children. Acta Otolaryngol 2000; 120 (545) 154-157
• 8 Gümüşsoy M, Uğur Ö, Arslan İB, Çukurova İ. Orbital complications of acute sinusitis: evaluation, management, and results. Turk Arch Otolaryngol 2014; 52: 131-138
• 9 Wolf G, Anderhuber W, Kuhn F. Development of the paranasal sinuses in children: implications for paranasal sinus surgery. Ann Otol Rhinol Laryngol 1993; 102 (09) 705-711
• 10 Bedwell J, Bauman NM. Management of pediatric orbital cellulitis and abscess. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (06) 467-473
• 11 Milinis K, Thompson N, Atsmoni SC, Sharma SD. Sinogenic intracranial suppuration in children: systematic review and meta-analysis. Otolaryngol Head Neck Surg 2022; 167 (02) 215-223
• 12 Younis RT, Anand VK, Childress C. Sinusitis complicated by meningitis: current management. Laryngoscope 2001; 111 (08) 1338-1342
• 13 Lazar R, Periera K, Younis R. Sinusitis and complications of sinusitis. In: de Souz C, Stankiewicz J, Pelliteri P. eds. Textbook of Pediatric Otorhinolaryngology-Head and Neck Surgery. San Diego, CA: Singular Publishing; 1999: 357-359
• 14 Bhat M, Vaidyanathan V, Vishak S, Pinto G. Spectrum of complications in sinusitis. Muller J Med Sci Res 2013; 4 (01) 34-38
• 15 Sultész M, Csákányi Z, Majoros T, Farkas Z, Katona G. Acute bacterial rhinosinusitis and its complications in our pediatric otolaryngological department between 1997 and 2006. Int J Pediatr Otorhinolaryngol 2009; 73 (11) 1507-1512
• 16 Tshifularo M, Monama G. Complications of inflammatory sinusitis in children: institutional review. S Afr Fam Pract 2006; 48 (10) 16
• 17 Ryan JT, Preciado DA, Bauman N. et al. Management of pediatric orbital cellulitis in patients with radiographic findings of subperiosteal abscess. Otolaryngol Head Neck Surg 2009; 140 (06) 907-911
• 18 Asrak HK, Ozlu C, Erbaş İC. et al. Complications of acute bacterial rhinosinusitis in children: a single tertiary care center. J Pediatr Infect 2022; 16 (03) E179-E188
• 19 Chang YS, Chen PL, Hung JH. et al. Orbital complications of paranasal sinusitis in Taiwan, 1988 through 2015: Acute ophthalmological manifestations, diagnosis, and management. PLoS One 2017; 12 (10) e0184477
• 20 Germiller JA, Monin DL, Sparano AM, Tom LWC. Intracranial complications of sinusitis in children and adolescents and their outcomes. Arch Otolaryngol Head Neck Surg 2006; 132 (09) 969-976
• 21 Kombogiorgas D, Seth R, Athwal R, Modha J, Singh J. Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. Br J Neurosurg 2007; 21 (06) 603-609
• 22 Pucher B, Prauzińska M, Kotowski M. et al. Orbital complications of acute rhinosinusitis in children: a retrospective review of 33 patients. Family Med Primary Care Rev 2018; 20 (03) 259-262
• 23 Lizé F, Verillaud B, Vironneau P. et al. Septic cavernous sinus thrombosis secondary to acute bacterial sinusitis: a retrospective study of seven cases. Am J Rhinol Allergy 2015; 29 (01) e7-e12
• 24 Otto WR, Paden WZ, Connors M. et al. Suppurative intracranial complications of pediatric sinusitis: a single-center experience. J Pediatric Infect Dis Soc 2021; 10 (03) 309-316
• 25 Blin P, Blazejewski S, Lignot S. et al. Effectiveness of antibiotics for acute sinusitis in real-life medical practice. Br J Clin Pharmacol 2010; 70 (03) 418-428
• 26 Lee S, Yen MT. Management of preseptal and orbital cellulitis. Saudi J Ophthalmol 2011; 25 (01) 21-29
• 27 Çayır S, Kayabaşı S. An approach to orbital complications in sinusitis. ENT Updates 2019; 9 (03) 180-184
• 28 Patel NA, Garber D, Hu S, Kamat A. Systematic review and case report: Intracranial complications of pediatric sinusitis. Int J Pediatr Otorhinolaryngol 2016; 86: 200-212