2015 HSC Section 1 Book of Articles

Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2014; 78(6):923-925.

International Journal of Pediatric Otorhinolaryngology 78 (2014) 923–925

Contents lists available at ScienceDirect

International Journal of Pediatric Otorhinolaryngology

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Do you need to operate following recovery from complications of pediatric acute sinusitis? Ruchin G. Patel a , Opeyemi O. Daramola a , David Linn a , Valerie A. Flanary a , b , Robert H. Chun a , b , * a Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, United States b Division of Pediatric Otolaryngology, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Children’s Hospital of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, United States

A R T I C L E I N F O

A B S T R A C T

Article history: Received 2 January 2014 Received in revised form 7 March 2014 Accepted 7 March 2014 Available online 18 March 2014

Objectives: There are many studies that evaluate the role of surgery in the treatment of complications of pediatric acute sinusitis; however there are few studies, if any that report the incidence of surgery following recovery from acute complicated sinusitis. The goal of this study was to report the incidence and indications for surgical intervention after recovery from complications of pediatric acute sinusitis. Methods: We reviewed the records of all children admitted to a tertiary care children’s hospital between January 2005 and September 2010 with a diagnosis of sinusitis and an orbital or intracranial complication. Eighty-six patients met inclusion criteria. Charts were reviewed for type of complication, initial treatment (medical or surgical), type of procedure, secondary procedures, age, and comorbidities. Statistical analysis was completed using independent samples student t -tests and Mann–Whitney tests. Results: A total of 86 patients with a mean age of 6.38 years (2 months to 18 years) were identified. Eighty patients had orbital complications while six presented with intracranial complications. Twenty- seven patients (31%) underwent sinus surgery during the acute phase of their illness whereas 59 patients (69%) were treated medically. After hospitalization and recovery for acute complicated sinusitis, surgery was performed on nine patients (mean age 4.86 years) within 1 month to 2 years post hospitalization. Of the nine patients who required secondary surgery following resolution of the initial complicated sinusitis, four patients were following initial surgical intervention and five patients had initially resolved their complication with medical therapy alone. Indications for subsequent surgery included failure of medical therapy for persistent rhinosinusitis (8 patients) and second complication (1 patient). Conclusions: This study suggests that following resolution of complicated pediatric rhinosinusitis, very few patients may need further surgical intervention. Subsequent intervention is best guided by clinical judgment, symptoms during outpatient clinic visits, and failure of medical therapy. 2014 Elsevier Ireland Ltd. All rights reserved.

Keywords: Pediatric sinusitis Complicated sinusitis Acute sinusitis Orbital complications Intracranial complications

1. Introduction

estimated that 5–10% will go on to develop an orbital and/or intracranial complications [3,4] . Orbital complications are more common than intracranial complications and are typically due to spread from ethmoid sinusitis. These complications can be classified using the criteria devised by Chandler et al. [1,5,6] . Briefly, class I is ‘preseptal cellulitis’, class II is ‘orbital cellulitis’, class III is ‘subperiosteal abscess’, class IV is ‘orbital abscess’, and class V is ‘cavernous sinus thrombosis’ [5] . This classification system does not represent a disease spectrum with one stage progressing to the next but rather a description of increasing severity of orbital complications. Intracranial complications include meningitis, epidural abscess, subdural empyema, or cerebral abscess [1,7] .

Rhinosinusitis is one of the most common diseases in the pediatric population, accounting for nearly a quarter of all pediatric antibiotic prescriptions [1] . Given the ease at which communicable disease spread in the pediatric population, children can experience up to six to eight upper respiratory infections (URIs) per year. Up to 5% of these URIs can be complicated by acute sinusitis [2] . Most patients with acute sinusitis will recover; however it is

* Corresponding author at: 9000W Wisconsin Avenue, Milwaukee, WI 53226, United States. Tel.: +1 414 266 8383; fax: +1 414 266 2693.

http://dx.doi.org/10.1016/j.ijporl.2014.03.008 0165-5876/ 2014 Elsevier Ireland Ltd. All rights reserved.

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