2015 HSC Section 1 Book of Articles

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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
1. Introduction
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
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].
A R T I C L E I N F O
Article history:
Received 2 January 2014
Received in revised form 7 March 2014
Accepted 7 March 2014
Available online 18 March 2014
Keywords:
Pediatric sinusitis
Complicated sinusitis
Acute sinusitis
Orbital complications
Intracranial complications
A B S T R A C T
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.
* Corresponding author at: 9000W Wisconsin Avenue, Milwaukee, WI 53226,
United States. Tel.: +1 414 266 8383; fax: +1 414 266 2693.
Contents lists available at
International Journal of Pediatric Otorhinolaryngology
jour nal homepage:
0165-5876/ 2014 Elsevier Ireland Ltd. All rights reserved.
Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2014; 78(6):923-925.
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