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Cress VJ, Green KJ, Jain A, Viaud-Murat EM, Patel PA, Wiedermann JP. A Scoping Review of the Intracranial Complications of Pediatric Sinusitis. Otolaryngol Head Neck Surg 2024; 171:937-945. [PMID: 38895865 DOI: 10.1002/ohn.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/25/2024] [Accepted: 04/19/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Intracranial complications of pediatric sinusitis are uncommon but are often associated with significant morbidity, especially when appropriate care is delayed. The present study aimed to identify commonalities for the development and progression of these complications in the pediatric population. DATA SOURCES CENTRAL, CINAHL, Citation searching, ClinicalTrials.gov, Embase, Google Scholar, MEDLINE, PsycINFO, PubMed, Scopus, Web of Science, and World Health Organization. REVIEW METHODS A comprehensive literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses scoping review guidelines. Studies describing intracranial infections secondary to sinusitis in the pediatric population (age <18 years) were included. Studies in which adult and pediatric data were not separated and studies in which the pediatric cohort was fewer than 10 cases were excluded. Ultimately, 33 studies describing 1149 unique patient cases were included for data collection and analysis. RESULTS Our analysis revealed intracranial complications were more common in adolescent males. Most children presented with over 1 week of vague symptoms, such as headache and fever. The majority of complications were diagnosed radiographically with computed tomography. Subdural empyema and epidural abscess were the most common intracranial complications reported. On average, patients were admitted for over 2 weeks. Most children were treated with a combination of antibiotics and surgical intervention. Complications were rare, but when present, were often associated with significant morbidity. CONCLUSION This scoping review of the available literature has provided insight into commonalities among pediatric patients who develop intracranial complications of sinusitis, providing a foundation for further study to inform medical and surgical decision-making in this population.
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Affiliation(s)
- Victoria J Cress
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katerina J Green
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amiti Jain
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Punam A Patel
- Department of Pediatric Otolaryngology, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Joshua P Wiedermann
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatric Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Raineau M, Crowe AM, Beccaria K, Luscan R, Simon F, Roux CJ, Ferroni A, Kossorotoff M, Harroche A, Castelle M, Gatbois E, Bourgeois M, Roy M, Blanot S. Pediatric intracranial empyema complicating otogenic and sinogenic infection. Int J Pediatr Otorhinolaryngol 2024; 177:111860. [PMID: 38224655 DOI: 10.1016/j.ijporl.2024.111860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To describe and compare clinical and microbiological features, surgical and medical management, and outcomes of children with otogenic and sinogenic intracranial empyema (IE) in an institution with an established multidisciplinary protocol. To use the study findings to inform and update the institutional algorithm. METHODS Retrospective analysis was carried out on the electronic healthcare records of all children with oto-sinogenic IE admitted in a 5-year period. RESULTS A total of 76 patients were identified and treated according to an institutional protocol. Two distinct groups were identified: intracranial empyema related to otogenic infection (OI-IE, n = 36) or sinogenic infection (SI-IE, n = 40). SI-IE was seen in older children and had a significantly higher morbidity. Sub-dural IE was seen in a minority (n = 16) and only in SI-IE and required urgent collaborative ENT-neurosurgery. Extra-dural IE occurred more frequently and was seen in both SI-IE and OI-IE. No death and overall low morbidity were observed. Particularities found in SI-IE and OI-IE groups (as thrombosis, microbiology, antibiotic treatment, duration and outcome) permitted the delineation of these groups in our updated algorithm. CONCLUSION The presence of a collaborative multidisciplinary protocol permits the step-wise co-ordination of care for these complex patients in our institution. All patients received prompt imaging, urgent surgical intervention, and antibiotic treatment. Microbiological identification was possible for each patient and antibiotic rationalization was permitted through use of Polymerase chain reaction (PCR) testing in cases of sterile cultures. Of note, intracranial empyema related to sinogenic infection is shown to have significantly more severe clinical presentation, a higher morbidity, and a longer duration of antibiotic therapy than that related to otogenic infection. Study findings allowed for the update and clarification of the institutional protocol, which now clearly demarcates the clinical presentation, biological evidence, radiology, surgical and medical treatments in children with oto-sinogenic IE.
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Affiliation(s)
- Mégane Raineau
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Ann-Marie Crowe
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Kevin Beccaria
- Pediatric Neurosurgery Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Romain Luscan
- Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Francois Simon
- Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Charles-Joris Roux
- Pediatric Radiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Agnès Ferroni
- Clinical Microbiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Annie Harroche
- Clinical Hematology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Martin Castelle
- Pediatric Immunology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Edith Gatbois
- Hospitalization at Home Department, Assistance Publique des Hôpitaux de Paris, Hôpital Armand Trousseau - Sorbonne Université, Paris, France.
| | - Marie Bourgeois
- Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Mickaela Roy
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Stéphane Blanot
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
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3
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Milinis K, Thiagarajan J, Leong S, De S, Sinha A, Sharma R, Sharma S. Review of management practices of sinogenic intracranial abscesses in children. J Laryngol Otol 2023; 137:1135-1140. [PMID: 36751894 DOI: 10.1017/s0022215123000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the management practices and outcomes in children with sinogenic intracranial suppuration. METHOD This was a retrospective cohort study in a single paediatric tertiary unit that included patients younger than 18 years with radiologically confirmed intracranial abscess, including subdural empyema and epidural or intraparenchymal abscess secondary to sinusitis. Main outcomes studied were rate of return to the operating theatre, length of hospital stay, death in less than 90 days and neurological disability at 6 months. RESULTS A cohort of 39 consecutive patients presenting between 2000 and 2020 were eligible for inclusion. Subdural empyema was the most common intracranial complication followed by extradural abscess and intraparenchymal abscess. Mean length of hospital stay was 42 days. Sixteen patients were managed with combined ENT and neurosurgical interventions, 15 patients underwent ENT procedures alone and 4 patients had only neurosurgical drainage. Four patients initially underwent non-operative management. The rates of return to the operating theatre, neurological deficits and 90-day mortality were 19, 9 and 3, respectively, and were comparable across the 4 treatment arms. In the univariate logistic regression, only the size of an intracranial abscess was found be associated with an increased likelihood of return to the operating theatre, whereas combined ENT and neurosurgical intervention did not result in improved outcomes. CONCLUSION Sinogenic intracranial abscesses are associated with significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.
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Affiliation(s)
- K Milinis
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - J Thiagarajan
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | - S Leong
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S De
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - A Sinha
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - R Sharma
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - S Sharma
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
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4
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Raguso G, Cornale N, Rebelo R, Molteni G. Pediatric Sinogenic Subdural Empyema: Case Report and Operative Technique. Indian J Otolaryngol Head Neck Surg 2023; 75:2460-2466. [PMID: 37636655 PMCID: PMC10447687 DOI: 10.1007/s12070-023-03754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 08/29/2023] Open
Abstract
Intracranial complications of sinusitis in the pediatric age are rare but potentially life threatening. They usually occur with nonspecific symptoms such as headache, fever, nausea and vomiting rather than a classic neurological presentation, but they may evolve in few hours, leading to significant morbidity with permanent brain damage and sometimes to death. For this reason, early diagnosis and prompt treatment are essential. Our case demonstrates a sinogenic subdural empyema in an immunocompetent young boy who reached our Emergency Department due to a continuous right-sided headache, unresponsive to pain relievers. The clinical history and the diagnostic process are described: at first, laboratory exams, neurologic and otolaryngological assessment were performed, together with a cranial CT scan showing an inflammatory involvement of the right frontal, ethmoidal and maxillary sinuses. Intravenous antibiotic therapy was initiated. After a few hours the patient showed a sudden worsening of his clinical conditions: he was drowsy with left lower extremity hyposthenia and ipsilateral deep tendon reflexes absence. Considering the patient's aggravated clinical presentation an emergent MRI with contrast enhancement was conducted, showing left midline shift, a widening of the liquor space on the right frontal and parietal convexity and noticeable meningeal enhancement after contrast injection. After a Neurosurgical and ENT evaluation the patient was taken to the operating room for a combined craniotomy and trans-nasal endoscopic drainage of the empyema. We present the surgical procedure with a pictorial step-by-step description. After the surgical procedure the patient's condition gradually improved. He regained full neurological function, was accompanied by a rehabilitation team on recovering full force on the left extremities. At discharge the patient had no apparent neurological deficits. Subdural empyema is a rare but severe complication of pediatric sinusitis. Early diagnosis with combined medical and surgical therapies play a key role to reduce morbidity and mortality.
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Affiliation(s)
- Giuseppe Raguso
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, VR Italy
| | - Nicola Cornale
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, VR Italy
| | - Rita Rebelo
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, VR Italy
| | - Gabriele Molteni
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, VR Italy
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Adil E, Kim JJ, Kawai K, Cunningham MJ. Management of Intracranial Sinusitis Complications in Children and Adolescents: Similarities and Differences Among Otolaryngology Subspecialists. OTO Open 2022; 6:2473974X221120635. [PMID: 36032987 PMCID: PMC9400408 DOI: 10.1177/2473974x221120635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to compare the management of intracranial sinusitis complications in pediatric patients between members of the American Rhinologic Society (ARS) and the American Society of Pediatric Otolaryngology (ASPO). A cross-sectional web-based survey was distributed twice to the ASPO and ARS membership over an 8-month period. The overall survey response rate was 12.1% (7.5% of ARS members and 17.3% of ASPO members). Recommended management was similar with respect to the use of intravenous antibiotics, nasal saline irrigations, topical decongestants, and nasal steroid sprays. Recommendations diverged with regards to systemic steroid use and urgent/emergent endoscopic sinus surgery (ESS). ARS members were more likely to recommend systemic corticosteroids. ASPO members were more likely to recommend immediate ESS. Based on survey responses, we found differences in practice patterns among subspecialists, which indicates additional collaborative research between societies is necessary to develop and disseminate evidence-based guidelines for these patients. Level of Evidence: 4
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Affiliation(s)
- Eelam Adil
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology and Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie J. Kim
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kosuke Kawai
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology and Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J. Cunningham
- Department of Otolaryngology & Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology and Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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6
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Sexton GP, Nae A, Cleere EF, O'Riordan I, O'Neill JP, Lacy PD, Amin M, Colreavy M, Caird J, Crimmins D. Concurrent management of suppurative intracranial complications of sinusitis and acute otitis media in children. Int J Pediatr Otorhinolaryngol 2022; 156:111093. [PMID: 35272257 DOI: 10.1016/j.ijporl.2022.111093] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/02/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Intracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications, concurrent neurosurgical and otolaryngological (ORL) intervention has been recommended to optimize outcomes. The aim of this study was to investigate outcomes following concurrent neurosurgical and ORL intervention. METHODS A retrospective cohort study of children undergoing neurosurgical intervention for intracranial complications of sinusitis or AOM in two neurosurgical centres in Ireland was conducted. RESULTS 65 children were identified. Mean age was 11.9 years. The most prevalent symptoms were headache, pyrexia, altered level of consciousness, facial swelling, and vomiting. Subdural empyema (n = 24, 36.9%) and extradural abscess (n = 17, 26.2%) were the most common complications. 54 underwent same admission ORL intervention; 47 (87%) were performed concurrently or earlier. For rhinogenic infections, 35 (64.8%) underwent endoscopic sinus surgery (ESS), 13 (24.1%) underwent frontal sinus trephine, and 5 (9.3%) underwent maxillary sinus washout alone. For otogenic infections, 10 (90.9%) underwent mastoidectomy and 7 (63.6%) underwent tympanostomy tube placement. 19 (29.2%) had post-operative neurological deficits, of which 2 (3.1%) were permanent. Streptococcus intermedius was the most common pathogen (n = 30, 46.2%). Concurrent intervention reduced the prevalence of residual collection (p = 0.018) and the need for revision neurosurgical intervention (p = 0.039) for sinogenic complications. The same trends did not achieve statistical significance for the otogenic group. Mortality was 0%. CONCLUSION Intracranial complications of sinusitis and AOM are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. ESS is the ORL modality of choice in experienced hands.
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Affiliation(s)
- G P Sexton
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland.
| | - A Nae
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland
| | - E F Cleere
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland
| | - I O'Riordan
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland
| | - J P O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland
| | - P D Lacy
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland
| | - M Amin
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland
| | - M Colreavy
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland; University College Dublin School of Medicine, Ireland
| | - J Caird
- University College Dublin School of Medicine, Ireland; Department of Neurosurgery, Beaumont Hospital, Ireland
| | - D Crimmins
- University College Dublin School of Medicine, Ireland; Department of Neurosurgery, Beaumont Hospital, Ireland
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7
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Milinis K, Thompson N, Atsmoni SC, Sharma SD. Sinogenic Intracranial Suppuration in Children: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2021; 167:215-223. [PMID: 34491863 DOI: 10.1177/01945998211043847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate temporal trends in the management of sinogenic intracranial suppuration and its outcomes in children. DATA SOURCES A systematic search of databases was performed (Medline, Embase, Cochrane, ClinicalTrials.gov). REVIEW METHODS Studies in children (age <18 years) with sinogenic subdural empyema, extradural abscess, and intraparenchymal abscess were included. Data on treatment strategies were extracted. Primary outcome was death <90 days. Secondary outcomes were return to theater, neurologic disability at 6 months, and length of stay. Random effects meta-analysis and meta-regression were performed to investigate the effect of time and endoscopic sinus surgery (ESS) on these outcomes. RESULTS A total of 32 retrospective observational studies involving 533 patients recruited across a 45-year period (1975-2020) were included. The pooled estimates for 90-day mortality, permanent neurologic disability, and return to theater were 2.3% (95% CI, 1.1%-3.6%; I2 = 0, P > .99), 21.3% (95% CI, 15.3%-27.3%; I2 = 75.2%, P < .001), and 37.3% (95% CI, 29.5%-45%; I2 = 71.2%, P < .001), respectively, with no significant differences found across the study period. The pooled estimate for ESS was 58.4% (95% CI, 44.2%-72.6%; I2 = 97.1%, P < .001) with a significantly increasing trend in its use in the more recent years. ESS was not associated with improved mortality, reduced need for revision surgery, or neurologic disability. CONCLUSION The outcomes of sinogenic intracranial complications have not changed over the last 45 years, and ESS was not associated with improved patient outcomes. Further high-quality studies are required to determine the most appropriate treatment modalities to improve the burden of morbidity associated with sinogenic intracranial suppuration in children.
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8
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Gillard DM, Cai Y, Rothey PK, Coleman N, Virbalas JM, Czechowicz JA, Weinstein JE. Efficacy of endoscopic sinus surgery alone versus in combination with neurosurgical intervention for the treatment of pediatric subdural empyema. Int J Pediatr Otorhinolaryngol 2021; 148:110836. [PMID: 34271525 DOI: 10.1016/j.ijporl.2021.110836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/22/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare treatment outcomes for sinogenic subdural empyema (SE) between those managed with initial endoscopic sinus surgery (ESS) alone versus those treated with a combination of ESS and craniotomy over the last decade at our institution. To better characterize subdural empyema with regard to presentation, causative pathogens, and treatment course. METHODS Retrospective single-center chart review to identify and evaluate pediatric SE patients between 2009 and 2019. Patients meeting inclusion criteria were classified in one of two groups: those who initially underwent ESS or frontal trephination without concurrent neurosurgical procedure and those who underwent craniotomy or burr hole in addition to a sinus procedure. Presenting characteristics and treatment outcomes were compared between the two groups. RESULTS Eighteen patients met inclusion criteria. The ESS alone and the ESS + craniotomy subgroups each had 9 patients with similar baseline characteristics. The ESS + craniotomy group was more likely to present with neurological symptoms (p = 0.039) and have multiple intracranial fluid collections (p = 0.046). 74.1% of patients presented to the Emergency Department (ED) or to their primary medical doctor and were treated with outpatient management prior to hospitalization with definitive surgical management. The most common presenting symptoms were fever, headache and nausea/vomiting. There were no differences between treatment groups in rate of return to the operating room (OR) (p = 1.00), length of stay (LOS) (p = 0.553), or adverse neurological outcomes (p = 0.456). 44.4% of patients in the ESS alone group eventually required neurosurgical intervention. CONCLUSIONS Surgical SE patients often present to medical professionals in the primary care setting or ED and are managed with outpatient treatment before admission with definitive treatment. In this small retrospective cohort patients who underwent sinus intervention alone had similar rates of return to OR, LOS and adverse neurological outcomes use as those who underwent a sinus procedure in coordination with a neurosurgical intervention. There may be a group of patients with SE who may be managed with endoscopic procedures alone and further studies should seek to determine the characteristics of this population.
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Affiliation(s)
- Danielle M Gillard
- Department of Otolaryngology- Head and Neck Surgery, University of California San Francisco, San Francisco CA, USA.
| | - Yi Cai
- Department of Otolaryngology- Head and Neck Surgery, University of California San Francisco, San Francisco CA, USA
| | - Pinar Karakas Rothey
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Nicolaus Coleman
- Department of General Surgery, University of Arizona, Tuscon, AZ, USA
| | - Jordan M Virbalas
- Department of Otolaryngology- Head and Neck Surgery, University of California San Francisco, San Francisco CA, USA
| | - Josephine A Czechowicz
- Department of Otolaryngology- Head and Neck Surgery, University of California San Francisco, San Francisco CA, USA
| | - Jacqueline E Weinstein
- Department of Otolaryngology- Head and Neck Surgery, University of California San Francisco, San Francisco CA, USA
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9
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May S, Outrey J, Desmettre T. Aggravation d’une sinusite en empyème sous-dural. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Chorney SR, Buzi A, Rizzi MD. Frontal Sinus Drainage in Acute Pediatric Sinusitis With Intracranial Complications. Am J Rhinol Allergy 2021; 35:732-738. [PMID: 33517674 DOI: 10.1177/1945892421991311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The indication for frontal sinus drainage is uncertain when managing pediatric acute sinusitis with intracranial complications. OBJECTIVE The primary objective was to determine if addressing the frontal sinus reduced need for subsequent surgical procedures in children presenting with acute sinusitis complicated by intracranial abscess. METHODS A case series with chart review was performed at a tertiary children's hospital between 2007 and 2019. Children under 18 years of age requiring surgery for complicated acute sinusitis that included the frontal sinus with noncontiguous intracranial abscess were included. Outcomes were compared among children for whom the frontal sinus was drained endoscopically, opened intracranially, or left undrained. RESULTS Thirty-five children with a mean age of 11.1 years (95% CI: 9.9-12.3) met inclusion. Most presented with epidural abscess (37%). Hospitalizations lasted 12.9 days (95% CI: 10.2-15.5), 46% required a second surgery, 11% required three or more surgeries, and 31% were readmitted within 60 days. Initial surgery for 29% included endoscopic frontal sinusotomy, 34% had a frontal sinus cranialization and 37% did not have any initial drainage of the frontal sinus. Groups were similar with respect to demographics, severity of infection, need for repeat surgery, length of stay, and readmissions (p > .05). Further, persistence of cranial neuropathies, seizures, or major neurological sequelae after discharge were no different among groups (p > .05). CONCLUSION Drainage of the frontal sinus, when technically feasible, was not associated with reduced surgical procedures or increased complications and there is unclear benefit on measured clinical outcomes.
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Affiliation(s)
- Stephen R Chorney
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas
| | - Adva Buzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark D Rizzi
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Yun J, McDowell MM, Gardner PA, Zenonos GA. Endoscopic Evacuation of a Panhemispheric Subdural Empyema. World Neurosurg 2020; 144:106-111. [PMID: 32889178 DOI: 10.1016/j.wneu.2020.08.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Subdural empyema (SDE) is a well-known entity in pediatric populations and is associated with a high rate of morbidity and mortality. Large scale evacuation of empyema, although effective, places the bone flap at risk of failure when replaced. CASE DESCRIPTION We report the case of a 19-year-old man with a history of a shunted left middle fossa cyst presenting with a panhemispheric SDE after removal of his cystoperitoneal shunt by an outside facility. Extensive evacuation was performed via the patients prior parietal shunt incision after expansion of the preexisting burr hole. Cultures grew methicillin-sensitive Staphylococcus aureus and Propionibacterium acnes, and he was treated with long-term antibiotics. The patient had a complete recovery with persistent empyema resolution on 6-month follow-up. CONCLUSIONS Endoscopic-assisted burr hole evacuation of large panhemispheric and loculated SDE is feasible, effective, and safe. The primary advantage over conventional open evacuations is that it negates the need for a bone flap and its potential complications related to a secondary infection.
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Affiliation(s)
- Jonathan Yun
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael M McDowell
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Georgios A Zenonos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Uyttebroek S, Poelmans M, Casteels I, De Vleeschouwer S, Vermeulen F, Jorissen M, Van Gerven L. How to approach complications of acute rhinosinusitis in children? Int J Pediatr Otorhinolaryngol 2020; 136:110155. [PMID: 32738622 DOI: 10.1016/j.ijporl.2020.110155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
Intraorbital and intracranial complications of acute rhinosinusitis (ARS) are uncommon, but potentially life threatening. Signs of progression of ARS should be recognized early to allow timely surgical treatment in order to avoid irreversible lesions such as vision loss and neurological deficits. In this case series, we provide an overview of 6 representative cases who presented at our tertiary center (2017-2018). The aim of this case series is (1) to draw new attention to the clinical manifestations and management of these complications, since even in highly-developed medical settings we still observe permanent sequellae due to delayed or inadequate treatment, (2) to give an updated analysis of the guidelines, stressing the low threshold for endoscopic sinus surgery, even in children, (3) to underline the benefits of a multidisciplinary approach in these young patients.
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Affiliation(s)
- Saartje Uyttebroek
- Clinical Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - Michelle Poelmans
- Clinical Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - Ingele Casteels
- Clinical Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | - François Vermeulen
- Clinical Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Mark Jorissen
- Clinical Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - Laura Van Gerven
- Clinical Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.
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Abstract
PURPOSE OF REVIEW The purposes of the review are as follows: (1) to define acute rhinosinusitis (ARS) and their phenotypes, (2) to highlight the ARS management according to international guidelines, (3) to compare the physicians' management with the ARS guideline recommendations, and (4) to report ARS socioeconomic burden. RECENT FINDINGS Bacterial and non-bacterial ARS have similar symptoms, although they can be discriminated by using a combination of specific signs and symptoms. The prescription of antibiotics should be limited to clearly suspected bacterial ARS. There is an overuse of diagnosis tools and treatment prescriptions. The total cost per ARS episode in Europe is over €1000. ARS is mainly an inflammatory disease triggered by viral infection, and few cases end up developing bacterial infection. In most of the cases, it is a self-resolving disease which diagnosis is mainly clinical and the treatment symptomatic. The incidence of complications is low and independent of antibiotic use. There is a high socioeconomic burden associated to ARS.
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Affiliation(s)
- Francesca Jaume
- Servei d'Otorrinolaringologia, Hospital Comarcal d'Inca, Carretera Vella de Llubí, 07300, Inca, Illes Balears, Spain.
| | - Meritxell Valls-Mateus
- Servei d'Otorrinolaringologia, Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
- Immunoal.lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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Treatment of pediatric extra-axial sinogenic infection: case series and literature review. Childs Nerv Syst 2020; 36:755-766. [PMID: 31773238 DOI: 10.1007/s00381-019-04378-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Analyze the clinical presentation, microbiology, outcomes, and medical and surgical treatment strategies of intracranial extension of sinogenic infection in pediatric patients. METHODS A retrospective, single-center study of patients < 18 years of age, presenting with intracranial extension of bacterial sinogenic infections requiring surgical intervention over a 5-year period, was conducted. Electronic medical records were reviewed for age, sex, primary symptoms, duration of symptoms, presence of sinusitis at initial presentation, microorganisms isolated, mode of surgery, timing of surgery, length of stay, and neurologic sequelae. RESULTS Seventeen patients were identified; mean age was 10 years with 82.3% male predominance. Average duration of illness prior to presentation was 9.8 days, with 64.7% of patients displaying disease progression while on oral antibiotics prior to presentation. Sinusitis and intracranial extension were present in all patients upon admission. Simultaneous endoscopic endonasal drainage and craniotomy were performed on 70.5% of the patients, with the remaining 29.5% undergoing endonasal drainage only. Of the patients who underwent simultaneous endoscopic endonasal drainage and craniotomy, 17.6% required repeat craniotomy and 5.8% required repeat sinus surgery. The most commonly isolated organisms were S. intermedius (52.9%), S. anginosus (23.5%), and S. pyogenes (17.6%). All patients were treated postoperatively antibiotic on average 4-6 weeks. Frequently occurring long-lasting complications included seizures (29.4%) and focal motor deficits (17.6%); learning disability, anxiety disorders, impaired cognition, and sensory deficits occurred less frequently. CONCLUSION In the case of intracranial extension of bacterial sinogenic infection, early identification and surgical treatment are crucial to avoid neurological sequelae.
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Din-Lovinescu C, Mir G, Blanco C, Zhao K, Mazzoni T, Fried A, El Khashab M, Lin G. Intracranial complications of pediatric rhinosinusitis: Identifying risk factors and interventions affecting length of hospitalization. Int J Pediatr Otorhinolaryngol 2020; 131:109841. [PMID: 31901485 DOI: 10.1016/j.ijporl.2019.109841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify risk factors and interventions affecting length of hospitalization (LOH) and clinical outcome in children with intracranial complications of rhinosinusitis. METHODS Retrospective chart review of 12 children hospitalized at 2 academic medical centers for intracranial complications of rhinosinusitis over the past 5 years. RESULTS 12 patients were identified with an average age at presentation of 13 years old. 92% were male and 75% were African American. The most common presenting symptoms were fever and headache. Localizing neurological symptoms including hemiparesis and aphasia, in addition to seizures occurred in 33% of patients and increased LOH significantly (33 versus 15 days, p = 0.03). Epidural (EA) and subdural abscesses (SA) were the most common intracranial complications. 58% of patients were initially treated with a combination of open neurosurgical (ON) intervention and endoscopic sinus surgery (ESS) and LOH was significantly shorter for these patients compared to those treated otherwise (14 versus 31 days, p = 0.02). Streptococcus species were the most common group of bacteria identified in 75% of cases, with S. anginosus accounting for 42% of cases. The overall average LOH was 21 days with 92% of patients having complete resolution of symptoms by time of discharge. CONCLUSIONS Treatment of intracranial complications of acute rhinosinusitis can have favorable outcomes after appropriate surgical management. Localizing neurologic symptoms and seizures portend longer hospital stay and recovery time. Shorter hospital stay was seen in those undergoing early combined ON and ESS interventions.
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Affiliation(s)
- Corina Din-Lovinescu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Ghayoour Mir
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Conor Blanco
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kevin Zhao
- Department of Neurosurgery, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Thomas Mazzoni
- Department of Otolaryngology-Head and Neck Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Arno Fried
- Department of Neurosurgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Mostafa El Khashab
- Department of Neurosurgery, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Giant Lin
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology-Head and Neck Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
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16
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Levy DA, Pecha PP, Nguyen SA, Schlosser RJ. Trends in complications of pediatric rhinosinusitis in the United States from 2006 to 2016. Int J Pediatr Otorhinolaryngol 2020; 128:109695. [PMID: 31568952 DOI: 10.1016/j.ijporl.2019.109695] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/17/2019] [Accepted: 09/21/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES 1) Evaluate the changing prevalence of complications from pediatric acute bacterial rhinosinusitis and 2) elucidate factors associated with the development of complicated acute rhinosinusitis in this population. STUDY DESIGN/SETTING Cross-sectional analyses of the Kids' Inpatient Database. SUBJECTS AND METHODS Children <20 years with a diagnosis of acute rhinosinusitis were included. Diagnosis codes pertaining to acute rhinosinusitis-related complications were then queried for each subject. All patients were ultimately categorized into one of four groups: uncomplicated acute rhinosinusitis, orbital complications, intracranial complications, or both orbital and intracranial complications. Weighted measures were applied to provide national estimates. RESULTS Over the decade studied, national estimates for children admitted with acute rhinosinusitis decreased from 8,312 cases in 2006 to 5,592 in 2016. There was an increase in the rate of orbital complications from 8.9% to 19.3% and intracranial complications from 2.2% to 4.3%. Children with both complications increased from 0.5% to 1.0% of cases. Children with orbital complications were significantly younger (8.6 years) compared to those with intracranial complications (12.4 years) and both complication types (12.2 years) (p < 0.001). CONCLUSION Despite an overall decrease in cases of acute rhinosinusitis, rates of orbital and intracranial complications continued to increase over a ten-year period. Antibiotic prescribing patterns, vaccination effects, and evolving practice patterns may help explain these observations. Further studies warrant investigation into the cause of these trends. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Dylan A Levy
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA.
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Levy DA, Nguyen SA, Harvey R, Hopkins C, Schlosser RJ. Hospital utilization for orbital and intracranial complications of pediatric acute rhinosinusitis. Int J Pediatr Otorhinolaryngol 2020; 128:109696. [PMID: 31585355 DOI: 10.1016/j.ijporl.2019.109696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Orbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost. METHODOLOGY Analysis of Kids' Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median [IQR]. RESULTS A weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 [8] v 4 [3]days, p < 0.001). Daily cost for IC was greater than OC ($2861 [4044] v $1683 [1187], p < 0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, p < 0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 [41,976] v $32,299 [18,235], p < 0.001) but similar LOS (12 [10] v 11 [9] days, p = 0.783). CONCLUSIONS Children with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.
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Affiliation(s)
- Dylan A Levy
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA.
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Richard Harvey
- Rhinology and Skull Base Surgery, University of New South Wales, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Claire Hopkins
- ENT Department, Guy's and St. Thomas Hospitals, London, United Kingdom
| | - Rodney J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Touchette CJ, Crevier L, Weil AG. Neuronavigation-Guided Endoscopic Endonasal Drainage of Pediatric Anterior Cranial Base Epidural and Subdural Empyema. Pediatr Neurosurg 2020; 55:67-71. [PMID: 31962318 DOI: 10.1159/000503055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
In children, epidural and/or subdural intracranial empyema can complicate frontal sinusitis or pansinusitis. The standard transcranial approach used to treat epidural or subdural empyema has many drawbacks, but these can be avoided with an endoscopic expanded endonasal approach (EEA). To support the feasibility and advantages of this approach, we report the successful drainage through endoscopic EEA of a bifrontal empyema caused by an intracranial extension of pansinusitis. Our case and the ones previously reported in the literature establish well that endoscopic EEA offers several advantages over the standard craniotomy. Hence, EEA should be considered as an alternative to the transcranial approach when surgically draining anterior skull base empyema resulting from pansinusitis in children.
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Affiliation(s)
- Charles J Touchette
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Louis Crevier
- Pediatric Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital Center, Montreal University, Montreal, Québec, Canada
| | - Alexander G Weil
- Pediatric Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital Center, Montreal University, Montreal, Québec, Canada,
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Luscan R, Truffert E, Simon F, Belhous K, Verillaud B, Garabedian N, Leboulanger N, Couloigner V. Premaxillary abscess without bony erosion: An unusual complication of pediatric acute maxillary sinusitis. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:349-353. [PMID: 31427214 DOI: 10.1016/j.anorl.2019.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To report an unusual complication of pediatric acute maxillary sinusitis: premaxillary abscess. To describe clinical, radiological and biological presentation, treatment strategy and progression. MATERIAL AND METHODS A retrospective study included all pediatric patients treated for premaxillary abscess complicating acute maxillary sinusitis in two ENT reference centers between 1999 and 2017. Disease history, clinical presentation, biological and radiological findings, treatment modalities and progression were studied. RESULTS Ten patients were included, with a mean age of 10±4.2 years. All presented with fever, rhinorrhea and premaxillary edema. Contrast-enhanced CT scan systematically found complete opacity of the maxillary sinus, without bone lysis, and extensive effusion along the intersinonasal wall up to the premaxillary region, extending in 3 cases back toward the parapharyngeal space. Bacteriology isolated Streptococcus anginosus most frequently (n=4; 40%). Treatment comprised intravenous wide-spectrum antibiotics, with surgical drainage of the abscess if>10mm (n=9; 90%). Seven of these 9 patients (78%) had recurrent abscess requiring surgical revision and 3 (33%) required a third drainage. All patients were cured without sequelae at 1 month. CONCLUSION In case of acute maxillary sinusitis with premaxillary edema, premaxillary abscess should be suspected. The high recurrence rate argues for maximalist surgery associated to close clinical monitoring with radiological examination.
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Affiliation(s)
- R Luscan
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - E Truffert
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - F Simon
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - K Belhous
- Service de radiologie pédiatrique hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - B Verillaud
- Service d'oto-rhino-laryngologie, hôpital Lariboisière, assistance publique-hôpitaux de Paris, université Paris Diderot, 75010 Paris, France
| | - N Garabedian
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - N Leboulanger
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France
| | - V Couloigner
- Service d'oto-rhino-laryngologie pédiatrique, hôpital Necker-Enfants-Malade, assistance publique-hôpitaux de Paris, université Paris Descartes, 75015 Paris, France.
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20
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Raheja A. Editorial. Endoscopic sinus surgery in sinusitis-induced intracranial abscess: concepts and controversies. Neurosurg Focus 2019; 47:E13. [PMID: 31370016 DOI: 10.3171/2019.5.focus19374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Koizumi M, Ishimaru M, Matsui H, Fushimi K, Yamasoba T, Yasunaga H. Outcomes of endoscopic sinus surgery for sinusitis-induced intracranial abscess in patients undergoing neurosurgery. Neurosurg Focus 2019; 47:E12. [PMID: 31370015 DOI: 10.3171/2019.5.focus1947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although sinusitis-induced intracranial complications rarely occur in the current era of antibiotics, they can induce neurological symptoms or death. The authors of this study investigated the association between endoscopic sinus surgery (ESS) and outcomes in patients who had undergone neurosurgical procedures for sinusitis-induced intracranial abscess. METHODS The authors obtained data on patients with sinusitis-induced intracranial abscess from the Japanese Diagnosis Procedure Combination inpatient data for the period from 2010 to 2017. They excluded patients with fungal sinusitis, orbital complications, immunodeficiency, and malignant disease. They also excluded patients who had received antifungal agents, chemotherapy, immunosuppressants, and antidiabetic drugs. Eligible patients were divided into those with and those without neurosurgical procedures. Propensity score-adjusted regression analyses were performed to examine the association between ESS within the same hospitalization and outcomes (mortality, blood transfusion, readmission, revision neurosurgery, and length of stay). RESULTS Of the 552 potentially eligible patients, 255 were treated with neurosurgical procedures, including 104 who underwent ESS within the same hospitalization and 151 who did not. ESS was not significantly associated with mortality (OR 0.54, 95% CI 0.05-5.81, p = 0.61), blood transfusion (OR 1.95, 95% CI 0.84-4.51, p = 0.12), readmission (OR 0.86, 95% CI 0.34-2.16, p = 0.75), revision neurosurgery (OR 0.65, 95% CI 0.24-1.74, p = 0.39), or length of stay (percent difference -10.8%, 95% CI -24.4% to 5.1%, p = 0.18). CONCLUSIONS The present study suggests that ESS may not have significant benefits with respect to reducing mortality, blood transfusion, readmission, revision neurosurgery, or length of stay.
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Affiliation(s)
- Megumi Koizumi
- 1Department of Clinical Epidemiology and Health Economics, School of Public Health.,2Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo; and
| | - Miho Ishimaru
- 1Department of Clinical Epidemiology and Health Economics, School of Public Health
| | - Hiroki Matsui
- 1Department of Clinical Epidemiology and Health Economics, School of Public Health
| | - Kiyohide Fushimi
- 3Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Tatsuya Yamasoba
- 2Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo; and
| | - Hideo Yasunaga
- 1Department of Clinical Epidemiology and Health Economics, School of Public Health
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Lundy P, Kaufman C, Garcia D, Partington MD, Grabb PA. Intracranial subdural empyemas and epidural abscesses in children. J Neurosurg Pediatr 2019; 24:14-21. [PMID: 31553545 DOI: 10.3171/2019.1.peds18434] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a retrospective analysis of a consecutive series of children with intracranial subdural empyemas (SEs) and epidural abscesses (EAs) to highlight the important clinical difference between these two entities. They describe the delays and pitfalls in achieving accurate diagnoses and make treatment recommendations based on clinical and imaging findings. METHODS They reviewed their experience with children who had presented with intracranial SE and/or EA in the period from January 2013 to May 2018. They recorded presenting complaint, date of presentation, age, neurological examination findings, time from presentation to diagnosis, any errors in initial image interpretation, timing from diagnosis to surgical intervention, type of surgical intervention, neurological outcome, and microbiology data. They aimed to assess possible causes of any delay in diagnosis or surgical intervention. RESULTS Sixteen children with SE and/or EA had undergone evaluation by the authors’ neurosurgical service since 2013. Children with SE (n = 14) presented with unmistakable evidence of CNS involvement with only one exception. Children with EA alone (n = 2) had no evidence of CNS dysfunction. All children older than 1 year of age had sinusitis. The time from initial presentation to a physician to diagnosis ranged from 0 to 21 days with a mean and median of 4.5 and 6 days, respectively. The time from diagnosis to neurosurgical intervention ranged from 0 to 14 days with a mean and median of 3 and 1 day, respectively. Delay in treatment was due to misinterpretation of images, a failure to perform timely imaging, progression on imaging as an indication for surgical intervention, or the managing clinician’s preference. Among the 14 cases with SE, initial imaging studies in 6 were not interpreted as showing SE. Four SE collections were dictated as epidural even on MRI. The only fatality was associated with no surgical intervention. Endoscopic sinus surgery was not associated with reducing the need for repeat craniotomy. CONCLUSIONS Regardless of the initial imaging interpretation, any child presenting with focal neurological deficit or seizures and sinusitis should be assumed to have an SE or meningitis, and a careful review of high-resolution imaging, ideally MRI with contrast, should be performed. If an extraaxial collection is identified, surgical drainage should be performed expeditiously. Neurosurgical involvement and evaluation are imperative to achieve timely diagnoses and to guide management in these critically ill children. ABBREVIATIONS EA = epidural abscess; SE = subdural empyema.
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Affiliation(s)
| | - Christian Kaufman
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - David Garcia
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - Michael D Partington
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - Paul A Grabb
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,2Children's Mercy Hospital and.,3University of Missouri at Kansas City, Kansas City, Missouri
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Pandrangi V, Reiter ER. Impact of Sinus Surgery on Hospital Utilization for Complications of Sinusitis. EAR, NOSE & THROAT JOURNAL 2019; 100:48-54. [PMID: 31155941 DOI: 10.1177/0145561319853786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Sinusitis complications are potentially lethal conditions that generally require extensive treatment and thus place a significant burden on the health-care system. The purpose of this study was to assess the impact of surgery on hospital utilization associated with treatment of sinusitis complications. METHODS Retrospective cohort study using a national hospital database. The 2012 to 2013 National Inpatient Sample was queried for adult patients with sinusitis and complications. Patients were grouped based upon the presence or absence of sinus procedures. Patient demographics and health status, hospital characteristics, length of stay (LOS), and charges were determined. RESULTS Of 1645 patients with sinusitis and associated complications, 232 (14%) underwent sinus procedures. These patients had higher LOS (8.0 ± 7.3 days vs 4.3 ± 5.2 days; P < .001) and charges (US$96 107 ± 108 089 vs US$30 661 ± 47 138; P < .001) than nonprocedure patients. Increased time to procedure in one operation patients (n = 209) of more than 2 days increased total LOS (11.4 ± 9.3 days vs 6.2 ± 5.5 days; P < .001) and charges (US$120 306 ± 112 748 vs US$76 923 ± 81 185; P = .005). Patients with multiple sinus procedures (n = 23) versus one had increased LOS and charges, despite no time difference from admission to first procedure (P = .35). On regression analysis, sinus procedure patients had excess LOS of 0.827 days and charges of US$36 949. CONCLUSION Although often necessary, sinus procedures lead to increased LOS and charges. As prolonged time to sinus procedure and revision operations also increase charges, shorter trials of medical therapy and earlier surgical intervention may improve outcomes and reduce costs.
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Affiliation(s)
- Vivek Pandrangi
- Department of Otolaryngology-Head and Neck Surgery, 6886Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Evan R Reiter
- Department of Otolaryngology-Head and Neck Surgery, 6886Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Guignard N, Roujeau T, Saumet L, Gascou G, Mondain M, Akkari M. Sphenoidal sinogenic extradural empyema associated with juvenile myelomonocytic leukemia. Int J Pediatr Otorhinolaryngol 2018; 115:45-48. [PMID: 30368391 DOI: 10.1016/j.ijporl.2018.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/16/2018] [Accepted: 09/16/2018] [Indexed: 10/28/2022]
Abstract
Intracranial empyema is a rare but serious complication of sinusitis in children. Myelodysplastic/myeloproliferative syndromes (MMS), including juvenile myelomonocytic leukemia (JMML), can lead to immunosuppression, thus favouring infections. We report the case of a sphenoid sinogenic retro-clival extradural empyema in a 14-year-old female patient associated with JMML. Treatment consisted in an endonasal transphenoidal drainage of the empyema associated with intravenous antibiotherapy. The patient was thereafter enrolled in chemotherapeutic treatment with Azacitidine. The disease progressed to blast phase, indicating bone marrow graft. This is the first reported case of an endocranial complication of bacterial sinusitis associated with MMS in a child.
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Affiliation(s)
- N Guignard
- Department of ENT and Head and Neck Surgery, University Hospital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, University of Montpellier, France
| | - T Roujeau
- Department of Pediatric Neurosurgery, University Hospital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, University of Montpellier, France
| | - L Saumet
- Department of Pediatric Oncology, University Hospital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, University of Montpellier, France
| | - G Gascou
- Department of Neuroradiology, University Hospital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, University of Montpellier, France
| | - M Mondain
- Department of ENT and Head and Neck Surgery, University Hospital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, University of Montpellier, France
| | - M Akkari
- Department of ENT and Head and Neck Surgery, University Hospital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, University of Montpellier, France.
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Kou YF, Killeen D, Whittemore B, Farzal Z, Booth T, Swift D, Berg E, Mitchell R, Shah G. Intracranial complications of acute sinusitis in children: The role of endoscopic sinus surgery. Int J Pediatr Otorhinolaryngol 2018; 110:147-151. [PMID: 29859578 DOI: 10.1016/j.ijporl.2018.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the role of endoscopic sinus surgery (ESS) in the management of intracranial complications of children with acute rhinosinusitis METHODS: Retrospective chart review at a tertiary care pediatric hospital MAIN OUTCOMES: Demographics, intracranial complications, length of hospital stay (LOS), neurological sequelae, ESS, neurosurgical procedures RESULTS: Twenty-four children with a mean age (SD) of 12.9 years (+/-3.2) with an intracranial complication(s) of acute rhinosinusitis were identified between 2005-2016. A total of 22 were included and 15 (68%) of these were males. The most common complications were: subdural abscess (n=10), epidural abscess (n=10), meningitis (n=5), intraparenchymal abscess (n=5), and cavernous sinus thrombosis (n= 2). Neurologic symptoms included headache (n=12), hemiparesis (n=5) and aphasia (n=3). Average length of stay was 16 (+/- 9.2) days. Average follow up was 7 (+/-5.6) months. One patient had residual seizures and 1 had recurrent rhinosinusitis. Aphasia and hemiparesis resolved in all patients within 1 year. Nineteen (86%) patients had ESS within 4 days of admission. Fourteen patients (63%) had a neurosurgical procedure, 6 (27%) required more than 1 neurosurgical procedure. Six patients (27%) had concurrent neurosurgical drainage and ESS. Four patients (17%) had neurosurgical procedure followed by ESS and 3 patients (13%) were treated only by a neurosurgical procedure. Patients who underwent ESS prior to a neurosurgical procedure had significantly less risk of needing a neurosurgical intervention (OR = .02, p < .01). There was a significantly higher proportion of neurosurgical patients with positive Strep anginosus cultures compared to the ESS only group (85.7% vs 37.5%, p = .02). Studies with larger patient populations are needed to determine the role of ESS in the management of intracranial complications of children with acute rhinosinusitis. DISCUSSION Early ESS may be associated with less need for neurosurgical procedures.
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Affiliation(s)
- Yann-Fuu Kou
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States.
| | - Daniel Killeen
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States
| | - Brett Whittemore
- Children's Medical Center Dallas, United States; University of Texas Southwestern Medical Center Department of Neurosurgery, United States
| | - Zainab Farzal
- University of North Carolina at Chapel Hill Department of Otolaryngology, Head and Neck Surgery, United States
| | - Tim Booth
- Children's Medical Center Dallas, United States; Children's Medical Center Dallas Department of Neurosurgery, United States
| | - Dale Swift
- Children's Medical Center Dallas, United States; University of Texas Southwestern Medical Center Department of Neurosurgery, United States
| | - Eric Berg
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States; Children's Medical Center Dallas, United States
| | - Ron Mitchell
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States; Children's Medical Center Dallas, United States
| | - Gopi Shah
- University of Texas Southwestern Medical Center Department of Otolaryngology, United States; Children's Medical Center Dallas, United States
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Hibi A, Amakusa Y. Intracranial subdural abscess with polymicrobial infections due to frontal sinusitis in an adolescent: life-threatening complication of a common disease. Clin Case Rep 2018; 6:516-521. [PMID: 29531731 PMCID: PMC5838286 DOI: 10.1002/ccr3.1355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/17/2017] [Accepted: 12/10/2017] [Indexed: 01/28/2023] Open
Abstract
Intracranial abscess is one of the most serious complications of frontal sinusitis, particularly among adolescents, even in the absence of odontogenic infection. Polymicrobial infections due to anaerobes are common. Because antibiotic therapy alone is usually ineffective, early endoscopic sinus surgery is the key for infection control and good clinical outcomes.
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Affiliation(s)
- Arata Hibi
- Division of Nephrology and RheumatologyDepartment of Internal MedicineKariya Toyota General Hospital5‐15, Sumiyoshi‐choKariyaAichi448‐8505Japan
| | - Yoshinobu Amakusa
- Department of NeurologyKariya Toyota General Hospital5‐15, Sumiyoshi‐choKariyaAichi448‐8505Japan
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Kofoed MS, Fisker N, Christensen AE, Kjeldsen AD. Sinogenic intracranial complications: is adalimumab a culprit? BMJ Case Rep 2018; 2018:bcr-2017-221449. [PMID: 29348274 DOI: 10.1136/bcr-2017-221449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We present two 11-year-old girls with chronic recurrent multifocal osteomyelitis, treated with adalimumab. Both developed severe intracranial complications to sinusitis. Patient 1 had been treated with adalimumab for 15 months when she developed acute sinusitis complicated by an orbital abscess, forehead swelling, a subdural empyema and osteomyelitis of the frontal bone. She was treated with a rhinosurgical and neurosurgical approach with intravenous antibiotics.Patient 2 had been in adalimumab treatment for 10 weeks. Adalimumab was discontinued 8 weeks prior to developing subdural empyema and subcortical abscesses in combination with sinusitis. She was treated with endoscopic sinus surgery and intravenous antibiotics. Both patients had developed psoriasis and episodes of infection during treatment. They were non-septic and had low fever on presentation. None of the patients suffered any long-term neurological sequelae. The immunosuppressive treatment with adalimumab is considered to be the cause of the sinogenic intracranial complications in our cases.
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Affiliation(s)
| | - Niels Fisker
- Department of Paediatrics, The Hans Christian Andersen Children's Hospital, Odense, Denmark
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28
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Sites of infection associated with Streptococcus anginosus group among children. J Infect Chemother 2017; 24:99-102. [PMID: 29050796 DOI: 10.1016/j.jiac.2017.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 07/26/2017] [Accepted: 09/16/2017] [Indexed: 11/20/2022]
Abstract
Streptococcus anginosus group (SAG) are parts of normal flora of the oral cavity and associated with abscess forming in various sites on the body. Although the clinical features of infections caused by each member of the SAG in adults has been reported, it has not well been known in children. The aim of this study was to clarify the site of infections associated with individual SAG species among children. Medical records from March 2010 to July 2016 were reviewed at Tokyo Metropolitan Children's Medical Center. Any SAG species (S. anginosus, S. constellatus, or S. intermedius) isolated from clinical samples and recorded in the microbiological database were included for analysis. Analysis of 52 infectious episodes found that S. anginosus was most frequently isolated from the genitourinary tract, and 73% of genitourinary tract infection was balanoposthitis. All genitourinary tract infections were associated with S. anginosus. These findings were different from those of a previous study of adults. Of all the patients, 45 patients (87%) had polymicrobial infections. More than 70% of patients infected by S. anginosus and S. constellatus were co-infected by obligate anaerobes, in comparison with only 21% of S. intermedius cases. Among the obligate anaerobes species, Bacteroides spp. was significantly accompanied with S. anginosus. Susceptibility to penicillin, ampicillin, cefotaxime, erythromycin, clindamycin, levofloxacin, and vancomycin was 100%, 100%, 100%, 77%, 89%, 97% and 100%, respectively. S. anginosus was often isolated from balanoposthitis among children.
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Abstract
BACKGROUND Sinusitis is a common disorder associated with significant patient symptomatology that adversely affects quality of life. Sinusitis can cause further morbidity and mortality through its impact on comorbid disorders, progression of inflammation, and extension of infection. OBJECTIVE This review highlights common complications of acute bacterial rhinosinusitis (ABRS) and chronic rhinosinusitis (CRS). RESULTS ABRS is complicated by orbital infections, such as pre- or postseptal cellulitis, and by intracranial infections, including abscesses of the epidural and subdural spaces. CRS can contribute to asthma, sleep disordered breathing, and smell disorders. CRS can be complicated by development of allergic fungal rhinosinusitis or deformity of surrounding bony structures. Fungal complications contribute to morbidity and mortality. CONCLUSION Complications of ABRS, although relatively rare, can cause significant morbidity and mortality, and must be promptly recognized. CRS commonly complicates or drives comorbid diseases, which adversely impacts quality of life. Treatment of these complications often requires coordinated multidisciplinary care.
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Affiliation(s)
- Tara F Carr
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
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30
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Systematic review and case report: Intracranial complications of pediatric sinusitis. Int J Pediatr Otorhinolaryngol 2016; 86:200-12. [PMID: 27260608 DOI: 10.1016/j.ijporl.2016.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 11/22/2022]
Abstract
CONTEXT Intracranial complications of rhinosinusitis are rare in the post-antibiotic era. However, due to potentially devastating outcomes, prompt recognition and management are essential. OBJECTIVE This study aims to perform the first systematic review of the intracranial complications of rhinosinusitis in order to better characterize their clinical presentation, diagnosis, and treatment, and report a case of frontal lobe empyema secondary to pediatric frontoethmoid sinusitis. DATA SOURCES Ovid MEDLINE, Cochrane Library, and Google Scholar. STUDY SELECTION Full-text, peer-reviewed journal publications from 1947 to January 1, 2015 in English; focus on intracranial complications of sinusitis; pediatric patients (<18 years of age); studies including data on diagnostic workup and treatment. DATA EXTRACTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Sixteen studies involving 180 patients were included. An overwhelming majority of patients were young adolescent males (70%). The most common intracranial complications were subdural empyema (49%), epidural abscess (36%), cerebral abscess (21%), and meningitis (10%). Patients most often presented with nonspecific symptoms such as headache, fever, nausea and vomiting. Computed tomography with contrast or magnetic resonance imaging confirmed the diagnosis when intracranial complications were suspected. Typical treatment included surgical incision and drainage, often involving joint neurosurgical and otolaryngological procedures, combined with a long course of antibiotics. The morbidity rate was 27%, and the mortality rate was 3.3%. LIMITATIONS All studies were retrospective chart reviews, case series or case reports. CONCLUSIONS A review of the currently available literature shows that with a high degree of suspicion, multidisciplinary cooperation and aggressive treatment, favorable outcomes are attainable. The most effective surgical treatment for intracranial complications remains unclear and should be investigated further.
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