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Friedrich L, Sadeh R, Hazan I, Kordeluk S, Sabri ES, Tsumi E, Zloczower E, Leibovitz R, Leibovitz E, Kaplan D, Kraus M, Ziv O. Orbital complications of pediatric acute rhinosinusitis in the pneumococcal conjugate vaccine era. Pediatr Neonatol 2024:S1875-9572(24)00090-1. [PMID: 38886146 DOI: 10.1016/j.pedneo.2023.12.009] [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: 07/14/2023] [Revised: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES To evaluate the impact of the pneumococcal conjugate vaccines (PCVs) introduction on the orbital complications of acute rhino-sinusitis (OC-ARS). METHODS A retrospective cohort study of all pediatric patients with OC-ARS during the period 2002-2019. Data included clinical, demographic, laboratory, and microbiology findings. Patients were divided into three groups: before PCV7 introduction (group 1), after PCV7 and before PCV13 (group 2), and after PCV13 (group 3). RESULTS Of 265 enrolled patients, 117, 39, and 109 were assigned to groups 1, 2, and 3. During the study period, a significant decrease was recorded in the percentages of patients in Chandler classification severity category 1, with an increase in patients in category 3 (P = 0.011). The yearly incidence of OC-ARS decreased from 12.64 cases per 100,000 population in 2002 to 5.56 per 100,000 in 2008, and 2.99 per 100,000 in 2019 (P < 0.001). Patients aged 0-4 years showed a dramatic decrease from 29 cases per 100,000 population in 2002 to 4.27 per 100,000 in 2019 (P < 0.001). The pathogens retrieved from all cultures performed were Streptococcus pneumoniae (32.5%), non-typeable Haemophilus influenzae (27.5%), Streptococcus Species, (12.5%), and Staphylococcus aureus (20%), with no changes in distribution during the study periods. Surgery was performed in 28 (10.6%) patients. CONCLUSIONS A significant decrease was seen in the overall incidence of OC-ARS, mainly attributable to the decrease in patients aged 0-4 years. An increase was recorded in the severity of the disease following PCVs introduction.
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Affiliation(s)
- Lior Friedrich
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Re'em Sadeh
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itai Hazan
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sofia Kordeluk
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - El-Saied Sabri
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Erez Tsumi
- Division of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elchanan Zloczower
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ron Leibovitz
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eugene Leibovitz
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Daniel Kaplan
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mordechai Kraus
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oren Ziv
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hackenberg S, Renson A, Röseler SM, Baumann I, Topcuoglu MSY, Hebestreit H. Pädiatrische Rhinologie. Laryngorhinootologie 2024; 103:S188-S213. [PMID: 38697148 DOI: 10.1055/a-2178-2957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The following review article highlights key topics in pediatric rhinology that are currently the focus in research and at conferences as well as in the interdisciplinary discussion between otorhinolaryngologists and pediatricians. In particular, congenital malformations such as choanal atresia or nasal dermoid cysts are discussed, followed by statements on the current procedures for sinogenic orbital complications as well as on the diagnosis and therapy of chronic rhinosinusitis in children. Furthermore, updates on the role of the ENT specialist in the care for children with cystic fibrosis and primary ciliary dyskinesia are provided.
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Affiliation(s)
- Stephan Hackenberg
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Würzburg
| | - Ariane Renson
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik RWTH Aachen
| | - Stefani Maria Röseler
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik RWTH Aachen
| | - Ingo Baumann
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum Heidelberg
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Mukherjee G, Sufcak K, Hames N, Lantis P. Bugs Behind the Bulging Eyeball: Microbiology and Antibiotic Management in Orbital Cellulitis With or Without Subperiosteal Abscess. Clin Pediatr (Phila) 2024; 63:214-221. [PMID: 37752812 DOI: 10.1177/00099228231202158] [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] [Indexed: 09/28/2023]
Abstract
The objective of this study is to describe causative pathogens and current antibiotic management among hospitalized children with orbital cellulitis. This retrospective study, performed at a tertiary care children's health system, included patients up to 18 years old who presented with radiographic evidence of orbital cellulitis from 2012 to 2019. Of the 298 patients included in the study, 103 had surgery and an intraoperative culture obtained. A pathogen was recovered in 86 cultures (83.5%). The most common pathogens were Streptococcus anginosus group (26.2%), Streptococcus pyogenes (11.7%), methicillin-susceptible Staphylococcus aureus (10.7%), and Streptococcus pneumoniae (9.7%). Only 8/194 (4.1%) blood cultures returned positive. Median duration of intravenous antibiotics was 4 days and median total duration was 17 days. The most common empiric regimen prescribed was ceftriaxone and clindamycin (64.1%). Despite low incidence of methicillin-resistant S aureus, empiric antibiotics often consisted of 2 antibiotics to ensure coverage for this bacterium.
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Affiliation(s)
- Gargi Mukherjee
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristine Sufcak
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Nicole Hames
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Patricia Lantis
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA, USA
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Anselmo-Lima WT, Soares MR, Fonseca JP, Garcia DM, Velasco E Cruz AA, Tamashiro E, Valera FCP. Revisiting the orbital complications of acute rhinosinusitis. Braz J Otorhinolaryngol 2023; 89:101316. [PMID: 37678009 PMCID: PMC10495636 DOI: 10.1016/j.bjorl.2023.101316] [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: 05/19/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. METHODS Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. RESULTS 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001). Complications were present at higher rates in the OA group compared to the other three groups. CONCLUSIONS ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Wilma T Anselmo-Lima
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Mateus R Soares
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Jefferson P Fonseca
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Denny M Garcia
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Antonio A Velasco E Cruz
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
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Erci E, Avcu G, Ozer EC, Bal ZS, Ozkinay F, Kurugol Z, Gode S, Aydemir SS. A Rare Cause of Orbital Cellulitis: Eikenella corrodens. Pediatr Infect Dis J 2023:00006454-990000000-00393. [PMID: 37000931 DOI: 10.1097/inf.0000000000003909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Ece Erci
- Division of Infectious Disease Department of Pediatrics Medical School of Ege University Izmir, Turkey
| | - Gulhadiye Avcu
- Division of Infectious Disease Department of Pediatrics Medical School of Ege University Izmir, Turkey
| | - Emine Cigdem Ozer
- Division of Infectious Disease Department of Pediatrics Medical School of Ege University Izmir, Turkey
| | - Zumrut Sahbudak Bal
- Division of Infectious Disease Department of Pediatrics Medical School of Ege University Izmir, Turkey
| | - Ferda Ozkinay
- Division of Infectious Disease Department of Pediatrics Medical School of Ege University Izmir, Turkey
| | - Zafer Kurugol
- Division of Infectious Disease Department of Pediatrics Medical School of Ege University Izmir, Turkey
| | - Sercan Gode
- Department of Otorhinolaryngology Medical School of Ege University Izmir, Turkey
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Boiko NV, Stagnieva IV, Gukasyan EL, Stateshnaya PA. [Children's rhinosinusitis orbital complications]. Vestn Otorinolaringol 2023; 88:74-79. [PMID: 37184558 DOI: 10.17116/otorino20228802174] [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: 05/16/2023]
Abstract
The number of cases of children's sinogenic orbital complications does not reduce in spite of the advanced methods of paranasal sinuses visualization, wide use of antibacterial therapy against sinusitis, and preventive vaccination against pneumococcal disease. Orbital complications are more common with children than with adults, the basic reason of their development being ethmoiditis. The prevailing classification of orbital complications proposed by J. Chandler et al. divides these into preceptal and postceptal forms and gives description to 5 development stages of orbital complications in the order of their increasing severity. At an early age preceptal and orbital cellulites prevail, and these commonly need conservative treatment only. In case of orbital cellulitis, the major treatment method is endovenous antibiotic therapy in which the chosen antibiotic is to cover the whole spectrum of aerobic and anaerobic microbes often extracted in such cases. At small subperiostal abscesses (<0.5-1 ml), conservative treatment during 24-48 hours is possible. If there is no positive dynamics, or abscess grows in size, or eye symptoms progress, abscess and affected sinuses drain is recommended. Orbital abscess is to be given surgical treatment; at the same time endoscopic management of paranasal sinuses might by complemented with external surgical approaches (lateral and medial orbitotomy).
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Affiliation(s)
- N V Boiko
- Rostov State Medical University, Rostov-on-Don, Russia
| | - I V Stagnieva
- Rostov State Medical University, Rostov-on-Don, Russia
| | - E L Gukasyan
- Rostov State Medical University, Rostov-on-Don, Russia
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Shah VP, Haimowitz SZ, Desai AD, Barron K, Patel P, Fang CH, Grube JG, Baredes S, Eloy JA. Sex Disparities in Pediatric Acute Rhinosinusitis: A National Perspective. Otolaryngol Head Neck Surg 2022; 167:760-768. [PMID: 35133910 DOI: 10.1177/01945998221077190] [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: 11/16/2022]
Abstract
OBJECTIVE This study aims to provide an age-stratified analysis of associations with patient sex in pediatric inpatients with acute rhinosinusitis (ARS). STUDY DESIGN Retrospective cohort study. SETTING National administrative database. METHODS The 2016 Kids' Inpatient Database was queried for pediatric inpatients (<21 years old) with ARS (ICD-10 J01). Orbital and intracranial sequelae were selected via ICD-10 codes. Statistical associations by sex were determined via univariate and multivariable analyses. Weighted measures are reported to provide national estimates. RESULTS Of the 5882 patients identified with ARS, 2404 (40.9%) were female and 3478 (59.1%) were male. Male patients were younger than female patients (mean, 9.3 vs 9.9 years; P < .001). Multivariable analysis indicated that males and females had similar total charges ($71,094 vs $66,892, P = .464) and length of stay (5.8 vs 6.1 days, P = .263). However, male patients underwent more procedures (1.8 vs 1.5, P < .001). Mortality was similar between male and female patients (odds ratio [OR], 0.91; P = .664). Male patients also had increased odds for having orbital (OR, 1.58; P < .001) and intracranial (OR, 1.99; P < .001) complications. Differences in sex-dependent sequela risk were starkest in patients aged 14 to 20 years, with male patients being more likely to have orbital (OR, 2.91; P < .001) and intracranial (OR, 3.86; P < .001) complications. CONCLUSION In a cohort of pediatric inpatients with ARS, males have increased odds for orbital and intracranial sequelae and undergo more procedures than females. However, males and females have similar charges and length of stay. Our study highlights age-stratified differences in ARS across patient sex.
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Affiliation(s)
- Vraj P Shah
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sean Z Haimowitz
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Amar D Desai
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kendyl Barron
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Prayag Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christina H Fang
- Department of Otolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Jordon G Grube
- Department of Otolaryngology, Albany Medical Center, Albany, New York, USA
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJBarnabas Health, Livingston, New Jersey, USA
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J. Welkoborsky H, Pitz S, Grass S, Breuer B, Pähler vor der Holte A, Bertram O, Wiechens B. Sinogenic Orbital Complications. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:31-37. [PMID: 34874263 PMCID: PMC9011833 DOI: 10.3238/arztebl.m2021.0379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/04/2021] [Accepted: 11/08/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The term "orbital complication" does not designate an independent nosological entity, but is rather a collective designation for diseases or disease effects that involve the orbit and its internal structures by extension from outside. In general, their most prominent manifestation is swelling of the orbital soft tissues, usually unilaterally. The incidence of sinogenic orbital complications is approximately 1.6 per 100 000 children and 0.1 per 100 000 adults per year. METHODS This review is based on publications retrieved by a selective search of the literature on the epidemiology, diagnosis, and treatment of sinogenic orbital complications. RESULTS Acute sinusitis is the most common cause of orbital complications. These are diseases of the orbit with potentially serious consequences for the eye and the risk of intracranial complications such as cavernous sinus thrombosis, meningitis, or brain abscess. Aside from acute sinusitis, many other infectious and non-infectious diseases can extend to and involve the orbit. Because of the complexity and severity of the condition, its diagnosis and treatment are always an interdisciplinary matter. The treatment is primarily conservative, under observation in a hospital, and generally consists of the treatment of acute sinusitis with measures to combat edema along with the administration of broad-spectrum antibiotics. Surgical intervention is needed in severe cases or if there is an abscess. An endonasal approach is usually used for drainage. CONCLUSION In 95-98% of cases in stages I-IV, healing is complete and without further sequelae. Even if vision is affected preoperatively, it usually recovers fully when therapy is appropriate. Approximately 15% of the patients who undergo surgery need more than one operative procedure.
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Affiliation(s)
- Hans J. Welkoborsky
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hanover, Germany,Department for ENT Medicine, Center for Children and Adolescents, Hanover,*Regional Hospital Hanover Department of Otorhinolaryngology Haltenhoffstr. 41 30167 Hanover, Germany
| | - Susanne Pitz
- Academic Medical Center, Interdisciplinary Orbita Center, Department of Ophthalmology, Hanover,Bürger Hospital, Orbita Center, Ophthalmic Clinic, Frankfurt/M
| | - Sylvia Grass
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hanover, Germany
| | - Boris Breuer
- Academic Medical Center, Interdisciplinary Orbita Center, Department of Ophthalmology, Hanover
| | - Anja Pähler vor der Holte
- Department of Otorhinolaryngology, Head and Neck Surgery, Nordstadt Clinic, Academic Hospital, Hanover, Germany
| | - Oliver Bertram
- Department for ENT Medicine, Center for Children and Adolescents, Hanover
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Saltagi MZ, Rabbani CC, Patel KS, Wannemuehler TJ, Chundury RV, Illing EA, Ting JY. Orbital Complications of Acute Sinusitis in Pediatric Patients: Management of Chandler III Patients. ALLERGY & RHINOLOGY 2022; 13:21526575221097311. [PMID: 35496892 PMCID: PMC9052236 DOI: 10.1177/21526575221097311] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Surgery is often avoided in the setting of pediatric orbital complications from acute sinusitis unless necessitated by alarming ophthalmological signs. Criteria for surgical intervention are not well-defined. Objective We aim to review our experiences, management practices and patient outcomes over a ten-year period for Chandler III patients. Methods A retrospective review was performed from January 1, 2007 through December 31, 2016 of patients treated for orbital symptoms secondary to acute sinusitis at a free-standing tertiary-care pediatric hospital. Results Of the 186 patients reviewed, 42 Chandler III patients were included. Average age was 82.6 months (SD 50.6) with a slight male predominance (M to F, 1.8 to 1). 27 patients (64.3%) underwent intervention including endoscopic sinus surgery (ESS) with or without orbitotomy. Late surgical intervention (>48hrs from admission) demonstrated significant increase in overall length of stay (LOS) when compared with early surgical intervention and/or medical management (median, 6.9 vs 3.6 vs 3.7 days; p < 0.01). Postoperative LOS was also higher in the late surgery group compared with patients who had surgery within 48 hours of admission, but this did not reach statistical significance [median, 3.8 vs 2.8 days, p= 0.12]. There was no significant difference in overall abscess volume between patients who underwent intervention and those who did not (1019 mm3 vs 805 mm3, p = 0.5), but abscess width ≥ 1.2 cm was associated with higher rates of intervention. An alarming extraocular exam was the most common factor associated with surgical intervention. Conclusion Pediatric subperiosteal orbital abscess may prompt surgical intervention by ESS. An alarming ophthalmologic exam should prompt consideration of early intervention, which may lead to decreased overall and post-operative length of hospital stay. Level of Evidence 4 Meeting Information American Rhinologic Society, Fall National Meeting. Chicago, IL, USA. September 8–9, 2017.
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Affiliation(s)
- Mohamad Z. Saltagi
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cyrus C. Rabbani
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kunal S. Patel
- Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Ophthalmology, Indianapolis, IN, USA
| | - Todd J. Wannemuehler
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rao V. Chundury
- Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Ophthalmology, Indianapolis, IN, USA
| | - Elisa A. Illing
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan Y. Ting
- Department of Otolaryngology—Head and Neck Surgery, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
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Martins M, Martins SP, Pinto-Moura C, Leal V, Spratley J. Management of post-septal complications of acute rhinosinusitis in children: A 14-year experience in a tertiary hospital. Int J Pediatr Otorhinolaryngol 2021; 151:110925. [PMID: 34597875 DOI: 10.1016/j.ijporl.2021.110925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/17/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Acute rhinosinusitis accounts for most of the cases of orbital infections and is the most common cause of periorbital oedema in children. Up to 10% of patients with orbital complications of acute rhinosinusitis may experience vision loss and other complications such as meningitis, intracranial abscess or even death. Therefore, these patients require prompt diagnosis and proper treatment. OBJECTIVES This study aims to report the clinical presentation and management of post-septal orbital complications of acute rhinosinusitis in the paediatric population. MATERIALS AND METHODS A retrospective medical chart review of all children aged under 18 years old who were diagnosed with post-septal orbital complications of acute rhinosinusitis at a tertiary academic hospital, between 01/2007 and 12/2020. Patients were grouped according to the Chandler Classification (groups 2-5). RESULTS Fifty-five children (mean age of 6.91 ± 4.61 years) fulfilled the entry criteria for post-septal orbital complications of acute rhinosinusitis, based on clinical evaluation by an otorhinolaryngologist and CT-scan findings. Forty (72.72%) patients were also evaluated by an ophthalmologist. Most patients were male (76.36%). Twenty-four patients had post-septal cellulitis (43.63%), 21 patients had a subperiosteal abscess (38.18%) and 10 patients had an orbital abscess (18.18%). Eyelid swelling was the most frequent sign, followed by fever. Microbiology varied considerably and gram-positive agents were clearly predominant. Eighteen (32.73%) patients had been treated with oral antibiotics prior to hospital admission, exhibiting a significantly higher risk of recurrence of orbital infection (p = 0.020). Ethmoid and maxillary sinuses were the most involved paranasal sinuses (90.91%). Thirty-three patients (60%) were successfully treated medically, and 22 patients (40%) required surgical drainage. Seven patients (12.73%) developed further complications and six recovered without sequelae. The mean length of hospital stay was 8.0 ± 5.0 days and recurrence of orbital infection occurred in six patients (10.91%). The absolute neutrophil blood count was significantly different amongst Chandler groups (p = 0.021), with higher counts in patients with subperiosteal abscess. The duration of hospitalization was significantly higher in patients submitted to surgery (p < 0.001). CONCLUSION Post-septal orbital complications of acute rhinosinusitis are infrequent but dangerous events in the paediatric population. Close collaboration with Ophtalmology is paramount, as the child's vision is at risk. Eyelid swelling and proptosis are early signs. CT-scan imaging plays an invaluable role in the diagnosis and decision-making. Predictive indicators for surgery were not found. However, emergency endoscopic nasal surgery with abscess drainage should be considered whenever vision is at risk, if there is no improvement after aggressive medical treatment, and in cases of intracranial complications.
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Affiliation(s)
- Manuel Martins
- Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Faculty of Medicine, Porto, Portugal.
| | - Sónia Pires Martins
- Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Faculty of Medicine, Porto, Portugal; Department of Otorhinolaryngology, University Hospital S. João Centre, E.P.E., Porto, Portugal.
| | - Carla Pinto-Moura
- Department of Otorhinolaryngology, University Hospital S. João Centre, E.P.E., Porto, Portugal; Department of Genetics, University Hospital S. João Centre, Faculty of Medicine of University of Oporto, Portugal; I3S, Institute Research and Innovation Health, University of Oporto, Portugal.
| | - Vitor Leal
- Department of Ophtalmology, University Hospital S. João Centre, E.P.E., Porto, Portugal.
| | - Jorge Spratley
- Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Faculty of Medicine, Porto, Portugal; Department of Otorhinolaryngology, University Hospital S. João Centre, E.P.E., Porto, Portugal; Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal.
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11
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Burek AG, Melamed S, Liljestrom T, Qi J, Kelly TG, Suelzer E, Mitchell M, Harris GJ, Havens PL. Evaluation and Medical Management of the Pediatric Patient With Orbital Cellulitis/Abscess: A Systematic Review. J Hosp Med 2021; 16:680-687. [PMID: 34730499 DOI: 10.12788/jhm.3707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Pediatric orbital cellulitis/abscess (OCA) can lead to vision loss, intracranial extension of infection, or cavernous thrombosis if not treated promptly. No widely recognized guidelines exist for the medical management of OCA. The objective of this review was to summarize existing evidence regarding the role of inflammatory markers in distinguishing disease severity and need for surgery; the role of imaging in OCA evaluation; and the microbiology of OCA over the past 2 decades. METHODS This review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed in MEDLINE (Ovid), Web of Science Core Collection, Scopus, CINAHL (EBSCO), and Cochrane Central Register of Controlled Trials (CENTRAL), most recently on February 9, 2021. RESULTS A total of 63 studies were included. Most were descriptive and assessed to have poor quality with high risk of bias. The existing publications evaluating inflammatory markers in the diagnosis of OCA have inconsistent results. Computed tomography imaging remains the modality of choice for evaluating orbital infection. The most common organisms recovered from intraoperative cultures are Streptococcus species (Streptococcus anginosus group, group A Streptococcus, and pneumococcus) and Staphylococcus aureus. Methicillin-resistant S aureus in culture-positive cases had a median prevalence of 3% (interquartile range, 0%-13%). CONCLUSION This systematic review summarizes existing literature concerning inflammatory markers, imaging, and microbiology for OCA evaluation and management. High-quality evidence is still needed to define the optimal medical management of OCA.
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Affiliation(s)
- Alina G Burek
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Svetlana Melamed
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tracey Liljestrom
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jing Qi
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Teresa G Kelly
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Michelle Mitchell
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gerald J Harris
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter L Havens
- Children's Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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12
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Khan SA, Hussain A, Phelps PO. Current clinical diagnosis and management of orbital cellulitis. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1941876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sara A. Khan
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Ahsen Hussain
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul O. Phelps
- Department of Surgery, NorthShore University Health System, Glenview, IL, USA
- Department of Ophthalmology and Visual Science, University of Chicago Pritzker College of Medicine, Chicago, IL, USA
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13
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Pedrosa RCDC, Pimenta GM, Valletta RC, Jordão ND, Santos FM, de Camargo LA, Avelino MAG. A Periorbital Abscess with Combined Retinal Artery Occlusion and Retinal Vein Occlusion: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930808. [PMID: 33979319 PMCID: PMC8126588 DOI: 10.12659/ajcr.930808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 17-year-old Final Diagnosis: Periorbital abscess • retinal artery and vein occlusion Symptoms: Blindness • nasal congestion • pain the eye • proptosis Medication: — Clinical Procedure: Drainage • endoscopic sinus surgery Specialty: Otolaryngology
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Affiliation(s)
- Raul Calaça da Costa Pedrosa
- Head and Neck Unit, Department of Surgery, Clinical Hospital, Federal University of Goiás (HC-UFG), Goiânia, GO, Brazil
| | - Guilherme Mendes Pimenta
- Head and Neck Unit, Department of Surgery, Clinical Hospital, Federal University of Goiás (HC-UFG), Goiânia, GO, Brazil
| | - Raíssa Camelo Valletta
- Head and Neck Unit, Department of Surgery, Clinical Hospital, Federal University of Goiás (HC-UFG), Goiânia, GO, Brazil
| | - Nathalya Ducarmo Jordão
- Department of Radiology, Clinical Hospital, Federal University of Goiás (HC-UFG), Goiânia, GO, Brazil
| | - Felipe Macedo Santos
- Department of Radiology, Clinical Hospital, Federal University of Goiás (HC-UFG), Goiânia, GO, Brazil
| | - Leandro Azevedo de Camargo
- Head and Neck Unit, Department of Surgery, Clinical Hospital, Federal University of Goiás (HC-UFG), Goiânia, GO, Brazil
| | - Melissa Ameloti Gomes Avelino
- Head and Neck Unit, Department of Surgery, Clinical Hospital, Federal University of Goiás (HC-UFG), Goiânia, GO, Brazil
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14
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Predictors of surgical management for paediatric orbital subperiosteal abscesses. Curr Opin Otolaryngol Head Neck Surg 2020; 28:430-434. [DOI: 10.1097/moo.0000000000000668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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