Management options for orbital complications of acute rhinosinusitis in pediatric patients

• Published in: American journal of otolaryngology Vol. 43; no. 3; p. 103452
• Main Authors: Casanueva, R., Villanueva, E., Llorente, J.L., Coca-Pelaz, A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2022; Elsevier Limited
• Subjects: Abscesses; Acuity; Acute Disease; Acute rhinosinusitis; Adrenal Cortex Hormones - therapeutic use; Age; Anti-Bacterial Agents - therapeutic use; Antibiotics; Cellulitis; Child; Complications; Computed tomography; Corticoids; Corticosteroids; Cross-Sectional Studies; Edema; Hospitals; Humans; Intravenous administration; Length of stay; Medical imaging; Medical treatment; Mortality; Ophthalmoplegia; Orbital complications; Orbital Diseases - diagnostic imaging; Orbital Diseases - etiology; Orbital Diseases - therapy; Patients; Pediatric; Pediatrics; Retrospective Studies; Rhinitis; Rhinosinusitis; Sinuses; Sinusitis; Sinusitis - complications; Sinusitis - diagnostic imaging; Sinusitis - therapy; Steroids; Surgery; Surgical outcomes; Thrombosis; Visual acuity; Visual impairment; CT; EES; Corticosteroids; OC; Acute rhinosinusitis; Orbital complications; IC; ABRS; Pediatric
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2022.103452

Acute bacterial rhinosinusitis (ABRS) is a common pediatric condition. Despite its tendency to heal without complications, orbital complications (OC) are seen in 6% of patients and can cause vision impairment and put life at risk. Current treatment of this complications involves systemic antibiotics with or without surgical drainage, remaining controversial the use of corticosteroids. The aim of this study is to describe our results in the management of this complication both through medical and surgical treatment, with the inclusion of corticosteroids on it. A retrospective cross-sectional study was conducted in a tertiary hospital over pediatric patients with this complication. 23 patients were included with a mean age of 7.4 years. Ten of them (43.5%) presented ophthalmoplegia on admission and 2 of those also impaired visual acuity. A computerized tomography was performed in all patients and all of them received intravenous antibiotics and corticosteroids achieving that 60% did not require surgical treatment. The mean length of hospital stay was 6.2 days. The treatment of OC of ABRS with intravenous antibiotics and corticosteroids is safe, remaining surgical treatment available when necessary. When evolution is favorable, a reduced hospital stay must be sought. •Complications of acute rhinosinusitis are seen in 6% of pediatric patients.•The use of systemic corticosteroids in these complications remains controversial.•A retrospective cross-sectional study was conducted including 23 patients.•Treatment with intravenous antibiotics and corticosteroids is safe.•Patients over 7 years have a greater chance of requiring surgical treatment.