Complications of acute sinusitis in children

Introduction and objective: Acute sinusitis is frequently diagnosed in pediatric age, usually following an upper respiratory tract infection. Although most cases respond favorably to antibiotic treatment, occasionally orbital and intracranial complications can occur. Orbital complications are the most common and are associated with ethmoid sinusitis. Intracranial complications represent a more severe condition that requires early diagnosis and treatment due to the risk of serious sequelae. Our objective is to study the incidence and characteristics of complicated sinusitis in children, their epidemiological factors, clinical presentation, treatment and evolution. Method: We performed a descriptive retrospective study including pediatric patients (0-15 years) who required admission and imaging studies that confirmed complicated sinusitis at La Fe University and Polytechnic Hospital in Valencia over a period of 9 years (2011-2019). Results: Thirty patients with a diagnosis of complicated acute sinusitis were identified. A CT scan was performed in all cases, revealing isolated cellulitis in 8 patients (26.6%), subperiosteal abscess in 16 (53.3%), and intracranial complications in 6 (20%). The average age was 9 years, with 61% of the patients being male and 39% female. The average length of hospital stay was 8.7 days for orbital complications and 26.6 days for intracranial complications. Isolated cellulitis resolved with medical treatment alone, while surgery was necessary in 68.7% of isolated subperiosteal abscesses and 83.3% of abscesses with associated intracranial complications. Discussion: Early diagnosis and initiation of appropriate treatment are essential to achieve resolution of complications from acute sinusitis. CT scan of the paranasal sinuses is the imaging test of choice for the initial assessment of these patients. In cases of suspected intracranial complications or if a second test is needed during follow-up, MRI will be the test of choice. Although there is no established protocol for managing orbital complications, medical treatment has shown good results in isolated cellulitis and small abscesses without other associated complications. For larger abscesses, associated intracranial complications or lack of improvement after initiating medical treatment, surgery will be preferred. Conclusions: Orbital complications are the most frequently diagnosed. Medical treatment shows good results in managing cellulitis and small subperiosteal abscesses. The treatment of choice in patients with lack of response to medical treatment and in those with larger abscesses or intracranial extension.