Complications of inflammatory sinusitis in children: institutional review

Abstract

Background: Complications of acute inflammatory sinusitis into orbital and intracranial sepsis is a common problem in paediatrics.A delay in making a diagnosis and early appropriate treatment has a high morbidity and mortality rate.The commonest presenting symptoms are throbbing headache and facial or periorbital swelling usually fallowing a two week history of upper respiratory tract infection..A high resolution Computed Tomography(CT) scan is very helpful in making a proper and accurate diagnosis.Appropiate early medical and surgical treatment has a good outcome.We are reporting our epidemiological study of complicated sinusitis of 59 cases treated at Dr George Mukhari Hospital ,ENT Department a Tertiary referral centre, Medunsa Campus,University of Limpopo, RSA. Methods: A prospective case series of all patients admitted with complicate inflammatory confirmed on CT scan between April 2004 to August 2005(Winter months).An interview data collection sheet was used to collect all clinical information . . Results: Fifty-nine (59) inpatients (50 males and 9 females) admitted and treated at DGMH for complicated pan-sinusitis.The mean age of the patients was 13 years, with a male:female ratio of 7:1. All patients presented with a sporadic first episode of sinusitis, occurring within two weeks of upper airway infection. The affected age group was mainly paediatric of peripubertal age. In almost all the patients, headache and facial (peri-orbital) swelling were the main presenting symptoms. Most patients (85%) were initially referred to other departments 59.3% (35) to Ophthalmology, 18.6% (11) to Neurosurgery, 6.7 % (4) to Paediatrics and only 15.2 % (9) directly to ENT (Otorhinolaryngology). Of these patients, 36 (61%) had intracranial complications confirmed on CT scan and were managed in consultation with the neurosurgeons and ophthalmologists. No major surgical complications were reported. Staphylococcus species were the most common organisms isolated; however, 50% of the pus swabs had a negative culture. Medical treatment based on culture and sensitivity, together with surgical drainage, achieved good results. Three females with severe complications died during the period of the study, but there were no male deaths reported in this study, even though more males than females were affected. Conclusions: Complications of septic sinusitis are a common problem in the paediatrics, with males more commonly affected than females. Females, however, had a poorer prognosis than males in this study. Complicated sinusitis should be suspected in any adolescent with orbital, facial or frontal swelling associated with headache always during the winter (cold) months. To prevent morbidity and mortality, a high resolution contrasted CT scan is mandatory for the exclusion of complicated sinusitis,medical and surgical treatments are effective management of complicated sinusitis