Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Otorhinolaryngol. Feb 28, 2015; 5(1): 30-36
Published online Feb 28, 2015. doi: 10.5319/wjo.v5.i1.30
Complicated sinusitis in children: 18 cases report
Ali Mardassi, Nabil Mathlouthi, Hajer Mbarek, Chiraz Halouani, Sameh Mezri, Cyrine Zgolli, Ghassen Chebbi, Rania Ben Mhamed, Khemaies Akkari, Sonia Benzarti
Ali Mardassi, Nabil Mathlouthi, Hajer Mbarek, Chiraz Halouani, Sameh Mezri, Cyrine Zgolli, Ghassen Chebbi, Rania Ben Mhamed, Khemaies Akkari, Sonia Benzarti, ENT Department, Military Hospital, Tunis 1008, Tunisia
Author contributions: All authors contributed to the collection of data, the redaction of the manuscript and had approved this final version of the article.
Ethics approval: The study has been approved by the medical ethics committee of the military hospital, Tunis, Tunisia.
Informed consent: The legal guardian of all study participants provided informed written consent prior to study enrollment.
Conflict-of-interest: None.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at alimardassi@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ali Mardassi, MD, ENT Department, Military Hospital, Montfleury, Tunis 1008, Tunisia. alimardassi@gmail.com
Telephone: +216-22-552252
Received: September 27, 2014
Peer-review started: September 28, 2014
First decision: November 19, 2014
Revised: December 13, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: February 28, 2015
Processing time: 137 Days and 10.2 Hours
Abstract

AIM: To precise the clinical characteristics of rhinosinusitis in pediatric population, their complications and therapeutic approaches.

METHODS: All infants younger than 15 years admitted to the Ear, Nose and Throat Department of the Military Hospital of Tunis, Tunisia for a complicated rhinosinusitis between 2006 and 2013 were evaluated. Data related to patients and the disease were collected and analyzed: past medical history, complaints, clinical examination, radiologic findings, therapeutic management and evolution.

RESULTS: Eighteen cases were identified with a mean age of 5.1 years (5 mo to 13 years) (SD ± 3.1). A male preponderance was noted in 72% of the cases. Rhinorrhea and fever were the most common presenting symptoms. Radiological explorations (computed tomography-scan ± magnetic resonance imaging) have been practiced for all of our patients. Orbital involvement was found in 77% of the cases associated with meningitis in 2 cases. Antibiotherapy was prescribed to all our patients. Surgical procedures were performed in 8 cases: endoscopic sinus surgery and/or external drainage of orbital abscess. After an average follow-up period of 2.5 years, 3 of our patients were lost. The ophthalmic sequelae noted in 3 cases (16%) were permanent and caused important functional and social problems. A favourable outcome has been noted in the rest of our patients.

CONCLUSION: Rhinosinusitis can be extremely severe in children requiring urgent radiological imaging and aggressive treatment to avoid orbital and intracranial complications.

Keywords: Rhinosinusitis; Children; Imaging; Orbit; Meningitis; Antibiotherapy; Surgery

Core tip: Rhinosinusitis is a common condition in childhood. However, complicated cases occur less frequently and are potentially life-threatening. The clinical presentation is often modified by a prior antibiotic prescription. In this paper we report our experience in the management of complicated sinusitis in infants and compare it with literature data. Orbito-cranial extension must be suspected in presence of proptosis, Swelling and/or redness of the eye or persistent headache. Urgent contrast-enhanced computed tomography-scan is the recommended initial imaging. Once the diagnosis confirmed, intravenous antibiotherapy should be started. Surgery is indicated in selected cases. A regular follow-up is mandatory.