Rika Susanti

030.09.206

Children have, on average six to eight years old viral Upper

Respiratory tract Infections (URI) a year in which 510% of are
complicated by a secondary bacterial infection of the paranasal
sinuses .
Acute Bacterial Sinusitis (ABS) is the fifth most common disorder
for outpatient antibiotic treatment in children.

The diagnosis of chronic sinusitis can be more difficult in the

pediatric population because of the high rate of viral URI.

The most frequent organisms in ABS includes Streptococcus

pneumonia, Haemophilus influenza, and Moraxella catarrhalis
predominantly .

Patients that present with a complication of ABS often have

prolonged hospitalizations and require multiple surgical
interventions.
Many complicated ABS infections are polymicrobial.

Sinusitis is characterized by duration; infections lasting less than 4 weeks

as acute, those lasting 412 weeks as sub-acute, and those lasting more
than 12 weeks as chronic.

The two most common indications for the operative management of

sinusitis in pediatrics are chronic rhinosinusitis (CRS) resistant to
maximal medical management and ABS with a complication.
chronic sinusitis in pediatrics as an illness with 1 or more persistent
symptom of sinusitis for at least 3 months after medical treatment
that is supported by positive CT imaging

The medical records of all patients less than 18 years of age who
underwent surgical intervention for the treatment of sinusitis at
Cleveland Clinic between January 2002 and December 2011 were
reviewed
A total of 107 charts were reviewed and 104 met the inclusion
criteria.
Parameters reviewed included patient demographics, risk factors for
sinusitis including history of seasonal allergies, Gastro Esophageal
Reflux Disease (GERD), smoke exposure, history of adenoidectomy,
use of nasal steroid spray, bacterial cultures, location of sinusitis, and
the need for revision surgery.
The diagnoses of Chronic Rhino Sinusitis (CRS) and Acute Bacterial
Sinusitis (ABS) with complication were made based on history,
physical exam findings, and imaging

A total of 77 patients without and 27 patients with a complication of

ABS, who met the inclusion criteria, were reviewed.
The Chronic Rhino Sinusitis or CRS (without a complication group)
had a mean age of 11.8 years old (range of 417 years old); 57.1%
were male and 42.9% were female.
The Acute Bacterial Sinusitis or ABS with a complication group had
a mean age of 11.5 years old (range 417 years old); 70.37% were
male and 29.6% were female.
Most prevalent complications were preseptal
cellulitis (55.5%), orbital subperiosteal abscess (29.6%), subgaleal
abscess (22%), and epidural abscess (22%).
Five patients had simultaneous orbital and intracranial
complications.

Patients with a complication were statistically less likely to have

seasonal allergies, prior sinusitis, prior nasal steroid use, or
adenoidectomy (p < 0.05). In addition, they had more frequent
involvement of ethmoid and frontal sinuses (p < 0.05).
The predominate microorganism in the ABS group was S. anginosis
(milleri) (30.8%).
Twenty-one (51.2%) patients in the CRS group had cultures that
grew pathogenic organisms. The predominant microorganisms
included S. aureus (19.5%) and S. pneumoniae (9.8%).

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Complications of pediatric ABS are rare and can get the result
from delay in diagnosis, who patients often require multiple
surgical procedures and prolonged hospitalizations.
Recognizing the risk factors contributing to the disease and
identifying disease trends can help identify at-risk children and
hopefully result in earlier diagnosis.
Patients who require surgical treatment for a complication of
sinusitis are significantly less likely to have a history of nasal
steroid use, seasonal allergies, and they often do not have a
predictable history of sinusitis in comparison to CRS patients.
The risk factors of CRS in paediatrics include anatomic
abnormalities,
systemic
factors
(immune
deficiencies,
mucocilliary dysfunction), inflammatory factors (GERD, allergic
rhinitis, URI, bacterial infection), and environmental factors
(tobacco smoke).

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The CRS group had more patients with concha bullosa and Haller
cells. however, the difference was not significant.
Teenage males have a higher incidence of ABS complications.
Patients in the Acute Bacterial Sinusitis (ABS) group, orbital
complications were more common than intracranial.
Patients in this study who presented with subgaleal abscess or
orbital abscess had a very high rate of intracranial spread.
imaging of the brain should be considered whenever there are
symptoms or signs of orbital complications.

The results suggest that pediatric patients who require surgical

treatment for a complication of sinusitis are much less likely to have
a history of sinusitis, nasal steroid use, seasonal allergies, or
previous adenoidectomy than patients who undergo operative
management in a non-acute setting. In addition, these patients do
not have a predictable history of sinusitis.
Intracranial complications were commonly associated with orbital
abscess and subgaleal abscess.
MR imaging of the brain should be obtained when signs and
symptoms are suggestive of orbital abscess and subgaleal abscess
complications.