Published online Feb 28, 2015. doi: 10.5319/wjo.v5.i1.30
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
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.
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.