Related Experiment Video
Updated: Mar 9, 2026
Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression
Published on: June 15, 2019
Acute Rhinosinusitis in Immunosuppressed Children: Diagnostic and Therapeutic Management
Amit Ritter1, Salvador Fischer, Eitan Yaniv
1From the *Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; †Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, ‡Institute of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, and §Department of Otolaryngology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Insights
Endoscopic sinus surgery (ESS) effectively treats life-threatening sinonasal infections in pediatric patients with cancer or blood disorders. Fungal infections, particularly Aspergillus, increase mortality risk, highlighting the need for early diagnosis and treatment.
Area of Science:
- Otolaryngology
- Pediatric Oncology
- Infectious Diseases
Background:
- Immunosuppression in pediatric patients increases susceptibility to severe sinonasal infections.
- Nonspecific signs and symptoms complicate the diagnosis and management of these infections.
- Acute rhinosinusitis poses a significant threat to immunocompromised children.
Purpose of the Study:
- To evaluate the department's experience with surgical management of acute rhinosinusitis in immunosuppressed children.
- To assess the safety and efficacy of endoscopic sinus surgery (ESS) in this patient population.
Main Methods:
- Retrospective review of pediatric patients with hematologic or oncologic diseases undergoing ESS for acute rhinosinusitis (January 2005 - May 2014).
- Data collected included demographics, clinical presentation, imaging, microbiology, pathology, treatment, and outcomes.
- Analysis focused on factors influencing mortality and infection-related mortality.
Main Results:
- Thirty-four immunosuppressed children underwent ESS; fungal infections were common.
- Nineteen patients died, with 10 deaths attributed to infection.
- Facial swelling, underlying disease relapse, bone marrow transplant, and prolonged neutropenia correlated with infection-related mortality.
- Aspergillus infections were associated with increased mortality.
Conclusions:
- Endoscopic sinus surgery (ESS) is a safe and effective treatment for acute rhinosinusitis in immunosuppressed pediatric patients.
- Early diagnosis and aggressive medical and surgical management are critical for improving outcomes.
- Controlling underlying risk factors is essential for reducing mortality.
Background:
Immunosuppressive therapy places pediatric patients at risk of developing life-threatening sinonasal infections. Diagnosis and treatment are challenging owing to nonspecific signs and symptoms. The aim of this study was to present our department's experience with the surgical management of acute rhinosinusitis in immunosuppressed children.
Methods:
The records of all children with a hematologic or oncologic disease who underwent endoscopic sinus surgery (ESS) for acute rhinosinusitis from January 2005 to May 2014 were reviewed. Data were retrospectively collected on demographics, clinical and imaging characteristics, microbiology, pathology, treatment and outcome.
Results:
Thirty-four-immunosuppressed children underwent ESS for acute rhinosinusitis. Most patients had a fungal infection. Nineteen patients died at the end of follow-up; 10 deaths were infection-related. Facial swelling was the only symptom that correlated with death of infection. Relapse of the underlying disease, bone marrow transplantation, and long duration of neutropenia correlated with infection-related mortality. Fungal infection, and specifically Aspergillus, correlated with death from infection.
Conclusions:
ESS is a safe and efficient procedure for diagnosing and treating immunosuppressed pediatric patients with acute rhinosinusitis. Early detection and aggressive medical and surgical treatment, with control of underlying risk factors, are crucial to improve outcome.
Related Concept Videos
01:26Tonsillitis II: Management
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:16Drugs Used in Upper Respiratory Disorders: Overview
Antihistamines (e.g., Benadryl) block histamines from binding. Histamines are chemicals released during an allergic reaction in the body. As a...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:30Epistaxis
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...
01:28Acute Pyelonephritis II: Diagnostic Studies and Management