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Can Initial Management of Paediatric Acute Rhinosinusitis With Orbital Complications Predict Future Outcomes? A
Elchanan Zloczower1, Itay Pansky2, Batel Lasry3
1Department of Otorhinolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
Children with orbital complications from acute rhinosinusitis (ARS) treated surgically face higher risks of recurrent ARS episodes, especially within the first year post-operation. Conservative management is often successful, but surgical cases require careful follow-up for future ARS.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Ophthalmology
Background:
- Acute rhinosinusitis (ARS) affects 6%-8% of children, with orbital complications (OC) being the most common serious issue.
- Both conservative and surgical approaches are effective for OC-ARS, with treatment choice depending on clinical presentation and surgeon expertise.
Purpose of the Study:
- To evaluate and compare the long-term outcomes of conservative versus surgical management for pediatric OC-ARS.
- To assess the recurrence rates of ARS and OC-ARS following different treatment modalities over a 5-year period.
Main Methods:
- Retrospective analysis of pediatric patients (<16 years) diagnosed with OC-ARS between 2002 and 2019.
- Patients were categorized into conservative and surgical treatment groups.
- Outcomes included ARS recurrence, OC-ARS, and subsequent hospitalizations/surgeries over 5 years.
Main Results:
- Of 213 children, 90.1% received conservative treatment, while 9.9% underwent surgery (mostly endoscopic).
- Surgically treated patients were older and presented with more severe symptoms (proptosis, impaired eye movement, higher Chandler scores).
- Recurrent ARS rates were significantly higher in the surgical group (28.6%) compared to the conservative group (8.3%).
Conclusions:
- Most children with OC-ARS achieve full recovery without long-term sequelae.
- Pediatric patients requiring surgery for OC-ARS exhibit an elevated risk of subsequent ARS episodes, particularly within the first year post-intervention.
- Long-term monitoring is crucial for surgically treated children to manage potential ARS recurrences.
Background:
Approximately 6%-8% of children diagnosed with acute rhinosinusitis (ARS) would experience complications, primarily periorbital or orbital complications (OC). Both conservative and surgical management have been shown to be successful, and the choice of proper management depends on the presentation and the surgeon's discretion. The objective of this study was to describe the long-term outcomes of each modality on future ARS episodes, with or without OC.
Methods:
This retrospective study included patients < 16 years old with OC-ARS admitted to a tertiary hospital from 2002 to 2019. Patients were divided into groups based on treatment: conservative and surgical. Outcomes measured included recurrence of ARS, OC-ARS and future hospitalisations or surgeries due to ARS over a 5-year follow-up period.
Results:
Among 213 children diagnosed with OC-ARS, 192 (90.1%) were treated conservatively and 21 (9.9%) surgically. Most surgeries were performed endoscopically (16/21, 76.2%). Surgically treated children were older and had significantly higher rates of proptosis, impaired eye movement and higher Chandler scores at presentation (p = 0.034, p < 0.001, p < 0.001, p < 0.001, respectively). Overall, recurrent ARS rates were 10.3%, with significantly higher rates in the surgical group compared with the conservative group (28.6% vs. 8.3%, p = 0.012). While the surgical group did not have a significantly shorter interval to recurrence compared with the conservative group (8 vs. 15 months, p = 0.8), a significant risk reduction over time was observed (OR 6.22 and 3.71 after 1 and 5 years, respectively, p < 0.005).
Conclusion:
Most children with OC-ARS recover fully without future sequela. However, children that needed surgical treatment during the acute phase of OC-ARS, are at greater risk for future ARS episodes, particularly within the first-year post-surgery.
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