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Published on: May 16, 2025
Long-term outcomes after recovery from pediatric acute sinusitis with orbital complications
Chau Phung1, Kimberly Wei1, Mark D Rizzi2
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Insights
Most children with acute sinusitis and orbital complications recover well. A small percentage develop chronic rhinosinusitis (CRS), but initial severity doesn't predict outcomes, suggesting routine follow-up is adequate.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Ophthalmology
Background:
- Acute sinusitis with orbital complications in children is a serious condition.
- Understanding long-term sequelae is crucial for effective management.
- Identifying predictors of persistent or recurrent disease is important.
Purpose of the Study:
- To assess long-term complications of childhood acute sinusitis with orbital complications.
- To determine the incidence of chronic rhinosinusitis (CRS) post-infection.
- To identify clinical factors associated with persistent or recurrent disease.
Main Methods:
- Retrospective cohort study at a tertiary children's hospital.
- Reviewed records of children with acute sinusitis and orbital complications (Jan 2017-June 2023).
- Quantified subsequent sinusitis episodes, sinus surgery, and CRS development; evaluated risk factors.
Main Results:
- 181 patients included; average follow-up 647 days.
- 3.9% experienced recurrent complicated sinusitis; 1.7% required subsequent sinus surgery.
- 7.8% were diagnosed with CRS; no significant association found between risk factors and outcomes.
Conclusions:
- Most children recover without long-term issues after acute sinusitis with orbital complications.
- A small proportion develop chronic rhinosinusitis (CRS).
- Initial disease severity or treatment did not predict long-term outcomes, supporting routine primary care follow-up.
Objective:
This study aims to assess whether an occurrence of acute sinusitis with orbital complications in childhood is associated with the development of long-term complications, including the development of chronic rhinosinusitis (CRS), and to identify clinical factors associated with persistent or recurrent disease.
Study Design:
Retrospective cohort study.
Setting:
A tertiary children's hospital.
Methods:
We reviewed records of children diagnosed with acute sinusitis with orbital complications at a tertiary institution from January 2017 to June 2023. Episodes of subsequent acute sinusitis, sinus surgery, or the development of CRS were quantified and evaluated for correlation with several risk factors.
Results:
One hundred eighty-one patients were included in the study. Average follow-up was 647 days. The mean age was 8.2 years and 66.3% were male. Medical management for the initial infection was more common (66.9%), while 33.1% underwent surgery. Mean hospital stay was 3.9 days, with 7.8% 30-day readmissions. Seven patients (3.9%) experienced another episode of complicated sinusitis similar to their initial presentation, and three (1.7%) required subsequent sinus surgery after resolution of the initial infection. CRS was subsequently diagnosed in 14 (7.8%) patients. There was no significant association between risk factors and our primary outcomes. Among 23 patients with follow-up imaging, mean Lund-Mackay scores improved (7.6 to 1.7).
Conclusions:
Most children with orbital complications of sinusitis recovered without long-term sequelae, and a small proportion developed CRS. Disease severity at presentation or initial treatment did not predict long-term outcomes. These findings suggest that routine follow up with primary care providers after the initial presentation was appropriate for most children.
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