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Introduction

Children have, on average, six to eight viral upper respiratory tract infections (URI) a year in which 5–10% 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. Sinusitis is characterized by duration; infections lasting less than 4 weeks as acute, those lasting 4–12 weeks as subacute, 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.

The diagnosis of chronic sinusitis can be more difficult in the pediatric population because of the high rate of viral URI. Chan defined 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 . Adenoidectomy is considered the first-line surgical treatment in most children who have failed maximal medical management . When adenoidectomy is not successful, endoscopic sinus surgery is indicated .

Complications of ABS in pediatric patients are rare and are estimated to occur once in every 95,000 hospital admissions . The complications relate directly to the development of the paranasal sinuses and their proximity to the orbit and brain. They are categorized as orbital, intracranial, and those involving the bone of the sinus wall. Orbital complications were described and classified by increasing severity in the 1970s by Chandler . Group I patients have preseptal cellulitis or inflammatory edema superficial to the tarsal plate, a fascial extension of periosteum. Group II patients have orbital cellulitis, where there is edema of the orbital contents without a discrete abscess. Group III patients have a subperiosteal abscess adjacent to the lamina papyracea. Group IV patients have an orbital abscess. Group V patients have cavernous sinus thrombosis. Intracranial complications include epidural empyema, subdural empyema, meningitis, cerebral abscess, and cavernous and/or sagittal sinus thrombosis .

Previously studies have shown that the most frequent organisms in ABS includes S treptococcus pneumonia , Haemophilus influenza , and Moraxella catarrhalis predominantly . CRS in pediatrics has a similar profile of pathogens as well as Stapholococcus aureus , anaerobes, and fungi . Complicated sinusitis isolates include the previously listed, and commonly Streptococcus anginosis (formerly Streptococcus milleri ), anaerobes, and methicillin-resistant S. aureus (MRSA). Many complicated ABS infections are polymicrobial .

Patients that present with a complication of ABS often have prolonged hospitalizations and require multiple surgical interventions. Understanding the risk factors, microbiology, and patient and disease characteristics for those developing a complication of sinusitis is useful for prevention and early treatment of this disease. We review the complications of ABS that occur at an urban tertiary care center over a 10 year period and compare demographics, disease patterns, and risk factors to those patients who undergo sinus surgery for the management of chronic sinusitis.