Management of orbital complications due to rhinosinusitis

TY - JOUR

T1 - Management of orbital complications due to rhinosinusitis

AU - Siedek, V

AU - Kremer, A

AU - Betz, C S

AU - Tschiesner, U

AU - Berghaus, A

AU - Leunig, A

PY - 2010/12

Y1 - 2010/12

N2 - Emergencies in sinusitis are in 60-75% orbital complications defined by blepharedema (stage I), periostitis (stage II), subperiostal abscesses (SPA) (stage III) and orbital cellulites (stage IV). Ophthalmic complications such as diplopia, exophthalmia and reduced visual acuity are seen in stages III and IV. There is a consensus for primary conservative treatment in stage I or II and until recently for surgery in stages III and IV. The discussion concerns the decision for surgery versus conservative therapy in stage III in children. Another question is the definitive outcome of ophthalmic symptoms. The charts of 127 patients with orbital complications of sinusitis from 1995 until 2003 were analyzed. A follow-up questionnaire was sent to all asking for general quality of life, ophthalmic symptoms, and symptoms of sinusitis, further surgery or other treatments. The ratio of male to female was 2.3:1; 32 of the patients (25.2%) were ≤ 16 years and 37% had chronic rhinosinusitis. Of the adult patients, 37.9% had blepharedema, 45.3% periostitis, 4.2% SPA and 12.6% orbital cellulitis (children: 31.3, 40.6, 12.5 and 15.6%). Children with orbital cellulites were significantly (P < 0.01) older than those with SPA. Motility disorders, e.g., diplopia, were seen in 11%, exophthalmia in 12% and reduced visual acuity in 5.5%. As much as 51.2% were treated conservatively. Intervention was endoscopic sinus surgery in 81% and a combined intervention in 19%. After a mean of 40.5 months, 6 of 55 patients who had returned the questionnaire still had ophthalmic symptoms. Treatment of stages I and II are conservative, but if it fails surgery is required within 24-28 h. There is a trend for a more conservative therapy in children with stage III. However, we plead for a flexible approach to therapy in stage III and for primary surgery in patients with recurrent chronic sinusitis.

AB - Emergencies in sinusitis are in 60-75% orbital complications defined by blepharedema (stage I), periostitis (stage II), subperiostal abscesses (SPA) (stage III) and orbital cellulites (stage IV). Ophthalmic complications such as diplopia, exophthalmia and reduced visual acuity are seen in stages III and IV. There is a consensus for primary conservative treatment in stage I or II and until recently for surgery in stages III and IV. The discussion concerns the decision for surgery versus conservative therapy in stage III in children. Another question is the definitive outcome of ophthalmic symptoms. The charts of 127 patients with orbital complications of sinusitis from 1995 until 2003 were analyzed. A follow-up questionnaire was sent to all asking for general quality of life, ophthalmic symptoms, and symptoms of sinusitis, further surgery or other treatments. The ratio of male to female was 2.3:1; 32 of the patients (25.2%) were ≤ 16 years and 37% had chronic rhinosinusitis. Of the adult patients, 37.9% had blepharedema, 45.3% periostitis, 4.2% SPA and 12.6% orbital cellulitis (children: 31.3, 40.6, 12.5 and 15.6%). Children with orbital cellulites were significantly (P < 0.01) older than those with SPA. Motility disorders, e.g., diplopia, were seen in 11%, exophthalmia in 12% and reduced visual acuity in 5.5%. As much as 51.2% were treated conservatively. Intervention was endoscopic sinus surgery in 81% and a combined intervention in 19%. After a mean of 40.5 months, 6 of 55 patients who had returned the questionnaire still had ophthalmic symptoms. Treatment of stages I and II are conservative, but if it fails surgery is required within 24-28 h. There is a trend for a more conservative therapy in children with stage III. However, we plead for a flexible approach to therapy in stage III and for primary surgery in patients with recurrent chronic sinusitis.

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Anti-Bacterial Agents

KW - Child

KW - Cohort Studies

KW - Endoscopy

KW - Female

KW - Humans

KW - Male

KW - Ophthalmoplegia

KW - Orbital Diseases

KW - Retrospective Studies

KW - Rhinitis

KW - Sinusitis

KW - Treatment Outcome

KW - Vision Disorders

KW - Journal Article

U2 - 10.1007/s00405-010-1266-3

DO - 10.1007/s00405-010-1266-3

M3 - SCORING: Journal article

C2 - 20464411

VL - 267

SP - 1881

EP - 1886

JO - EUR ARCH OTO-RHINO-L

JF - EUR ARCH OTO-RHINO-L

SN - 0937-4477

IS - 12

ER -