Pediatric Sinusitis, Medical Treatment Follow-up

  • Author: Hassan H Ramadan, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Apr 22, 2009
 

Further Inpatient Care

  • In general, sinusitis can be managed on an outpatient basis. In cases of resistant organisms or for patients with orbital or intracranial complications, inpatient treatment with intravenous antibiotics may be necessary.
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Further Outpatient Care

  • Family support is essential in treating this disorder.
  • Just giving medication to a child can be taxing on all involved, so the less frequent dosing the better.
  • Management of chronic sinusitis or an associated condition may be very labor intensive.
  • Children in day care settings are often sent home when they have URTI symptoms. This results in missed days of work for family members and additional financial stressors. Still, most patients with sinusitis are treated as outpatients.
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Inpatient & Outpatient Medications

See Medical Care and Medication.

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Transfer

If a pediatric intensive care unit or skill in dealing with acutely ill children is unavailable, transfer children with sinusitis complications to the nearest appropriate facility.

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Deterrence/Prevention

Good nasal hygiene and use of saline irrigations may be critical for the prevention of exacerbations of acute or chronic sinusitis. Maximize control of associated conditions and warn patients to avoid exposure to environmental irritants such as cigarette smoke.

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Complications

  • Orbital involvement
    • Orbital involvement usually occurs subsequent to direct spread from disease in the ethmoid sinuses.
    • Obtain a CT scan with contrast study to determine the full extent of orbital involvement and to identify ring-enhancing fluid collections typical of a subperiosteal abscess.
    • Chandler classification is as follows:
      • Preseptal cellulitis - Eyelid edema, erythema, normal globe movement
      • Orbital cellulitis - Proptosis, chemosis
      • Periorbital abscess - Proptosis with globe displaced inferolaterally, decreased extraocular muscle movement
      • Orbital abscess - Severe proptosis, impaired visual acuity, fixed globe, toxic patient
      • Cavernous sinus thrombosis - High fever, bilateral symptoms
    • Sinusitis involving the orbit is potentially life threatening and has a high risk of rapid visual loss. Manage orbital involvement closely, even in early cases, because visual changes may be permanent.
    • Orbital involvement requires intravenous antibiotics and possible endoscopic or open surgical management by physicians with expertise in treating these patients.
    • Strongly consider consulting an ophthalmologist early in the course of sinusitis to document and monitor the visual examination.
  • Intracranial involvement
    • Intracranial involvement usually occurs subsequent to direct spread from sphenoid or frontal sinus disease.
    • Subdural and frontal lobe abscesses are most common.
    • Meningitis may occur.
    • Administer intravenous antibiotics with good cerebrospinal fluid (CSF) penetration, such as third-generation cephalosporins. Obtain empiric broad-spectrum intravenous antibiotic coverage while awaiting more specific culture and sensitivity results.
    • Obtain a CT scan with contrast to detect ring-enhancing fluid collections.
    • Consulting a neurosurgeon is necessary.
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Prognosis

Prognosis is excellent for acute rhinosinusitis. Chronic sinusitis can be much more difficult to manage, but with optimal treatment of associated conditions and full medical treatment, high cure rates are probable. Only rarely is surgery required.

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Patient Education

  • Patient and family education is important. Understanding the mechanism underlying development of rhinosinusitis gives the caregiver much more incentive for the often-arduous task of compliance with medical treatment for a child.
  • With the rising rate of resistant pathogens, educating the public about the proper uses of antibiotics is mandatory. Dispensing antibiotics over the phone or prophylactically is strongly discouraged. Long courses of antibiotics should be based on culture results.
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Contributor Information and Disclosures
Author

Hassan H Ramadan, MD, MSc  Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University

Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Rhinologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Ted L Tewfik, MD, FRCS(C)  Professor, Department of Otolaryngology, Director of Continuing Medical Education of Otolaryngology, McGill University Medical School; Director, Director of Professional Affairs of Otolaryngology, Department of Otolaryngology, Montreal Children's Hospital; Senior Staff, Montreal General Hospital and Royal Victoria Hospital

Ted L Tewfik, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society of Pediatric Otolaryngology, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Gregory C Allen, MD  Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

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Preseptal cellulitis of the left eye. Courtesy of Dwight Jones, MD.
Axial CT scan of subperiosteal abscess of the left eye.
Coronal CT scan of subperiosteal abscess of the left eye.
Coronal CT scan of superior subperiosteal abscess of the left eye.
Axial CT scan of orbital cellulitis of the right eye.
 
 
 
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