Medical Treatment of Pediatric Sinusitis Follow-up

Updated: Jan 25, 2017
  • Author: Hassan H Ramadan, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA  more...
  • Print
Follow-up

Further Outpatient Care

See the list below:

  • 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.
Next:

Further Inpatient Care

See the list below:

  • 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.
Previous
Next:

Inpatient & Outpatient Medications

See Medical Care and Medication.

Previous
Next:

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.

Previous
Next:

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.

Previous
Next:

Complications

See the list below:

  • 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.
Previous
Next:

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.

Previous
Next:

Patient Education

See the list below:

  • 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.
Previous