Acute Rhinosinusitis and Outcome of Orbital Infections in Children

Introduction: Orbital infections in children are commonly caused by acute rhinosinusitis (ARS).

Objective: To study the association of ARS with the severity and outcome of orbital infections in children.

Methods: Retrospective cohort study of children presenting to the West Virginia University Hospitals with acute orbital infections over 11 years (August 2011 to August 2022). Patients were divided into 2 cohorts based on presence or absence of ARS. All children had a CT scan of orbits/sinuses performed at time of presentation. Patients’ characteristics, disease severity, treatment, hospital length of stay (LoS), and readmission were collected.

Results: 118 patients were included. Mean age was 7.28 years (range 0.5-18), 55.1% were males. 55.7% had ARS and orbital infections concomitantly vs 44.3% without ARS. There was no age or gender differences between the 2 groups (p=0.43 and p=0.17). Orbital cellulitis (+/- abscess) was more common in the ARS group (67.7% vs 17.3%, p< 0.0001) and Preseptal cellulitis was more common in the non-ARS group (82.7% vs 32.3%, p< 0.0001). LoS was longer in the ARS group (3.6 days vs 1.42 days, p< 0.0001). Patients with ARS were more likely to require IV antibiotics 95.3% vs 54.9%, p= < 0.0001), and more likely to require surgical intervention (23.1% vs 5.8%, p=0.009). Six patients required readmission with 4 of them in the ARS group.

Conclusions: Children presenting with acute orbital infections and ARS tend to have more severe disease requiring higher level of care. Early recognition is important for optimal outcome.