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Orbital Complications of Rhinosinusitis in the Adult Population: Analysis of Cases Presenting to a Tertiary Medical Center Over a 13-Year Period.
- Source :
-
The Annals of otology, rhinology, and laryngology [Ann Otol Rhinol Laryngol] 2019 Jun; Vol. 128 (6), pp. 563-568. Date of Electronic Publication: 2019 Feb 21. - Publication Year :
- 2019
-
Abstract
- Background: Orbital complications of rhinosinusitis in adults are scarcely discussed in the literature.<br />Objective: To review our experience with the management of orbital complications of rhinosinusitis in the adult patient population and identify key factors in the characteristics and management of these patients.<br />Design: Retrospective case series during the years 2004 to 2016 in a tertiary referral center including all patients with rhinosinusitis and orbital complications.<br />Main Outcomes and Measures: Severity of complications, risk factors, clinical, imaging and microbiological data, treatment outcomes.<br />Results: Seventy patients were identified. Median age at diagnosis was 38 years. In 57%, complications were associated with acute rhinosinusitis and in 43% with chronic rhinosinusitis, most of whom had a history of previous sinus surgery. Thirty-five percent of patients received antibiotics prior to admission. The majority of the previously operated patients (61%) had some form of orbital wall dehiscence noted on imaging. Preseptal cellulitis was the most common complication (61.5%) encountered, followed by orbital cellulitis (23%), sub-periosteal abscess (11.5%), orbital abscess (3%), and cavernous sinus thrombosis (1.5%). Gram-positive bacteria were more commonly isolated from acute rhinosinusitis patients and gram-negative bacteria from chronic rhinosinusitis (CRS) patients. Complete recovery was noted in all patients, of whom 85% were managed conservatively. All, but 1 patient, with an abscess or cavernous sinus thrombosis required surgical drainage. Older age was the only risk factor identified for severe complications.<br />Conclusions: In contrast to the pediatric population, CRS is very common in adults with orbital complications of rhinosinusitis, with previous sinus surgery and orbital wall dehiscence being noticeably common. Older patients are at risk for more severe complications. Conservative treatment suffices in patients with preseptal and orbital cellulitis. In more advanced stages, surgical drainage is advocated with excellent results. Larger cohort studies are needed to further investigate this patient group.
- Subjects :
- Abscess diagnosis
Abscess drug therapy
Abscess surgery
Acute Disease
Adult
Anti-Bacterial Agents therapeutic use
Cavernous Sinus Thrombosis diagnosis
Cavernous Sinus Thrombosis drug therapy
Cavernous Sinus Thrombosis surgery
Chronic Disease
Drainage
Female
Gram-Negative Bacterial Infections diagnosis
Gram-Negative Bacterial Infections drug therapy
Gram-Positive Bacterial Infections diagnosis
Gram-Positive Bacterial Infections drug therapy
Humans
Male
Orbital Cellulitis diagnostic imaging
Orbital Cellulitis drug therapy
Orbital Cellulitis surgery
Retrospective Studies
Rhinitis drug therapy
Rhinitis microbiology
Rhinitis surgery
Risk Factors
Sinusitis drug therapy
Sinusitis microbiology
Sinusitis surgery
Tertiary Care Centers
Treatment Outcome
Orbital Cellulitis etiology
Rhinitis complications
Sinusitis complications
Subjects
Details
- Language :
- English
- ISSN :
- 1943-572X
- Volume :
- 128
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Annals of otology, rhinology, and laryngology
- Publication Type :
- Academic Journal
- Accession number :
- 30788974
- Full Text :
- https://doi.org/10.1177/0003489419832624