Objective Review cases of complicated sinusitis requiring PICU admission to ascertain demographics, preceding symptoms, sinus involvement, causative organisms, interventions, complications and outcomes.
Methods Retrospective review of case notes from January 2003 to April 2007. Patients identified from the PICU database.
Results Eight patients, 6 females and 2 males, were identified. Median age was 12 years (range 6–15 years). Seven patients presented with symptoms of pyrexia, headache, vomiting, coryza and meningism. Pneumonia was a major presenting feature in 2 cases. Only one patient had otitis media. Five cases involved multiple sinuses and three involved single sinuses. Organisms were identified in 7 cases, all streptococcus species with 3 cases of S. milleri, 1 Group C streptococcus, 2 Group A streptococcus, 1 streptococcus species.75% of patients required intracranial empyema evacuation±antral washouts. Two patients had single and four required multiple interventions. 83% of patients had both neurosurgical and ENT interventions. Complications included 5 cases of seizures, 1 superior sagittal sinus thrombosis, 1 right middle cerebral artery territory infarction and 1 cavernous sinus thrombosis. Outcomes were divided into intermediate and long term with 4 cases of transient hemiparesis, 1 persistent hemiplegia and aphasia. Three cases had no clinical sequelae.
Conclusion Complicated sinusitis can present non-specifically, mainly affecting children over the age of ten. Streptococcus species was the commonest pathogen, in 88% of cases. Sinusitis causes important morbidity with seizures, intracranial empyemas, cerebral infarct, sagittal and cavernous sinus thrombosis as seen in our patients. Prompt diagnosis and treatment may help minimise complications and their sequelae.
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