title: Orbital sequelae of rhinosinusitis after cochlear implantation in children.
abstract: OBJECTIVE
  The objectives of this retrospective case review were to describe orbital complications in children after cochlear implantation, to define rhinosinusitis as a possible preoperative risk factor, and to suggest a possible pathophysiological mechanism for this previously unreported occurrence.
  
  
  METHODS
  Records of children undergoing cochlear implantation over a 7-year period at a tertiary academic medical center were reviewed. Four children who experienced postoperative orbital sequelae were identified. We describe the demographics, clinical course, and radiologic findings in these children.
  
  
  RESULTS
  The records of 91 children who underwent cochlear implantation were reviewed. The mean age was 6.0 years (range, 0.9-16.9 years). Forty-nine children (54%) were female and 51 (56%) were white. Four children developed postoperative orbital complications on the ipsilateral side to implantation. Orbital complications were characterized by periorbital edema and preseptal cellulitis necessitating prolonged hospitalization in all four children (mean length of stay, 3.3 days). Each child's orbital complication resolved with medical therapy that included intravenous antibiotics and nasal saline. Temporal bone images before implantation showed evidence of rhinosinusitis in all four cases. Of 76 available preoperative scans from the unaffected children, only 11 (14%) studies showed evidence of rhinosinusitis.
  
  
  CONCLUSIONS
  Children with preoperative radiologic evidence of rhinosinusitis may be at risk of orbital sequelae after cochlear implantation. Positioning of the patient during surgery, length of surgery, and minor trauma to the lamina papyracea during drilling of the mastoid may be important etiologic factors. A careful review of medical history and computed tomography imaging before implantation may identify at-risk children.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Virginia Commonwealth University Medical Center, Richmond, VA, USA. emilyrudnick@yahoo.com
authors.forename: Emily F
authors.initials: EF
authors.lastname: Rudnick
authors.forename: Michael W
authors.initials: MW
authors.lastname: Chu
authors.forename: Aristides
authors.initials: A
authors.lastname: Sismanis
authors.forename: Kelley M
authors.initials: KM
authors.lastname: Dodson
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D002481:Cellulitis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009916:Orbital Diseases / Q000188:drug therapy / Q000209:etiology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012852:Sinusitis / Q000150:complications*