title: Rhinosinusitis in children: a comparison of patients requiring surgery for acute complications versus chronic disease.
abstract: BACKGROUND
  Patient characteristics, risk factors, and microbiology are important to consider in the management of complications of acute bacterial sinusitis (ABS) in pediatric patients. This study evaluates this subset of patients and compares them to patients that undergo surgery for chronic rhinosinusitis (CRS).
  
  
  METHODS
  This study is a retrospective review of all pediatric patients from 2002 to 2011, who underwent sinus surgery at a tertiary hospital. Patients who underwent surgery for ABS complication were compared to patients who underwent surgery for CRS. Statistical analysis was completed using chi-square test or Fisher's exact test with a statistical significance set at p<0.05.
  
  
  RESULTS
  Twenty-seven patients with a complication of ABS and 77 patients with CRS were analyzed. The groups did not differ demographically. Patients with a complication were statistically less likely to have seasonal allergies, prior sinusitis, prior nasal steroid use, or adenoidectomy (p<0.05). In addition, they had more frequent involvement of ethmoid and frontal sinuses (p<0.05). The most common cultures results were no growth (30.8%), Streptococcus milleri (30.8%), and normal flora (19.2%) in ABS for the with a complication group, and normal flora (41.5%), coagulase negative Staphylococcus (22%), and Propionobacterium (19.5%) for the CRS group. Most prevalent complications were preseptal cellulitis (55.5%), orbital subperiosteal abscess (29.6%), subgaleal abscess (22%), and epidural abscess (22%). Five patients had simultaneous orbital and intracranial complications.
  
  
  CONCLUSIONS
  Patients who present with complications of ABS vary significantly from the CRS patients. Location of most commonly affected sinuses and microbiology also differ and is crucial for understanding the management of this disease process.
authors: Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
authors: Janalee
authors: J
authors: Stokken
authors: Case Western Reserve University School of Medicine, Cleveland, OH.
authors: Amar
authors: A
authors: Gupta
authors: Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
authors: Paul
authors: P
authors: Krakovitz
authors: Head and Neck Institute, Cleveland Clinic, Cleveland, OH.
authors: Samantha
authors: S
authors: Anne
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications* / Q000382:microbiology / Q000601:surgery*; D012307:Risk Factors; D012852:Sinusitis / Q000150:complications* / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome