Management Outcome of Acute Complicated Juvenile Rhinosinusitis in a Low-income Setting: A Retrospective Study

Abstract

Neglected or poorly contained viral rhinosinusitis in children younger than 18 years can result in acute complicated bacterial rhinosinusitis which is life-threatening and can lead to morbidity and mortality. To report demographics, the mode of clinical presentation, and management outcome of complicated acute juvenile rhinosinusitis in our environment. This is a retrospective descriptive study of  records of 20 children aged 8-18 years with acute complicated rhinosinusitis hospitalized at the University of Benin Teaching Hospital from January 2015- December 2019. Data recorded included social demographics, clinical presentations, duration of symptoms, diagnostic techniques, therapeutic management, course, and outcome, and days of hospitalization. Data were analysed with SPSS version.20.0. Results were presented in tables and figures. A record of 20 patients aged 8-18 years  were retrieved and  included in this study. The mean age was12.75 ( SD ± 2.88). Male: female ratio was 4:1.More patient presented  in January (4). Symptoms were fever, headache, and rhinorrhoea (100%), eye swelling (30%). Most symptoms occurred within 30 days. Radiological investigation was computed tomography scan. Ethmoid and maxillary sinuses were affected  in 100% of cases. Subdural empyema was the most common intracranial complication in 60%. Otorhinolaryngological and neurosurgical interventions included external frontoethmoidectomy, intranasal antrostomy, and stenting, craniotomy, and abscess drainage in 90% and 75% respectively, and repeated surgeries in 60%. Antibiotics was administered pre and postoperatively. Sixty-five percent of patients spent more than 36 days in the hospital. Management outcome was good for 90% while death occurred in 2(10%). There was a statistical significance between surgical interventions and length of hospital stay (p=0.001) at 95% confidence interval. No patient was immunocompromised. Juvenile complicated acute rhinosinusitis still ravages young lives in our environment. A high index of suspicion and urgent referral is required on the part of primary physicians, and multi-disciplinary efforts of physicians and surgeons for a good outcome.

Keywords: Juvenile, complications, rhinosinusitis, intracranial, management.