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. 2025 May 20;17(5):e84505.
doi: 10.7759/cureus.84505. eCollection 2025 May.

Trends of Sinusitis-Associated Orbital Cellulitis in Pediatric Patients: A Retrospective Cohort Review

Saleh Khurshied  1 , Hira G Shah  2 , Aisha Babar  3 , Asma Afsar  1 , Muhammad A Zahid  4 , Mehrun Nisa  5
Affiliations

Trends of Sinusitis-Associated Orbital Cellulitis in Pediatric Patients: A Retrospective Cohort Review

Saleh Khurshied et al. Cureus. .

Abstract

Background and objective Orbital cellulitis is mostly associated with sinusitis. The pediatric cases have a peculiar clinical presentation and variability with respect to different factors like season, type of sinus involved, and number of sinuses involved. In this study, we aimed to analyze the trends of sinusitis-associated orbital cellulitis in pediatric patients, which, we believe, would help physicians in managing these patients. Material and methods We retrospectively reviewed the discharge records of 74 pediatric patients treated at the ENT-Head and Neck Surgery Department of the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, between January 2015 and March 2025. The study included only inpatients aged 1-14 years who were diagnosed with orbital cellulitis secondary to associated sinusitis, confirmed by CT findings. Data on patients' demographics, clinical characteristics, month of presentation, type of sinusitis, and sinuses involved were recorded. Trends in the form of results were presented in tables and figures. Results The mean age of the cohort was 7 ± 4.3 years, with 47 (63.51%) being male and 27 (36.49%) female. Out of all the cases admitted, 70 (94.6%) had fever at the time of presentation, 74 (100%) had headache, 74 (100%) had pain, and 74 (100%) had chemosis and periorbital edema. Of the patients, 41 (55.40%) had ophthalmoplegia, 29 (39.19%) had facial edema, and 14 (18.92%) had reduced eyesight. There were 49 (66.22%) known cases of chronic sinusitis. Of the total number of cases, 29 (39.19%) occurred in the winter, 18 (24.32%) in the spring, 17 (22.97%) in the summer, and 10 (13.51%) in the fall. Of the total cases, 23 (31.08%) involved a single sinus, 46 (62.16%) involved two or more sinuses, and five (6.76%) involved pansinusitis. In cases with single sinus sinusitis, the ethmoid was most frequently involved (72.4%). Conclusions We observed that cases of sinusitis-associated orbital cellulitis had a peculiar presentation including headache, discomfort, chemosis, periorbital pain, and fever. Orbital cellulitis was more frequently linked to chronic rhinosinusitis. Orbital cellulitis linked to sinusitis peaked in the winter and spring. The most frequent cause of orbital cellulitis in children was ethmoidal sinusitis. Orbital cellulitis was typically caused by sinusitis involving two or more sinuses.

Keywords: clinical findings; common factors; orbital celluliits; trends analysis; sinusitis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Department of ENT-HNS, Pakistan Institute of Medical Sciences Hospital Islamabad issued approval F.03-04/2025/ENT/PIMS. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Trends with respect to gender of patients with sinusitis-associated orbital cellulitis
Figure 2
Figure 2. Clinical presentation of cases with sinusitis-associated orbital cellulitis
Figure 3
Figure 3. Type of sinusitis in patients with sinusitis-associated orbital cellulitis
Figure 4
Figure 4. Trends of sinusitis-associated orbital cellulitis in different seasons
Figure 5
Figure 5. Number of sinuses involved in sinus-associated orbital cellulitis
See this image and copyright information in PMC

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