Longitudinal Outcomes in Children Undergoing Surgical Drainage for Orbital and Intracranial Complications of Sinusitis

Introduction: Orbital and intracranial complications of pediatric sinusitis frequently require surgery and hospitalization. Although often considered isolated events without long-term sequelae, their impact on functional and mental health has not been well studied. This study evaluates long-term disability and quality-of-life outcomes in children undergoing surgery for complicated sinusitis.

Methods: We performed a retrospective chart review of pediatric patients who underwent functional endoscopic sinus surgery for complicated sinusitis between 2010 and 2020. Patients without at least 5 years of follow-up or who had surgery for other indications were excluded. Data on infection severity, operations, hospitalization, postoperative treatment, and long-term outcomes—including additional sinonasal surgery and persistent disability—were analyzed. Patients were grouped as intracranial (IC) or non-intracranial complications (NIC), and outcomes were compared.

Results: Thirty-six patients were included (23 male, 13 female), with a mean age of 9.9 years and mean follow-up of 6.8 years. Twenty-two patients were in the NIC group and fourteen in the IC group. The median hospital length of stay was significantly longer for the IC group (17 vs 8 days, p=0.0004). The IC group required more reoperations prior to discharge than the NIC group (57% vs 27.3%), though this was not statistically significant (p=0.15). Only 6 patients were later diagnosed with chronic sinusitis, and only four patients required additional sinonasal surgery after discharge. While not statistically significant, the IC group demonstrated higher rates of long-term issues such as seizures, migraines, visual disturbances, or psychiatric disorders (78.5% vs 50%, p=0.16) and underwent more CT scans (median 3 vs 2, p=0.08) than the NIC group.

Conclusions: These findings suggest that complicated pediatric sinusitis, particularly with intracranial involvement, may have meaningful long-term consequences. This knowledge can aid in proper counseling and longitudinal surveillance of this high-risk population.