Zloczower Elchanan, Pansky Itay, Lasry Batel, Sapir Aviad, Samin Michael, Hazan Itai, Freidrich Lior, Gluck Ofer, Cohen Oded, Ziv Oren
Department of Otorhinolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Clin Otolaryngol. 2025 Sep;50(5):864-870. doi: 10.1111/coa.14329. Epub 2025 May 20.
Approximately 6%-8% of children diagnosed with acute rhinosinusitis (ARS) would experience complications, primarily periorbital or orbital complications (OC). Both conservative and surgical management have been shown to be successful, and the choice of proper management depends on the presentation and the surgeon's discretion. The objective of this study was to describe the long-term outcomes of each modality on future ARS episodes, with or without OC.
This retrospective study included patients < 16 years old with OC-ARS admitted to a tertiary hospital from 2002 to 2019. Patients were divided into groups based on treatment: conservative and surgical. Outcomes measured included recurrence of ARS, OC-ARS and future hospitalisations or surgeries due to ARS over a 5-year follow-up period.
Among 213 children diagnosed with OC-ARS, 192 (90.1%) were treated conservatively and 21 (9.9%) surgically. Most surgeries were performed endoscopically (16/21, 76.2%). Surgically treated children were older and had significantly higher rates of proptosis, impaired eye movement and higher Chandler scores at presentation (p = 0.034, p < 0.001, p < 0.001, p < 0.001, respectively). Overall, recurrent ARS rates were 10.3%, with significantly higher rates in the surgical group compared with the conservative group (28.6% vs. 8.3%, p = 0.012). While the surgical group did not have a significantly shorter interval to recurrence compared with the conservative group (8 vs. 15 months, p = 0.8), a significant risk reduction over time was observed (OR 6.22 and 3.71 after 1 and 5 years, respectively, p < 0.005).
Most children with OC-ARS recover fully without future sequela. However, children that needed surgical treatment during the acute phase of OC-ARS, are at greater risk for future ARS episodes, particularly within the first-year post-surgery.
约6%-8%被诊断为急性鼻-鼻窦炎（ARS）的儿童会出现并发症，主要是眶周或眼眶并发症（OC）。保守治疗和手术治疗均已证明有效，恰当治疗方式的选择取决于临床表现和外科医生的判断。本研究的目的是描述每种治疗方式对未来ARS发作（无论有无OC）的长期结果。
这项回顾性研究纳入了2002年至2019年在一家三级医院住院的16岁以下患有OC-ARS的患者。根据治疗方法将患者分为两组：保守治疗组和手术治疗组。测量的结果包括ARS复发、OC-ARS以及在5年随访期内由于ARS导致的未来住院或手术情况。
在213例被诊断为OC-ARS的儿童中，192例（90.1%）接受了保守治疗，21例（9.9%）接受了手术治疗。大多数手术是在内窥镜下进行的（16/21，76.2%）。接受手术治疗的儿童年龄较大，就诊时眼球突出、眼球运动障碍的发生率以及Chandler评分显著更高（分别为p = 0.034、p < 0.001、p < 0.001、p < 0.001）。总体而言，ARS复发率为10.3%，手术组的复发率显著高于保守组（28.6%对8.3%，p = 0.012）。虽然手术组与保守组相比复发间隔时间没有显著缩短（8个月对15个月，p = 0.8），但随着时间推移复发风险显著降低（分别在1年和5年后风险比为6.22和3.71，p < 0.005）。
大多数患有OC-ARS的儿童可完全康复且无后遗症。然而，在OC-ARS急性期需要手术治疗的儿童，未来发生ARS发作的风险更高，尤其是在术后第一年。
