Orbital Complications of Acute Rhinosinusitis in Adulthood: Predictors of Outcome and Management
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: Orbital infections of acute rhinosinusitis are commonly classified thanks to the Chandler classification and may lead to vision loss or diplopia if not properly managed. While pediatric cases are well documented and their management is supported by clear evidence, data guiding adult management remain limited and fragmented. This study analyzes a large international cohort of patients that evaluates treatment approaches and outcome predictors for orbital complications (OCs) of acute sinusitis in adulthood. METHODS: This multicentric retrospective study included adults with OCs of acute sinonasal infections. Patients were classified using the Chandler classification, with an additional subdivision for pre-septal infections (modified Chandler classification). Clinical, radiologic, and therapeutic data were analyzed, evaluating treatment success, hospital stay, and complications. Predictors of treatment and outcomes were studied (p < 0.05). RESULTS: Among 213 patients (65.3% male, median age 48), 68.2% required surgery, mainly endoscopic (60.7%). Logistic regression identified the presence of additional complications (p = 0.015) and modified Chandler classification (p < 0.001) as the strongest predictors for treatment modality, while sinus opacification and visual impairment lost significance in the multivariate model. Infection resolution after primary treatment was significantly associated with nasal corticosteroid use (p = 0.037). Despite differences in treatment approach and hospitalization duration across modified Chandler categories, no significant differences were observed in final ophthalmologic outcomes. CONCLUSION: This study emphasizes the role of the modified Chandler classification for upfront treatment decisions. Abscess-related and type II OCs often needed surgery, yet all cases achieved similarly optimal ophthalmologic outcomes and final infectious resolution.
Source: The Laryngoscope
DOI: 10.1002/lary.70309
Authors: Alessandro Vinciguerra, Vittorio Rampinelli, Mario Turri‐Zanoni, Marco Ferrari, Marco Valentini, Alberto Daniele Arosio, Federico Raimondi, Florian Chatelet, Stefano Taboni, Davide Mattavelli, Alberto Schreiber, Fabio Sovardi, Matteo Barucco, Lorena Di Girolami, Piergiorgio Gaudioso, Antonio Daloiso, Giulia Danè, Umberto Tanzini, Nicola Tessari, Jessica Zuppardo, Kays Burak Cakir, Yetkin Zeki Yilmaz, Yasar Unlu, Andrea Ronchi, Stefania Gallo, Francesca De Bernardi, Vasileios Chatzinakis, Argyro Leventi, Fabio Pagella, Benjamin Verillaud, Giuseppe Mercante, Apostolos Karligkiotis, Mario Bussi, Cesare Piazza, Alperen Vural, Paolo Castelnuovo, Piero Nicolai, Maurizio Bignami, Christos Georgalas, Iacopo Dallan, Philippe Herman, Paolo Battaglia
Institutions: University of Insubria, Azienda Socio Sanitaria Territoriale Lariana, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, University of Padua, Azienda Ospedale - Università Padova, Ospedale Papa Giovanni XXIII, Université Paris Cité, Hôpital Lariboisière, Policlinico San Matteo Fondazione, Azienda Ospedaliera Universitaria Pisana, IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, Humanitas University, IRCCS Humanitas Research Hospital, Istanbul University-Cerrahpaşa, Istanbul University, Erciyes University, University of Nicosia
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,840
OpenAlex ID: W4417292522