Early Endoscopic Sinus Surgery Versus Antibiotics Alone for Orbital Cellulitis from Acute Rhinosinusitis – A Retrospective Cohort Study

Abstract

Background: Orbital cellulitis is a common complication of sinusitis that can cause blindness, intracranial infection, or even death. The standard treatment of orbital cellulitis from acute rhinosinusitis is to administer antibiotics and closely monitor the visual acuity. In this study, we explored the benefit of early endoscopic sinus surgery to improve the clinical outcome of the patients. Objective: To study the clinical outcomes of orbital cellulitis from acute rhinosinusitis patients who were treated with early endoscopic sinus surgery (within 48 hours after admission) versus antibiotics alone. Methods: We retrospectively reviewed the patients who were admitted to the Otolaryngology Department, Khon Kaen Hospital, Thailand with orbital cellulitis from acute rhinosinusitis from January 2013 to May 2023. The demographic data, treatment received, and clinical outcomes were collected. Results: This study included 77 patients. All patients were treated with empirical intravenous antibiotics. The mean age for all patients was 43.7 years. The most common underlying diseases were diabetes and hypertension. The most common symptoms and signs were periorbital swelling and chemosis. The early endoscopic sinus surgery was performed in 44 patients while 33 patients received antibiotics only. At 48 hours after admission, one patient in the early endoscopic sinus surgery group (2.27%) and 12 patients in the antibiotics-only group (36.36%) had no clinical improvement. The odds ratio of improvement after early endoscopic sinus surgery was 24.57 (95% CI 2.99 to 201.80, p = 0.003). The intravenous antibiotics duration and length of stay were also shorter in the early endoscopic sinus surgery group (p = 0.020 and 0.065, respectively) Conclusions: Early endoscopic sinus surgery in orbital cellulitis from acute rhinosinusitis patients may improve clinical outcomes, shorter intravenous antibiotics duration, and hospital stay.