University of Pretoria
Title: Complicated Sinusitis
Mashudu Tshifularo is among the best ENT specialists in the country well recognised by his peers as such. He is the first and only Black HOD and Professor in ENT in South Africa who has trained more South African Black local specialists ENT than all 8 Universities combined in ten year period. He is the first doctor to have a patented medical device (middle ear and stapes prosthesis registered with patent office) among all ENT specialists in South Africa. He has published more than 30 articles and is currently busy with his PhD studies with the University of Pretoria.
Objectives: An epidemiological review of complicated bacterial sinusitis among our patients.
Study Design: A prospective case series.
Setting: Tertiary referral center, ENT Dept. University of Pretoria.
Subjects: Eight nine (89) inpatients (65) males and (14) females admitted and treated in our hospital with complicated pan-sinusitis between April 2002 and August 2012.
Results: The mean age was 13 years, with a M:F ratio of 7:1. All patients presented with sporadic first episode of sinusitis occurring within 2 weeks of upper airway infection. The affected age group was mainly pediatric of peri-purbetal age. In almost all patients headache and facial (per orbital) swelling were the main presenting symptoms. 85% were initially referred to other departments; 59.3% (45) Ophthalmology, 18.6% (16) Neurosurgery, 6.7% (9) Pediatrics and only 15.2% (14) directly to ENT (Otorhinolaryngology). 46 (61%) of these patients had intra-cranial complications confirmed on Computed Tomography (CT) scan and were managed in consultation with the neurosurgeons and ophthalmologists. There were no major iatrogenic complications reported. Staphylococcus species were the most organisms isolated, 50% of the pus swab had a negative culture. Medical treatment based on culture and sensitivity together with surgical drainage as a multidiscipline approach achieved good outcome.
Conclusion: Complications of bacterial sinusitis is a common problem in the pediatric age group in this community, with males more affected than females. A high index of suspicion of complicated sinusitis in any adolescent with orbital, facial or frontal swelling associated with headache. A high resolution contrasted Computed Tomography (CT) scan is mandatory for exclusion of complicated sinusitis.
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