In spite of radical progress in antibiotic therapy, acute ethmoiditis in children is often burdened with numerous complications. During 1994-1997, 16 children between the ages of 3 to 15 were hospitalised in the Department of Otolaryngology at the Regional Hospital in Tarnow because of acute ethmoiditis accompanied by various degrees of blepharoedema (Table 1).

The group consisted of 10 child-ren with isolated ethmoiditis, and 6children with polysinusitis. The cases of isolated ethmoiditis were found in the younger group, whereas the cases of polysinusitis were found in the older group. The diagnoses were assessed on the basis of plain sinus film.

We found ethmoiditis more often in boys (12) than girls (4); collected material complications referred only to the male gender (4 boys).

Treatment was administered using intravenous antibiotics in maximal doses, mucolytics and local vasoconstricting drugs. Constant visual acuity monitoring (twice daily) including eyeground assessment, as well as ultrasonographic and eventually orbit computed tomography examination were applied as routine procedures. Complications were present in 4 children (25%): 3 children had orbit- and 1 intracranial (Table 2).

We found a relation between the duration of pre-hospital symptoms and the occurrence of complications.

In 12 children isolated inflammatory blepharoedema (swelling of the eyelids, particularly the upper one) was present with no other distinct complications. This group of patients was admitted to the hospital briefly and had a short (several days) history of purulent rhinitis, raised body temperature and gradually increasing blepharoedema, which lasted up to one day. Depending on the degree of advancement, oedema was present within one or both eyelids. On ophthalmologic examination restrictions in eye mobility and visual acuity abnormalities were not found. In this group (75% of all patients), conservative medical treatment alone was sufficient.

In 2 children orbit subperiosteal abscesses were present. In both cases they were situated subperiostealy at the medial wall of the orbit with lateral eyeball displacement. Eyelids were swollen and eye rims were diminished. The first patient, a 12 year old boy, was treated successfully (complete resolution of clinical symptoms) with conservative treatment accompanied by visual acuity monitoring and daily ultrasonographic orbit examination. The second, an 8year old boy, in spite of rapid hospitalisation (2nd day after symptom development) and antibiotic treatment had an increase in blepharoedema and high fever persisted. A CT of the head showed inflammatory changes in the left paranasal sinuses and a focal abscess-like change (25x5 mm in diameter) at the medial orbit wall. Surgery of the left maxillary sinus and ethmoidal sinuses was performed.

Orbit phlegmone was discovered in a 13-year old boy. Clinical symptoms included a two-week history of purulent rhinitis, a week of headache, two days of eyelid oedema and painfulness. Ophthalmologic examination revealed a protruding eyeball, restriction of eye mobility in all directions, visual acuity impaired and weakness of pupillary light reflex at the right side. A CT scan of the head revealed inflammatory changes incorporating the right paranasal sinuses and orbit phlegmone displacing the eyeball and compressing the optic nerve at the same side. Surgical treatment was applied, the right frontal sinus and ethmoidal sinuses opened and drained.

In another child, a 15-year old boy, an epidural abscess located in the frontal region of the head was found. The child was admitted to the hospital because of subfebrile body temperature, frontal headache, and weakness, existing for 10 days. A week before, a transient oedema of the left eyelids occurred. Since that moment the boy was treated by family doctor in out-patients clinic. Several hours after the child was admitted to hospital a generalised attack of convulsions accompanied by nuchal rigidity took place. A CT scan of the head showed epidural abscesses located over the left frontal lobe and inflammatory changes in the paranasal sinuses on the same side. An uffenorde operation was performed on the left frontal sinus, and ethmoidal sinuses and maxillary sinus were opened and drained.

A complete resolution of clinical symptoms was achieved in all children and they were discharged without any complaints.

1. Complications of acute ethmoiditis are more common in boys.

2. Surgical intervention is usually necessary in children admitted to the hospital late with imminent or existing complications

3. Visual acuity assessment allows choice of the optimal moment for surgical intervention.