This week on the BackTable ENT podcast, Dr. Gopi Shah and Dr. Amanda Stapleton, a pediatric otolaryngologist from UPMC Children's Hospital of Pittsburgh, chat about the unique challenges of treating pediatric sinus and skull base diseases, orbital complications, and biofilm-covered Moraxella. They discuss source control, biofilm, and her research focused on the bacteriology of pediatric chronic sinusitis and patients with cystic fibrosis.

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SHOW NOTES

First, they discuss how to recognize the signs and symptoms of pediatric patients who present with orbital or intracranial abscesses and how age and location of the abscess can influence treatment decisions. They also explain how to distinguish between intracranial and orbital abscesses and how to recognize the symptoms of sphenoid sinusitis. Both doctors emphasize the importance of involving infectious disease colleagues to evaluate antibiotic coverage and surgical indications.

Next, the doctors discuss the techniques for sinus surgery, including the use of a scope for visualization, warm irrigations, navigation, and augmented reality systems in the acute setting. Dr. Stapleton also provides tips on when to remove a middle turbinate and the importance of source control, especially in patients under the age of seven. An adenoidectomy may be necessary if the patient has had multiple colds throughout the winter and the decision is made to take down the lamina to drain an abscess pocket.

Finally, the doctors discuss the follow up process for children with chronic sinusitis, which may include office endoscopy and allergy testing, and discuss the rare cases of intracranial abscesses. In addition to being vigilant and proactive in monitoring the potential for repeat infections, imaging to detect any scarring or residual mucosal inflammation that might have resulted from the initial infection is also helpful.