(A934) Meningitis Secondary to Sinusitis in Children: Clinical Features and Outcomes of Surgical vs. Medical Management

Introduction: Meningitis is a rare but serious complication of sinusitis in children, often associated with significant morbidity. This study characterizes the clinical, microbiologic, and epidemiologic features of meningitis secondary to sinusitis and compares outcomes of surgical versus medical management.

Methods: A retrospective single-center chart review was conducted, identifying pediatric cases of meningitis secondary to sinusitis using ICD-9/10 codes from 2008 to 2025. Microbiologic data from cerebrospinal fluid (CSF) and radiologic findings consistent with meningitis were analyzed. Primary outcomes included clinical recovery and complication rates, while secondary outcomes evaluated the roles of endoscopic sinus surgery and medical therapy.

Results: Of 134 charts reviewed, 68 cases met inclusion criteria. The median age was 5 years (IQR: 3–8), with 60.3% male and 39.7% female patients. Fever (85%), headache (76%), and altered mental status (48%) were the most common presenting symptoms.
Endoscopic sinus surgery was performed in 33.8% of cases, while 66.2% received medical therapy alone. Streptococcus anginosus (21.5%) was the predominant pathogen identified, with polymicrobial infections in 12% of cases. The median duration of intravenous antibiotics was 14 days, with surgical patients requiring longer courses compared to non-surgical patients (median: 15 vs. 12 days, p < 0.05). The median hospital stay was 7 days, with longer stays in the surgical group compared to the medical group (median: 9.3 vs. 6.3 days, p = 0.05).

Conclusions: Meningitis secondary to sinusitis in children is associated with substantial morbidity. Streptococcus species are the most common causative pathogens, underscoring the importance of targeted antibiotic therapy. While surgical intervention may necessitate prolonged antibiotic courses, it does not significantly impact hospital length of stay. Management should be tailored based on disease severity and individual patient factors.