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Kenny H. Chan, MD; Tania L. Kraai, MD; Gresham T. Richter, MD; Sharon Wetherall, MD; James K. Todd, MD

Arch Otolaryngol Head Neck Surg. 2009;135(6):538-542.

Objective  To determine the association between toxic shock syndrome (TSS) and rhinosinusitis in children.

Design  Eighteen-year retrospective review of medical records.

Setting  Tertiary children's hospital.

Patients  A total of 76 patients were identified as having TSS. Twenty-three of them were also diagnosed as having either acute or chronic rhinosinusitis, with no other source of infection in 17 cases.

Interventions  Of the 23 patients with TSS and rhinosinusitis, 10 were admitted to the intensive care unit, 4 required pressors, and 6 received surgical intervention. Surgical intervention for sinus disease included bilateral antral lavage in 5 patients and bilateral maxillary antrostomy and ethmoidectomy in 1 patient.

Main Outcome Measures  Patients with TSS and rhinosinusitis were identified using a rigorous set of definitions and detailed data pertaining to history, imaging studies, microbiologic studies, and hospital course.

Results  Correlation of the data revealed 4 patients who met the criteria for proven TSS and proven rhinosinusitis, 2 patients who met the criteria for probable TSS and proven rhinosinusitis, 7 patients who met the criteria for proven TSS and possible rhinosinusitis, and 3 patients who met the criteria for probable TSS and possible rhinosinusitis.

Conclusions  Rhinosinusitis was found to be the primary cause of TSS 21% of the time in this series. Rhinosinusitis should be considered the primary cause of TSS when another site of infection has not been identified. Once the link is made, prompt otolaryngology consultation and sinus lavage should be considered.

Author Affiliations: Departments of Otolaryngology (Drs Chan, Kraai, Richter, and Wetherall) and Pediatrics (Dr Todd), University of Colorado School of Medicine and The Children's Hospital of Denver; Division of Otolaryngology–Head and Neck Surgery, University of New Mexico, Albuquerque (Dr Kraai); Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock (Dr Richter); and Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts (Dr Wetherall).

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