Association of adenoid size and systemic immune-inflammation index with the severity of orbital complications in pediatric acute bacterial rhinosinusitis.

PURPOSE: To evaluate the relationship between adenoid size, systemic immune-inflammation index (SII), and the severity of orbital complications in pediatric acute bacterial rhinosinusitis.

METHODS

A retrospective analysis was conducted on 51 pediatric patients hospitalized with orbital complications of acute bacterial rhinosinusitis between 2011 and 2025. Demographic characteristics, length of hospital stay, adenoid-to-nasopharynx (A/N) ratio, computed tomography findings, and laboratory parameters were analyzed. Patients were classified as having preseptal or postseptal complications.

RESULTS

The median age was 8 years (range, 1-18), and 58.8% were male. Preseptal cellulitis was observed in 56.9% of patients, while 43.1% had postseptal complications. The A/N ratio was significantly higher in the postseptal group (0.63 vs. 0.55, p = 0.012), as was the length of hospital stay (15 vs. 7 days, p < 0.001). SII values were similar between groups (p = 0.238), but correlated with C-reactive protein levels and hospitalization duration (p < 0.05). The A/N ratio showed moderate discriminative ability (AUC = 0.72; cut-off: 0.60).

CONCLUSION

A higher A/N ratio may be associated with more severe orbital complications and prolonged hospitalization in pediatric acute bacterial rhinosinusitis. It may serve as an adjunctive radiologic marker for risk stratification, whereas SII appears to reflect systemic inflammatory burden without predicting complication severity.