Complications of Sinusitis

25 Complications of Sinusitis


25.1 Complications of Acute Sinusitis


• Divided into orbital (60–75%), intracranial (15–20%), and osseous (5–10%) complications


• Sinus disease accounts for:


figure 10% of intracranial suppuration


figure 10% of pre-septal orbital infection


figure 90% of post-septal orbital infection


• Incidence of complications:


figure 2.7 to 4.3 per million (intracranial complications)


figure 2.5 per million adults (all acute rhinosinusitis (ARS) complications)


figure 1 per 12,000 ARS episodes (children)


figure 1 per 36,000 ARS episodes (adults)


• More common during winter months


• Males > females


• Antibiotics for ARS do not change the incidence of complications


25.1.1 Orbital Complications


• Most common type of complication


• Associated with ethmoid, maxillary, frontal, sphenoid in reducing frequency


• Chandler classification (Fig. 25.1)


figure I—pre-septal cellulitis (strictly speaking, outside the orbit)


figure II—orbital cellulitis


figure III—subperiosteal abscess


figure IV—orbital abscess


figure V—cavernous sinus thrombosis (again, not “orbital,” and not necessarily the end stage of orbital infection)


• An ophthalmology review is mandatory


• IV antibiotics covering aerobic and anaerobic organisms


• Presence of ophthalmoplegia, loss of red–green vision/visual acuity—CT with contrast required → surgical drainage


• No improvement/deterioration after 48 h IV antibiotics → surgical drainage


• CT appearance:


figure Subperiosteal abscess:


– Medial rectus oedema


– Lateralization of medial rectus/periorbita


– Globe displacement inferolaterally


figure Orbital abscess:


– Loss of detail of extraocular muscles/optic nerve


– Possible orbital air


• Surgical drainage should also include addressing the adjacent sinuses


• Some evidence to suggest in small children with subperiosteal abscesses IV antibiotics sufficient if:


figure Improving over 48 h


figure Normal visual acuity


figure <1 mL volume, medial location


figure <4 years of age


figure Systemically well


25.1.2 Intracranial Complications


• Spread from sinuses through diploic veins or directly through bone erosion


• Often involve anaerobic or mixed aerobic/anaerobic organisms


• These include:


figure Epidural, subdural, cerebral abscesses


figure Meningitis, encephalitis


figure Superior sagittal, cavernous sinus thrombosis


• Symptoms:


figure Nausea and vomiting


figure Neck stiffness


figure Altered mental state


figure Focal neurological deficits


figure Headache


• Investigations


figure CT scan with contrast—bone erosion


figure MRI—soft tissue involvement, cavernous sinus thrombosis


figure Consider lumbar puncture


• Treatment


figure Long-term, high-dose IV antibiotics


figure Craniotomy and abscess drainage


figure Endoscopic drainage of sinuses


figure MC&S of pus, biopsy of abnormal tissue


25.1.3 Cavernous Sinus Thrombosis


• Venous drainage of paranasal sinuses to cavernous sinus—allows haematogenous spread of infection



figure
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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Complications of Sinusitis

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