Acute Bacterial Rhinosinusitis Complications

What are the complications of acute sinusitis? Let’s find out the complications of sinus infection!

Sinusitis Complications

Acute bacterial sinusitis complications – Local complications of acute bacterial rhinosinusitis include orbital cellulitis and abscess, osteomyelitis, cavernous sinus thrombosis, and intracranial extension.

Orbital complications typically occur by extension of ethmoid sinusitis through the lamina papyracea, a thin layer of bone that comprises the medial orbital wall. Any change in the ocular examination necessitates immediate CT imaging. Extension in this area may cause orbital cellulitis leading to proptosis, gaze restriction, and orbital pain.

Select cases are responsive to intravenous antibiotics, with or without corticosteroids, and should be managed in close conjunction with an ophthalmologist, otolaryngologist, or both. Extension through the lamina papyracea can lead to subperiosteal abscess formation (orbital abscess). Such abscesses cause marked proptosis, ophthalmoplegia, and pain with the medial gaze.

While some cases respond to antibiotics, such findings should prompt an immediate referral to a specialist for consideration of decompression and evacuation. Failure to intervene quickly may lead to permanent visual impairment and a “frozen globe.”

Osteomyelitis requires prolonged antibiotics as well as the removal of necrotic bone. The frontal sinus is most commonly affected, with bone involvement suggested by a tender forehead swelling (Pott puffy tumor). Following treatment, secondary cosmetic reconstructive procedures may be necessary.

Intracranial complications of sinusitis can occur either through the hematogenous spread, as in cavernous sinus thrombosis and meningitis, or by direct extension, as in epidural and intraparenchymal brain abscesses. Fortunately, they are rare today.

Cavernous sinus thrombosis is heralded by ophthalmoplegia, chemosis, and visual loss; MRI most commonly confirms the diagnosis. When identified early, cavernous sinus thrombosis typically responds to intravenous antibiotics. Frontal epidural and intracranial abscesses are often clinically silent. Still, they may present with altered mental status, persistent fever, or severe headache.

When sinusitis won’t go away

When to see a doctor for sinusitis? Suppose acute bacterial rhinosinusitis doesn’t disappear after a full course of oral antibiotics. In that case, it needs to be checked out by an otolaryngologist. Endoscopic cultures may help doctors decide how to treat the patient next. When symptoms last longer than 4 to 12 weeks, nasal endoscopy and CT scan are needed. Any patient who might have a disease outside of the sinuses should be seen as soon as possible by an otolaryngologist and have imaging done.

When is sinusitis dangerous?

• Face swelling and redness are signs of cellulitis on the face.
• Proptosis.
• Changes in vision or an unusual way of looking are signs of orbital cellulitis.
• Involvement of an abscess or a cavernous sinus.
• Changes in mental status that point to intracranial extension.
• Immunocompromised status.
• Failure to respond to appropriate first-line treatment or symptoms persisting longer than 4 weeks.

That’s an explanation of complications of sinusitis. So I hope you can understand acute bacterial rhinosinusitis complications.