JOSEPH R. ANTICAGLIA MD
Medical Advisory Board
Rhinosinusitis is an infection or inflammation of the nose and sinus. Since the introduction of antibiotics, the incidence of rhinosinusitis has decreased dramatically over the years. With the abuse of antibiotics, using them in cases where they are not indicated, there has been an alarming increase in the appearance of superbugs. The antibiotics that once worked against bacteria of certain infectious diseases no longer work against these superbugs. Antibiotics have been abused in the treatment of sinusitis. In view of this, clinicians are becoming more concerned about the uncommon, but potential devastating complications of sinusitis.
Three main complications of sinusitis:
- Orbital
- Intracranial
- Bony
Orbital Complications:
The orbit (eye socket) is in close proximity to the paranasal sinuses. A paper thin bone separates the eye socket from the ethmoid sinus. The orbit is the most common location where complications secondary to sinusitis occur and acute ethmoid sinusitis is a frequent cause of orbital complications.
The eyelids can initially become red and swollen. When the sinusitis spreads to involve the eye muscles, patients can complain of pain and double vision. If the complication progresses, an abscess can form with decreased vision of particular concern and if the complication continues, blood vessels may become blocked with dire consequences (e.g. “cavernous sinus thrombosis”).
Intracranial Complications:
Intracranial complications tend to be associated with chronic rhinosinusitis possibly because it eats away the bony protection of the sinus wall or it causes changes in the lining of the sinuses that prevent antibiotics from working optimally. Other causes of intracranial complications are sinus fractures that do not heal completely or complications from sinus surgery.
Meningitis:
The brain is covered by three layers of tissue called the meninges. Rhinosinusitis can spread to the brain causing an inflammation of the meninges (“meningitis”). Patients complain of fever, headache, nausea — vomiting, confusion, and stiff neck.
Brain Abscess:
Rhinosinusitis can also spread through the natural weakness and openings of the bone to the brain causing a brain abscess and cavernous sinus thrombosis.
Bony Complication:
Acute sinusitis has a tendency to break down the architecture of the bone making it more susceptible to infections. Frontal sinusitis can infect the forehead bone with pus (‘frontal osteomyelitis’) causing deformity of this bone (“Potts’ Puffy Tumor”).
Sense of Smell:
Complications of rhinosinusitis can adversely affect the olfactory nerve resulting in a decrease in the sense of smell, at times permanently.
Mucocele:
A mucocele is a secreting, cyst-like mass (it’s like a balloon filled with snought that keeps on enlarging) caused by blockage of the sinus openings preventing mucus getting into the nasal cavity. It slowly increases in size causing pressure and thinning of the sinus walls. If it becomes infected with pus, it’s called a “pyocele.”
Conclusion
Complications from rhinosinusitis have decreased remarkably since the advent of antibiotics. Yet, when complications occur they can have horrible consequences. Surgical intervention may be needed to drain abscesses and/or open blocked sinuses. CT and MRI are useful from diagnostic and treatment standpoints.
Encourage your physician to consider consultations with specialists in infectious disease, ophthalmology and neurosurgery in the management of the three main complications of surgery.
References:
Viet Pham et al; Complications of Rhinosinusitis; UTM; Dept. of Otolaryngology; April 22, 2011
Otolaryngology–Head & Neck Surgery; Rosenthal, Richard M.et al; Clinical Practice Update, Adult Sinusitis; April, 2015.