Complications
Infection from any of the four sinuses can spread into the orbit through direct extension. Orbital complications are an emergency and require otolaryngological, and usually ophthalmological, consultation.
Patients will initially experience orbital swelling and pain that may progress to visual changes (diplopia or blindness) and cranial neuropathies.[63]
Orbital complications (Chandler classification, in order of severity) include preseptal cellulitis, subperiosteal abscess, orbital cellulitis, orbital abscess, and, finally, cavernous sinus thrombosis.[63]
Computed tomography scan of orbits with contrast is obtained and intravenous antibiotics are started immediately. Preseptal cellulitis can be treated with intravenous antibiotics. Abscesses will require surgical drainage. Endoscopic endonasal drainage is usually adequate but may require ophthalmological assistance. Suspicion of cavernous sinus thrombosis requires neurosurgical involvement.
Infection can spread into the intracranial cavity and cause meningitis, epidural abscess, subdural abscess, and brain abscess. These patients will have mental status changes, possibly with cranial neuropathies. Otolaryngological and neurosurgical consultation should be obtained. Computed tomography (CT) scan of the sinuses, in addition to CT of the brain with contrast, should be performed.
Meningitis can be treated with intravenous antibiotics; however, other intracranial complications usually require surgical intervention with abscess drainage. The involved sinuses should also be surgically drained to hasten resolution and prevent recurrence by appropriately dealing with the source of the infection. Craniotomy may be required to remove intracranial infection. These patients require intensive care unit care.
This results from longstanding blockage of mucus outflow. The benign, expansile lesions grow slowly and cause displacement of surrounding bone and structures (such as the brain and orbit). They occur most frequently in frontal sinuses followed by sphenoid sinuses. Surgical drainage is required.
Patients report poor quality-of-life scores at baseline, even worse than those in other chronic diseases.[5] It is important to take this into account when managing chronic rhinosinusitis and treat aggressively.
Recurrent acute exacerbations of chronic rhinosinusitis often occur. Symptoms are similar to long-standing nasal complaints, but worsen acutely and resemble the more pronounced symptoms of an acute bacterial rhinosinusitis (often with fever and toxicity). Treatment is with antibiotics. If there are recurrent acute exacerbations, culture-directed therapy should be considered based on endoscopically obtained samples from the middle meatus.
Can be considered an acute or long-term complication. Patients with longstanding or frequent recurring bacterial rhinosinusitis are more susceptible to developing infection in the surrounding bone. Osteomyelitis should be treated with long-term antibiotics.
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