Complicated Sinusitis

The ED physician must distinguish common maxillary sinusitis from more severe infections in the ethmoid, sphenoid, and frontal sinuses, which, because of risk of serious complications, may require hospital admission for administration of intravenous antibiotics.

Acute ethmoiditis is most commonly seen in children. It may be complicated by periorbital cellulitis (swelling, erythema, and warmth) and orbital cellulitis (chemosis, proptosis, and gaze disturbance). Sphenoid sinusitis can be occult because of its lack of significant facial drainage and facial tenderness. Headache can be retro-orbital or at the vertex and can also produce infraorbital hypesthesia. Features of acute sphenoid sinusitis include severe, progressive headache (++++), often increasing with activity or coughing, nausea and vomiting (+++), and fever (+++). Patients may not complain of nasal discharge or congestion.

Patients with sphenoid sinusitis often present late with complications (57%), which often produce ophthalmologic symptoms (chemosis, proptosis, ptosis, diplopia, ophthalmoplegia, and decreased visual acuity) or neurologic symptoms (hypoesthesia of the first and second divisions of the fifth cranial nerve, hemiparesis, meningitis, and altered sensorium). Patients may have a vertex headache.

Frontal sinusitis is associated with intracranial abscess and meningitis. Osteomyelitis of the frontal bone (Pott's puffy tumor) is a rare complication of frontal sinusitis characterized by pain and pitting edema over the forehead. The risk of complications is high among immunocompromised patients, individuals with previous history of intracranial surgery, orbital cellulitis, recurrent outpatient failure, and previous inadequate treatment (may mask complications), and those unable to obtain followup. Other complications of frontal sinusitis include cavernous sinus thrombosis and brain or parameningeal abscess.

Causes

• Sinusitis may be caused by a virus, bacteria, allergen, or other factors. If you have immunodeficiency disorders, then you are at higher risk for some types of sinusitis.
• Other infection may cause sinusitis such as fungal infections. These organisms are mostly present in the environment and it may be harmless for healthy people, indicating that the human body has a natural resistance to them. Fungi, such as includes Aspergillus may cause serious illness in people whose immune systems are not functioning properly.
• Chronic inflammation of the nasal passages may also lead to sinusitis. If you have allergic rhinitis or hay fever, then you can develop episodes of acute sinusitis.
• Several factors that may cause vasomotor rhinitis such as includes humidity, cold air, alcohol, perfumes, and other environmental conditions, it also may be complicated by sinus infections.

Symptoms

• Nasal discharge or congestion ++++
• Cough or recent upper respiratory tract infection ++++
• Headache +++
• Facial pain +++
• Tooth or palate pain (common in maxillary sinusitis)

Signs

• Fever +++
• Tenderness over sinuses +++
• Purulent rhinorrhea +++
• Abnormal transillumination of sinuses (frontal or maxillary)

Treatment

• For the treatment of chronic sinusitis, Surgery may be the only alternative. Because studies suggest that majority of patients who undergo through surgery have fewer symptoms and better quality of life. The most common surgery done today is functional endoscopic sinus surgery.
• If you have acute sinusitis, your doctor may recommend decongestants to reduce congestion and antibiotics to control a bacterial infection and also suggest about pain relievers to reduce any pain.