GENERAL
Acute bacterial sinusitis can complicate especially is untreated or if the patient has poor immunity.
Spread can occur to neighbouring structures, namely the eye, the brain, the bone and the skin, and can affect other systems.
ORBITAL COMPLICATIONS.
The separation between the ethmoid sinus and the eye is paper-thin (lamina papyracea).
- ORBITAL CELLULITIS
This is where there is inflammation and swelling of the tissues around the eye.
There is no protruding of the eye and the vision and the range of movement is normal. Management is intravenous antibiotics with or without washing out the sinuses.
This may progress.
- SUBPERIOSTIAL ABSCESS.
This is when there is pus collection in the bony orbit under the periosteal lining.
There is protrusion (proptosis) and the child may have decreases vision and decreased range of movement. Management is surgical to drain the abscess and once again, this may progress.
- ORBITAL ABSCESS AND CAVERNOUS SINUS THROMBOSIS.
The thrombosis occurs when there is spread of infection with blood clotting in the venous cavities in the skull base. Both of these conditions can lead to rapid blindness and death.
INTRACRANIAL (BRAIN) COMPLICATIONS.
- MENINGITIS.
This is when there is infection in the CSF surrounding the brain.
- SUBDURAL EMPYEMA.
There is a spread of pus with collection between the brain and the lining (dura) This needs to be drained.
- BRAIN ABSCESS.
Pus penetrates into the brain tissue often after severe frontal sinus disease. This can be rapidly fatal, and surgery needs to be done as a mater of urgency, draining the brain and the sinuses and obviously ICU and Intravenous Antibiotics.
BONE AND SKIN COMPLICATIONS.
Osteomyelitis (Often frontal) with spread to the skin often with an abscess formation (Potts Puffy Tumour)
Once again, management is urgent with surgery and antibiotics.
OTHER COMPLICATIONS.
This can lead to chronic sinusitis if the acute symptoms have lasted more than three months. The patient may develop decrease in smell and may also have chest problems, such as asthma, bronchitis and pneumonia.
WHEN TO SEEK MEDICAL HELP.
If the patient has severe pain in the head or the sinuses.
Any swelling of the face especially around the eye.
Decreased level of consciousness and confusion.
Decreased vision.
Neck stiffness.
Increased temperature, despite adequate antibiotics.