1. Complications of rhinosinusitis
Definition
A complication of rhinosinusitis may be defined as any adverse progression of chronic or acute
bacterial infection beyond the paranasal sinuses or compromise in function of any part of the body
due to local or distant effects of the condition.
Classification of complications
1. Acute (local & distant)
Local
Frontal : A subperiosteal abscess may result from an acute episode of frontal rhinosinusitis if
progression of the disease is through the outer table of the skull. This condition is referred to as
Pott’s puffy tumour. If the progress is inward, there may be an acute intracranial complications such
as intracranial abscess or meningitis.
Ethmoid : The most important & frequent acute complication of ethmoid rhinosinusitis is orbital
cellulitis which may vary in degree & severity. Five stage of complications;
1.Preseptal cellulitis; Inflammation does not extend beyond the orbital septum (orbital
periosteal reflection).
2.Orbital cellulitis :Inflammation extends into the tissues of the orbit.
3.Subperiosteal abscess: There is abscess formation deep to the periosteum of the orbital
bone.(between bone & periostum)
4.Orbital abscess: There is abscess formation within the orbit.
5.Cavernous sinus thrombosis/abscess:the inflammation process has extended through the
optic foramen.
Maxillary & sphenoid sinus rarely gives rise to acute local complications.
Distant
Brain abscess, septicaemia, toxic shock syndrome.
2.Chronic
Mucocoeles/pyocoeles
Examination
Clinical endoscopic examination of the nose should be performed to determined the site & extend of
disease.

2. Investigations
Haematological finding
CT & MRI
Treatment
1. Antibiotics will be mainstay of treatment. Accordingly , a regimen of intravenous
cephalosporin with metronidazole would be an appropriate first choice.
2. Nasal decongestant with the aim of facillating the resulation of the underlying rhinosinusitis.
3. Systemic steroid to accelerate the resulation of the inflammatory process.
Initially , medical management should be planned for 24 hours, with frequent monitoring of the
patient over this period. If there is no clinical improvement in the first 24 hours of medical
treatment, surgical intervention should be considered. Additionally, if there is clinical deterioration,
then emergency surgical intervention is likely to be appropriate.
An appropriate combination of ENT surgeons, Paediatricians,Ophthalmologists & Neurologists
should be involved in the management of the patient.