Complications of Bacterial Rhinosinusitis in Children and their Management

Abstract

Sinus infection can spread through anastomosing veins or by direct extension to close by structures. Orbital complications of rhinosinusitis were categorized by Chandler et al. [2] into five stages according to their severity. Contiguous spread to the oribital area can cause periorbital cellulitis, subperiosteal abscess, orbital cellulitis, and abscess. Orbital cellulitis can complicate acute ethmoiditis if thrombophlebitis of the anterior and posterior ethmoidal veins spreads to the lateral or orbital side of the ethmoid labyrinth. Sinusitis can also spread intracranially, where it can cause cavernous sinus thrombosis, retrograde meningitis, and epidural, subdural, and brain abscesses [2-5]. Orbital symptoms often precede intracranial extension of the infection [5]. Other complications include sinobronchitis, maxillary osteomyelitis, and frontal bone osteomyelitis [6-10]. Frontal bone osteomyelitis often originates from an extending thrombophlebitis. Frontal sinus periostitis can cause outer membrane osteitis and periostitis, which produces a tender, puffy swelling of the forehead. The most common pathogens causing these complications are those seen in acute and chronic rhinosinusitis, depending on the length and etiology of the primary rhinosinusitis. These include Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcos aureus (including methicillin resistant), anaerobic bacteria (Prevotella, Porphyromonas, Fusobacterium and Peptostreptococcus spp.) and Microaerophilic streptococci [5]. Anaerobic bacteria are mostly found in chronic rhinosinusitis and those associated with dental etiology [11]. Early diagnosis of a complication is of prime importance. Diagnosis is assisted by computed tomography (CT) and nuclear isotope scanning. Prevention of these complications is of great importance. This can be accomplished by administering appropriate empiric antimicrobial therapy, obtaining sinus cultures from those who fail to respond to treatment after 2-4 days and those with severe symptoms who do not respond within 48 hours, and the immunocompromised. These cultures