Complications Of Acute Bacterial Rhinosinusitis Research Articles

Complications of Acute Bacterial Rhinosinusitis in Contemporary Practice: Lessons Learnt and the Way Ahead.

There are variable presentations of complications of rhinosinusitis, which may be subtle especially due to use of antibiotics. Thus the classical picture as described by Chandler is rarely seen and threshold for diagnosing and treating a complication should be low. To identify possible risk factors for development of complications in acute bacterial rhinosinusitis (ABRS) and suggest a new method of reporting/classifying the complications. We conducted a retrospective study and observed the clinical presentation and risk factors of 9 patients who presented with complications of ABRS in our OPD during a period of 6years, and then tried to formulate a reporting method based on the risk factors. We identified certain risk factors which include age, gender, sinus involved, extension beyond sinus, history of trauma, anatomical variations, and duration of symptoms. There are possible risk factors for development of complications. These factors can be studied in further details to ascertain their causal relationship in causing these complications. We also suggest a new method of reporting the complications. Such a reporting system would help in accurately identifying the exact severity of the disease, prognosticating the disease and guide treatment.

Complications of Acute Bacterial Rhinosinusitis in Children: A Single Tertiary Care Center

Complications of Acute Bacterial Rhinosinusitis in Children: A Single Tertiary Care Center

Bilateral Longus Colli Abscesses as a Complication of Advanced Bacterial Rhinosinusitis.

Known complications of acute bacterial rhinosinusitis include retropharyngeal abscess, cavernous sinus thrombosis, intracranial abscess, and associated sequelae. We describe the case of a patient with longus colli abscess formation resulting from acute pansinusitis, complicated by bilateral cavernous sinus thrombosis in the setting of concurrent viral pneumonitis, severe sepsis, and a large area cerebral infarction. The bilateral longus colli abscesses were drained via stereotactic image-guided endonasal sinus surgery, yielding Staphylococcus hominis in culture. The described disease progressed rapidly over a 2-week course amid the COVID-19 pandemic.

Cost comparison between surgical and conservative management for pediatric sinogenic subperiosteal abscesses

BackgroundThere remains variation in management of orbital complications of acute bacterial rhinosinusitis (ABRS); specifically, those subperiosteal abscesses that present without immediate surgical indication. Recent systematic reviews on management and proposed treatment algorithms are helpful but do not consider the financial implications for healthcare systems and patients. MethodsA retrospective chart review of pediatric patients from a tertiary care children's hospital between 2002 and 2020 was performed, identifying patients via ICD coding corresponding to acute bacterial sinusitis and orbital involvement classified as Chandler 3 confirmed by contrasted computed tomography (CT). Two groups of patients were identified: intravenous (IV) antibiotics alone and IV antibiotics plus surgery. Billing records of total hospital charges and physician fees were recorded for financial analysis. Demographic, length of stay, and charges were analyzed. Results58 patients with ABRS and Chandler 3 orbital involvement were confirmed by CT imaging. Twenty-nine (50%) were treated with IV antibiotics alone, and twenty-nine (50%) underwent surgery in addition to IV antibiotics. There were no significant differences in patient demographics. The average total hospital charges for the medically managed group were $9262 ± 4831 compared to $30,830 ± 11,397 for the surgical group (p < 0.0001). In the medically managed group, the average hospital fees were $7305 ± 4048 and the average physician fees were $1543 ± 799. In the surgical group, the average hospital and physician fees were also significantly higher at $23,071 ± 7305 (p < 0.0001) and $7763 ± 3335 (p < 0.0001), respectively. Patients who were treated medically and had a longer than average LOS still had significantly fewer charges than those treated with antibiotics plus surgery and a shorter than average length of stay [$15,311 and $27,723, respectively (p = 0.02)]. ConclusionPediatric ABRS with orbital involvement requires prompt attention and management. Controversy persists over subperiosteal abscess management that present without overt surgical indications. Surgical intervention is expensive. Our subgroup analysis demonstrates the magnitude of this cost difference. Specifically, longer inpatient stays with IV antibiotics alone appear to be significantly cheaper than shorter ones that include surgery. Not all Chandler 3 patients are candidates for non-surgical management; however, clinicians are encouraged to keep these data in mind for those patients where further medical management is safe and may yield less expensive clinical resolution.

Complications of Acute Bacterial Rhinosinusitis in the Pediatric Population

AbstractAcute complicated sinusitis can occur in children and can lead to significant morbidity and mortality. While medical management is critical, it is important to provide multi-disciplinary care to involve surgical specialists. Since intracranial and extracranial complications can result from acute sinusitis, active communication among all these specialists is paramount to achieve the best patient outcomes. Children with these conditions are best managed at centers where appropriate pediatric medical and surgical subspecialty care is available.

Intracranial Complications of Acute Sinusitis on Brain CT

This 35-year-old woman presented to a peripheral hospital Accident and Emergency department in a moribund state. She was intubated, stabilized and transferred urgently to a tertiary centre. She had attended the hospital in the prior week with a diagnosis of sinusitis.&#x0D; An urgent CT brain was requested by the attending A and E officer which was undertaken on the basis of her low Glasgow coma scale (GCS). The paranasal sinuses were partially visualised on this investigation.&#x0D; Acute bacterial rhinosinusitis is a common disease presenting to both general practitioners and ENT surgeons. It is on the most part short-lived in duration responding to antibiotics and symptomatic medications. Rarely it may be associated with severe life threatening complications, in the form of intra-orbital extension or even less so intracranial complications. These typically occur in the pediatric and young adult population.1&#x0D; Cross-sectional imaging plays an essential role in the assessment of this small sub-set of patients and is largely and almost always in the first instance with CT.2 Computed Tomography is broadly available, even out of standard working hours, and facilitates the review of potential intracranial complications and thereby guide neurosurgical management. Given that a proportion of the paranasal sinuses are always visualised on a CT brain it is an important review area, especially in patients with sepsis.&#x0D; There are a number of well recognized intracranial complications of acute rhinosinusitis which include; meningitis, cerebral abscess, subdural empyema, cavernous sinus and dural venous thrombosis.3 Additional sequelae from the intracranial infection may result, such as arterial territory cerebral infarction, ventriculitis and hydrocephalus. &#x0D; Those patients in whom intracranial extension occurs often demonstrate bony destruction of the sinuses on imaging. Disease involving the frontal sinus is typically associated with intracranial complications, through foci of bony dehiscence or osteomyelitis involving the floor of the anterior cranial fossa.3 &#x0D; In this case the patient presented in a moribund state due to severe intracranial complications following failed treatment in the community. The initial CT imaging identified subdural collections (Figure 1a and 1b) as well as pan-sinusitis (Figure 2) and the suggestion of an arterial territory infarct (Figure 1a). The frontal sinus however was not involved in this instance.&#x0D; A complete CT study of the paranasal sinuses (with a dedicated paranasal sinuses protocol) is merited including isotropic reconstructions to review the bony integrity and aid the planning of ENT surgical intervention. An MRI brain if available would eloquently confirm the CT findings including confirmation of the acute parietal lobe infarct.4&#x0D; Neurosurgical drainage of the subdural empyemas was undertaken. Furthermore, functional endoscopic sinus surgery (FESS) was also performed with drainage of a large volume of pus from the sphenoid, ethmoidal and right maxillary sinuses.4&#x0D; This case demonstrates intracranial complications are not an entity unique to the paediatric population. When caring for patients with acute sinusitis always have a high index of suspicion for these potential complications and have a low threshold for engagement with radiology colleagues for imaging if concerned. &#x0D; &#x0D; REFERENCES&#x0D; &#x0D; Sultész M, Csákányi Z, Majoros T, Farkas Z, Katona G. Acute bacterial rhinosinusitis and its complications in our pediatric otolaryngological department between 1997 and 2006. Int J Pediatr Otorhinolaryngol. 2009 Nov;73(11):1507-12. DOI: 10.1016/j.ijporl.2009.04.027 PMID: 19500861&#x0D; Dankbaar JW, van Bemmel AJM, Pameijer FA. Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging. 2015 Oct; 6(5): 509–518. doi: 10.1007/s13244-015-0424-y PMCID: PMC4569601&#x0D; Osborn MK, Steinberg JP. Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 2007 Jan;7(1):62-7. DOI: 10.1016/S1473-3099(06)70688-0 PMID: 17182345&#x0D; Bickle IC. Intracranial complications of acute sinusitis. Case rID: 45559. Created 30 May 2016 in Radiopaedia.org ©2005-2017. [Cited 2017 June 13] Available from: https://radiopaedia.org/cases/intracranial-complications-of-acute-sinusitis.&#x0D;

Complications of sinusitis.

Sinusitis is a common disorder associated with significant patient symptomatology that adversely affects quality of life. Sinusitis can cause further morbidity and mortality through its impact on comorbid disorders, progression of inflammation, and extension of infection. This review highlights common complications of acute bacterial rhinosinusitis (ABRS) and chronic rhinosinusitis (CRS). ABRS is complicated by orbital infections, such as pre- or postseptal cellulitis, and by intracranial infections, including abscesses of the epidural and subdural spaces. CRS can contribute to asthma, sleep disordered breathing, and smell disorders. CRS can be complicated by development of allergic fungal rhinosinusitis or deformity of surrounding bony structures. Fungal complications contribute to morbidity and mortality. Complications of ABRS, although relatively rare, can cause significant morbidity and mortality, and must be promptly recognized. CRS commonly complicates or drives comorbid diseases, which adversely impacts quality of life. Treatment of these complications often requires coordinated multidisciplinary care.

Acute rhinosinusitis. The role of topical therapy

Rhinosinusitis is one of the most common diseases in clinical practice in relation to which which patients seek doctor's aid. The vast majority of acute rhinosinusitis is caused by viral agents with tropism to respiratory epithelium. In case of mild to moderate disease (mild pain, temperature less than 38.3° C), symptomatic treatment includes topical antibiotics, decongestants, topical corticosteroids, irrigation and elimination therapy. Antibacterial broad-spectrum drugs such as amoxicillin are recommended for patients whose symptoms do not improve within 7 days, or whose condition worsens. Radiographic studies are not recommended in examination for acute uncomplicated rhinosinusitis. Computed tomography also should not be used as a routine method of examination, though it can be used to identify anatomic abnormalities and suspected complications of acute bacterial rhinosinusitis, such as orbital, intracranial lesions and lesions of bone structures. Using compound topical preparations with a broad spectrum of anti-bacterial, anti-inflammatory and vasoconstrictor effects can help adequately manage uncomplicated forms of acute viral, postviral and bacterial sinusitis.

Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis.

In patients with acute bacterial rhinosinusitis severe orbital and intracranial complications can occur. This review will illustrate the anatomic relationship between the paranasal sinuses and the orbital and intracranial compartments. Subsequently, the spectrum of orbital and intracranial complications of rhinosinusitis and related imaging findings will be discussed and illustrated by case material from daily practice.Teaching Points• Acute bacterial rhinosinusitis can cause severe orbital and intracranial complications.• If orbital or intracranial complications are suspected, cross-sectional imaging is mandatory.• Infection can spread from the ethmoid sinus to the orbit through the lamina papyracea.• Frontal sinusitis can spread intracranially through dehiscences or osteomyelitis.• Radiologists must recognize imaging findings of complications of acute bacterial rhinosinusitis.

Prepontine Epidural Abscess

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Management of acute bacterial rhinosinusitis.

Acute bacterial rhinosinusitis is an infection of the nasal epithelium and paranasal sinus mucosa, usually caused in children by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and, less frequently, group A Streptococcus species. The clinical diagnosis is based on daytime cough that may be worse at night or purulent rhinorrhea, or both, lasting at least 10 days, often worsening after a period of initial improvement after initial symptoms of the common cold, and often associated with facial or dental pain, facial fullness, or swelling, headache, and fever. Sinusitis is diagnosed clinically; radiographic evaluation is not indicated for diagnosis. When the disease persists despite treatment, or is complicated by potential intracranial or orbital extension, CT is the preferred imaging modality. Initial therapy should be amoxicillin in a high dosage (80-90 mg/kg/day). Treatment is generally for 10 to 14 days and for at least 7 days beyond the time of substantial improvement in symptoms. Complications of acute bacterial rhinosinusitis in children are rare.