different complications of sinusitis.pptx

presentation about different complications of sinusitis including local complications and complications of nearby structures and systemic complications.

1. Complications of sinusitis

2. Introduction Most sinus infections are viral and will get better with time without treatment. Saline irrigations and decongestants may help improve symptoms while the infection is resolving. Rarely do complications occur from acute or chronic sinusitis. The most common complications are explained below.

3. Routes of spread of infection   Hematological : Septic cavernous sinus thrombosis occurs Local spread, often from valveless facial and ophthalmic veins Direct : The proximity of the ethmoid sinuses to the medial orbital wall and relative weak barrier of the lamina papyracea may predispose to extension of infection toward involving the eye.

4. Local comp l ication of sinusitis   Local complication affecting the sinus walls: Osteomyelitis (inflammation of diploic bone) of frontal bone or maxilla may lead to : 1-Sub-periosteal abcess : (Pott’s puffy tumor in frontal sinus). 2-Mucocele: cystic expansion of sinus as a result of retention of mucus secretion. It affects mainly frontal and ethmoidal sinuses.

5. Complications of nearby structures   Orbital infections are classified by a 5-tier system   Group I – Preseptal cellulitis Group II – Orbital cellulitis Group III – Subperiosteal abscess Group IV – Orbital abscess Group V – Cavernous sinus thrombosis

6. Preseptal cellulitis   is an Infection of the anterior portion of the eyelid, not involving the orbit or other ocular structures. Clinical picture Patients complain of eyelid swelling and redness. But also general malaise and low-grade fever are commonly reported. Treatment Broad-spectrum antibiotics must be prescribed to cover gram-positive and gram-negative bacteria.

7. Orbital cellulitis is an infection of the soft tissue of the orbit without abscess formation. It is a well-known complication of paranasal sinusitis, as well as periodontal abscesses, nasolacrimal infections, trauma, postsurgical infections, and rhabdomyosarcomas Clinical picture Patients with this infection may develop orbital signs and symptoms ( eg , chemosis, visual loss), and they often have more systemic toxicity than patients with preseptal cellulitis. Direct orbit CT scan has increased in its sensitivity over the years for diagnosing this entity. Most cases will show edema with or without microabscesses . Inflammation in all orbital content. Hot , Tender, Redness. General symptoms like Headache,Fever , and malaise Treatment orbital cellulitis is treated with antibiotics. patient probably needs to stay in the hospital and receive antibiotics through an IV (intravenously). If symptoms get better after a few days, the patient should be able to go home and switch to oral antibiotics (pills taken by mouth).

8. Subperiosteal abscesses   are collections of purulent material between the orbital bony wall and periosteum. This entity may develop in 7-9% of patients initially with orbital cellulitis or from spread of an adjacent infection, as occurs when ethmoid sinusitis spreads to the medial orbital subperiosteal space. Clinical picture   This diagnosis Is confirmed by CT scan, but It can be suspected based on physical examination. In addition to signs of orbital involvement (eg, chemosis, visual loss) Treatment Management of this condition typically involves expectant treatment with intravenous antibiotics, with or without surgical intervention based on clinical improvement or emergent visual compromise. Abscesses can be drained externally via a skin or conjunctival incision, or intranasally using an endoscopic approach. External skin approach to a medial SPA. This commonly used approach is a modified Lynch incision, the traditional incision for performing an external ethmoidectomy

9. Orbital abscesses are collections of pus within the orbital soft tis sue. Diagnosis is confirmed by CT scan, but the physical signs of severe exophthalmos and chemosis, with complete ophthalmoplegia, as well as venous engorgement or papilledema on funduscopic examination, are suggestive. Investigation : CT and MRI The treatment of orbital cellulitis include antibiotics and other supportive therapies. An ophthalmologist and otolaryngologist should also be consulted for proper examination because, in some cases, surgery may be required

10. Cavernous sinus thrombosis Definition is a blood clot in the cavernous sinuses. It can be life-threatening Clinical presentation proptosis this usually starts in one eye and spreads to the other eye. red eyes eye pain – which can be severe vision problems – such as double vision or blurred vision difficulty moving the eyes drooping of the eyelids Complication Leg: DVT Lung: embolism Brain: stroke and Meningitis Sepsis

11.   Treatment Hospitalization Antimicrobial therapy cross BBB includes an anti-staphylococcal agent (vancomycin if methicillin resistance is high, or nafcillin), a third-generation cephalosporin, and metronidazole (for anaerobic coverage) as well as antifungal therapy with amphotericin B. A prolonged duration of parenteral therapy, typically three to four weeks or at least two weeks beyond clinical resolution is suggested. Most experts recommend anticoagulation, in the absence of strong contraindications, with either unfractionated heparin (UFH) or low molecular weight heparin (LMWH) for several weeks to several months. 5. Corticosteroids are often given but without demonstrated efficacy. The potential benefit would be decreased inflammation and vasogenic edema surrounding cranial nerves and orbital structures.

12. Intracranial complications Extradural abscess An epidural abscess refers to a collection of pus and infectious material located in the epidural space superficial to the dura mater which surrounds the central nervous system.  Symptoms include pain at the forehead or ear, pus draining from the ear or sinuses, tenderness overlying the infectious site, fever, neck stiffness, and in rare cases focal seizures. Treatment Requires a combination of antibiotics and surgical removal of infected bone

13. Meningitis is an acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. Clinical picture: The most common symptoms are fever, headache, and neck stiffness. Treatment Meningitis is potentially life-threatening and has a high mortality rate if untreated. delay in treatment has been associated with a poorer outcome. Thus, treatment with wide-spectrum antibiotics should not be delayed while confirmatory tests are being conducted. Intravenous fluids should be administered if hypotension or shock are present. If there are signs of raised intracranial pressure, measures to monitor the pressure may be taken; this would allow the optimization of the cerebral perfusion pressure and various treatments to decrease the intracranial pressure with medication (e.g. mannitol). Seizures are treated with anticonvulsants

14. Subdural Abscess Subdural abscess is a collection of pus in the subdural space. Symptoms most patients are febrile, with headache and neck stiffness, and, if untreated, may develop focal neurologic signs, lethargy, and coma. If diagnosis and treatment are prompt, complete recovery is usual. It usually occurs in infancy. It can be associated with sinusitis.   Treatment includes surgical drainage .

15. Brain abscess ( Frontal lobe) Signs and symptoms Fever, headache, and neurological problems. The famous triad of fever, headache, and focal neurologic findings are highly suggestive of brain abscess. These symptoms are caused by a combination of increased intracranial pressure due to a space-occupying lesion (headache, vomiting, confusion, papilledema), infection (fever, fatigue etc.), and focal neurologic brain tissue damage (hemiparesis, aphasia).

16. Treatment includes lowering the increased intracranial pressure and starting intravenous antibiotics. Hyperbaric oxygen therapy (HBO2 or HBOT) is indicated as a primary and adjunct treatment that provides four primary functions. First , HBOT reduces intracranial pressure. Secondly , high partial pressures of oxygen act as a bactericide and thus inhibit the anaerobic and functionally anaerobic flora common in brain abscess. Third , HBOT optimizes the immune function thus enhancing the host defense mechanisms, and fourth , HBOT has been found to be of benefit when brain abscess is concomitant with cranial osteomyelitis. Surgical drainage of the abscess remains part of the standard management of brain abscesses.

17. Oro-Antral Fistula Fistula between oral cavity and maxillary antrum ( oro -maxillary) Causes Traumatic Surgical trauma Dental extraction (mainly premolar or 1 molar) Radical antrum operation Excision of dental or dentigerous cyst. Accidental trauma: penetrating injury. Inflammatory osteomyelitis of the maxilla or syphilitic osteitis Neoplastic cancer maxilla eroding the alveolar process Clinical Picture Symptoms Unilateral regurgitation of food and fluid. Unilateral offensive nasal discharge (sinusitis). Discharge through the fistula to the mouth.

18. Descending infection Otitis media Is an infection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum.   Anyone can develop a middle ear infection but infants between six and 15 months old are most commonly affected.   It's estimated that around one in every four children experience at least one middle ear infection by the time they're 10 years old. Symptoms of a middle ear infection In most cases, the symptoms of a middle ear infection (otitis media) develop quickly and resolve in a few days. This Is known as acute otitis media. Earache A high temperature (fever) Being sick A lack of energy Slight hearing loss – if the middle ear becomes filled with fluid

19. Fungal pharyngitis occurs In the setting of immunosuppression or chronic steroid and antibiotic use. Sometimes, allergies, such as hay fever or allergic rhinitis, can cause sore throat. Dry indoor air and chronic mouth breathing, especially in the winter, can lead to recurrent sore throat, particularly in the morning, after waking up. muscle strain associated with voice use can cause pain in the throat that is similar to pharyngitis. Gastroesophageal reflux disease (GERD) can lead to chronic sore throat because of stomach acid reflux Irritating the throat. Symptoms of pharyngitis Sore throat Dry, scratchy throat Pain when swallowing Pain when speaking Other symptoms may be present, depending on the cause. These include fatigue, malaise, muscle aches, headache, and fever — especially with the flu or other viral infections.

20. L aryngiti s is an Inflammation of your voice box (larynx) from overuse, irritation or infection. Inside the larynx are your vocal cords — two folds of mucous membrane covering muscle and cartilage. Normally, vocal cords open and close smoothly, forming sounds through their movement and vibration. Symptoms Laryngitis signs and symptoms can include: Hoarseness Weak voice or voice loss Tickling and rawness in throat Sore throat , Dry throat and Dry cough Bronchitis is an Infection of the main airways of the lungs (bronchi), causing them to become irritated and inflamed. The main symptom Is a cough, which may bring up yellow-grey mucus (phlegm). Bronchitis may also cause a sore throat and wheezing .

21. Osteomyelitis of the skull bone as a complication of sinusitis Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs. Frontal bone osteomyelitis   Description This is osteomyelitis with a subperiosteal (extradural) abscess in the frontal bone. It usually represents an anterior extension of a frontal sinus infection or as a complication of a compound skull fracture. It can also be a complication of mastoiditis and has been reported following an insect bite. Streptococcus milleri group is the most common pathogen. Symptoms Headaches. There may be localized swelling. Fever. Nuchal rigidity. Altered mental state (from subtle changes, confusion, or complete coma) Focal neurological signs, seizures

22. Pott’s puffy tumor   Diagnosis CT scan (with and without contrast) or MRI scan. CT scan may reveal bone erosion and evidence of rim-enhancing abscess formation.   There may be intracranial involvement, eg fluid collection and CT/MRI may also help in this. Management Admission with removal of the infected bone and prolonged intravenous antibiotics ( eg for six weeks). Antibiotics are usually of the penicillin group, eg high dose IV benzylpenicillin for 3 weeks followed by 3 weeks of oral amoxicillin. However, all cases should be discussed with the local microbiologist and antibiotics should be altered once sensitivities are known. Complications Extension of infection, eg brain abscess Meningitis Epidural empyema Subdural empyema

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