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Jay M. Dutton, MD
Rush-Presbyterian-St. Luke's Medical Center
Chicago, IL
When sinusitis is managed properly, complications rarely occur. However, because of the close proximity of such structures as the intracranial cavity and the orbit, in certain circumstances these infections may spread and cause life-threatening sequelae. These complications may occur after either acute or chronic infections but do so more commonly after the former. The following list includes many of the potential complications of sinusitis, but is by no means exhaustive:
- Intracranial Complications - The frontal, ethmoid and sphenoid sinuses are separated from the intracranial cavity by a layer of bone (Figure 1). If the infection passes through this bone it may infect the tissue and fluid that lines the brain, causing "meningitis". In even more severe cases the infection may spread to the brain itself causing an "abscess", or collection of pus. These problems are life threatening and require prompt and aggressive treatment.
- Orbital Complications - The frontal, maxillary, ethmoid and sphenoid sinuses sit immediately above, below, between and behind the eyes, respectively (Figure 2). For this reason, infections of any of the sinuses may spread to the orbit, causing a wide spectrum of complications from mild inflammation of the eyelid to abscesses with possible blindness.
- Vascular Complications - The carotid artery and cavernous sinus are two large vascular structures that border the sphenoid sinus. Infections that involve either of these structures may lead to aneurysms or infected blood clots in the intracranial cavity, both of which are potentially fatal.
- Asthma - A number of patients suffer from both asthma and chronic sinusitis and, for these individuals, flare-ups of the sinusitis can lead to asthma attacks. Many studies have shown that resolving the sinus condition will result in dramatic improvement of the asthma.
- Loss of Smell and Taste - Sinusitis may diminish the senses of smell and taste, since the two are interconnected. This may be either temporary or permanent, depending on the nature of the injury. In most cases, the cause is poor airflow to the olfactory nerve (which detects odors) and by improving the nasal airway the senses of smell and taste improve. This is particularly true in patients who suffer from nasal polyps. However, in some cases chronic sinusitis may permanently injure these nerve endings.
- Osteomyelitis - Some recent studies suggest that bone becomes actively involved during a chronic sinus infection, making the infection more difficult to treat. This may even cause the destruction of bone that leads to the intracranial and intraorbital complications discussed above.
Many patients are reluctant to undergo endoscopic sinus surgery for sinusitis but surgery may be imperative, as when one of these complications develops or to prevent one from occurring in the face of a chronic infection. While these complications are fortunately rare, their outcomes may be severe and tragic!
Acknowledgments
Original diagrams provided courtesy of AstraZeneca LP and modified by Jay M. Dutton, MD.
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