Sinusitis can lead to several intracranial and extracranial complications. Intracranial complications include meningitis, encephalitis, extradural abscess, subdural abscess, brain abscess, and cavernous sinus thrombosis which occur due to the spread of infection from paranasal sinuses to the brain. Extracranial complications include descending infections that can cause otitis media, pharyngitis, tonsillitis, laryngitis, and tracheobronchitis. Sinusitis may also act as a focus of infection leading to conditions like polyarthritis, tenosynovitis, and fibrositis.

1. COMPLICATIONS OF
SINUSITIS.
BIKASH BORAH
3RD YEAR MBBS
MODERATOR: DR. SOWMYA

2. COMPLICATIONS:-
• intracranial complications.
• descending infections.
• focal infections.

3. INTRACRANIAL COMPLICATIONS:-
• Frontal , ethmoid , and sphenoid sinuses are closed related to
the anterior cranial fossa.
• Infections from these causes -
 MENINGITIS & ENCEPHALITIS.
 EXTRADURAL ABSCESS.
 SUBDURAL ABSCESS.
 BRAIN ABSCESS.
 CAVERNOUS SINUS THROMBOSIS.

4. MENINGITIS :-
• Sinus infection if left untreated , has a potential to spread to our
meninges causing them to be inflamed and the condition is know
as meningitis.
• C/F :- high grade fever , neck stiffness , headache , nausea ,
vomiting , seizures and drowsiness.
• Diagnosis :- diagnosed by lumbar puncture , CT SCAN , MRI SCAN.
• Treatment :- antibiotic therapy.

6. EXTRADURAL ABSCESS:-
• Brain abscess , subdural empyema and epidural abscess are three of the most
commonly encountered focal supportive processes of the central nervous system.
• Frontal lobe abscesses are frequently caused by purulent nasal sinusitis.
• C/F :- Headache , changes in consciousness , vomiting , changes in sensation ,
weakness , trouble moving or walking , loss of bladder or bowel control.
• DIAGNOSIS :- Blood culture , CBC , CT SCAN , MRI
• TREATMENT :- epidural abscess related to sinusitis in children , drainage and
antibiotics treatment without surgery is the ideal choice.

7. EXTRADURAL
ABSCESS

8. SUBDURAL ABSCESS:-
• A chronic sinus infection can often lead to the collection of pus in a
potential space between the outer and middle layers of our
meninges (the subdural space), defining a condition known as the
subdural abscess.
• C/F – same as of meningitis along with changes in mental status like
confusion and irritability .
• Diagnosis – blood culture , CBC , CT SCAN , MRI SCAN.
• Treatment – surgical drainage to prevent coma and death from
rapidly rising pressure in brain along with antibiotic therapy.

10. BRAIN ABSCESS:-
• A brain abscess is a localized collection of pus within our brain substance.
• It occurs because of the direct spread of infection from our paranasal sinuses.
• C/F- headache , change in mental state , problems with nerve function such as
muscle weakness , slurred speech or paralysis on one side of the body, fever ,
seizures , stiff neck.
• DIAGNOSIS – CT guided aspiration used to remove pus for testing , MRI , CBC.
• TREATMENT – Antibiotic therapy , draining of pus through surgical procedures.

12. CAVERNOUS SINUS. ( ANATOMY )
• Cavernous sinus is a large venous space situated on
either side of the body of the sphenoid and sella turcica in
the middle cranial fossa.
• Floor - endosteal layer.
• Wall , roof , medial wall – meningeal layer.

14. CAVERNOUS SINUS THROMBOSIS.
• It occurs mainly due to the infection of ethmoid and
sphenoid sinuses.
• It is also cause by the infections from the frontal and
orbital complications.
• Causes thrombophlebitis of the cavernous sinus spreading
via the superior and inferior ophthalmic veins.

16. OTHER SOURCES & ROUTES OF INFECTION.

17. CLINICAL FEATURES.
• Onset – abrupt.
• Chills
• Rigors.
• Swollen eyelids.
• Chemosis and proptosis of eyeballs.
• Cranial nerves III , IV , VI gets involved and causes
ophthalmoplegia.

18. CONTD….
• dilated pupils.
• congestion of optic disc.
• diminution of vision.
• Sensation in the distribution of ophthalmic branch of CN
V is diminished.

20. DIAGNOSIS AND TREATMENT.
• Contrast enhanced CT scan or MRI is used for diagnosis.
• Treatment consist of IV antibiotics and proper drainage of
infected ethmoid and sphenoid sinus.

21. DESCENDING INFECTIONS:-
In suppurative sinusitis , discharge constantly flows into the
pharynx and causes:-
• Acute and chronic otitis media.
• Pharyngitis and tonsillitis.
• Persistent laryngitis and tracheobronchitis.

22. ACUTE AND CHRONIC OTITIS MEDIA:-
• In sinusitis , mucus is accumulated in
sinuses which travel throughout and
reaches the medial ear through
eustachian tube , thereby causing
inflammation there.

23. PHARYNGITIS AND TONSILITIS:-
• Sinus infection can often lead to
complications with post nasal drip
where excess mucus is drained down
to throat resulting in sore throat and
cough.
• Hypertrophy of lateral lymphoid
bands behind the posterior pillars is
indicative of chronic sinusitis.

24. PERSISTENT LARYNGITIS AND
TRACHEOBRONCHITIS:-
• Sinusitis may be associated with
recurrent laryngitis , bronchiectasis
and asthma.
• Asthma may or may not present.

25. FOCAL INFECTIONS:-
• Role of sinus infection to act as focus of infection is
doubtful.
• Conditions responding to elimination of infection in the
sinuses are-
• Polyarthritis.
• Tenosynovitis.
• Fibrositis.

26. POLYARTHITIS:-
• It is referred to the condition where
at least five joints are affected with
arthritis.
• it may be caused due to sinusitis.

27. TENOSYNOVITIS:-
• Tenosynovitis is a broadly defined as
inflammation of a tendon and its
respective synovial sheath.
• May be caused by sinusitis.

28. FIBROSITIS:-
• Fibrositis can be defined as the pain
or inflammation of the muscle
sheaths, muscles and connective-
tissue layers of the joints, bones,
tendons and muscles.
• The regularly affected areas in
fibrositis are the muscular regions of
the lower back, thighs, hips, arms,
chest, neck, shoulder and thighs.
• age commonly affected= 30 to 60
years.
• Women are affected more than men.