From the Guidelines
Complications of sinus infections can be severe and potentially life-threatening, and it is crucial to seek immediate medical attention if symptoms worsen or if there are signs of severe infection, such as high fever, severe pain, or neurological changes, as these complications require prompt treatment, often with intravenous antibiotics or surgical drainage. The most common complications of sinus infections include spread of infection to nearby structures such as the eyes (orbital cellulitis), brain (meningitis, brain abscess), or bones (osteomyelitis of the skull) 1. Patients may develop chronic sinusitis when acute infections don't resolve completely, leading to persistent symptoms lasting more than 12 weeks. Mucoceles can form when blocked sinuses fill with mucus, potentially eroding surrounding bone. In rare cases, cavernous sinus thrombosis can occur when infection spreads to blood vessels near the sinuses, causing blood clots.
Some of the key complications of sinus infections include:
- Orbital complications, such as orbital cellulitis, subperiosteal abscess, and cavernous sinus thrombosis 1
- Intracranial complications, such as meningitis, brain abscess, and epidural or subdural empyema 1
- Bone complications, such as osteomyelitis of the skull 1
- Fungal sinusitis, which can be invasive and noninvasive, and has different subtypes with varying treatment strategies and prognoses 1
Symptoms suggesting complications include severe headache, visual changes, facial swelling, high fever, confusion, or stiff neck. These complications occur because the sinuses are anatomically close to critical structures like the brain, eyes, and major blood vessels, allowing infections to spread through thin bone walls or connecting blood vessels. According to the American Academy of Pediatrics, acute bacterial sinusitis is defined as a persistent illness with nasal discharge of any quality and/or daytime cough lasting for >10 days without improvement, a worsening clinical course, a severe onset of symptoms with concurrent fever, and purulent nasal discharge for at least 3 consecutive days 1.
In patients with recurrent or chronic sinusitis, one must consider other underlying causes such as asthma, gastroesophageal reflux, cystic fibrosis, obstructive sleep apnea, or allergic rhinitis 1. The most serious complication of chronic sinusitis is intracranial extension of infection 1. Infection of specific paranasal sinuses can lead to characteristic symptoms and associated complications, such as orbital and intracranial complications of sinusitis, which are uncommon but may cause significant morbidity and mortality 1. Low socioeconomic status and poor access to health care appear to have a positive correlation with intracranial complications of sinusitis 1.
It is essential to note that the diagnosis and management of sinusitis should be based on clinical presentation and physical examination findings, and imaging is not recommended in the absence of signs suggesting associated complications 1. However, when a complication of ABRS or an alternative diagnosis is suspected, imaging studies may be obtained, and CT imaging of the sinuses is appropriate when a complication of ABRS is suspected based on severe headache, facial swelling, cranial nerve palsies, or forward displacement or bulging of the eye (proptosis) 1.
From the Research
Complications of Sinus Infection
- Sinusitis can lead to various complications, including severe diarrhea as a side effect of antibiotic treatment, as reported in studies 2, 3
- The use of high-dose amoxicillin plus clavulanate may not provide significant benefits over standard-dose treatment, and may even increase the risk of severe diarrhea 3
- Ceftriaxone has been found to be more effective than amoxicillin-clavulanic acid in treating acute bacterial rhinosinusitis, with a significant cure response observed in patients treated with ceftriaxone 4
- Short-term therapy with amoxicillin-clavulanate and corticosteroids may be effective in treating acute sinusitis, but the optimal duration of treatment depends on individual patient factors, such as history of recurrence or previous surgical sinus drainage 5
- Sinusitis can involve a wide spectrum of presentations, both acute and chronic, and complications can arise if left untreated or poorly managed, highlighting the need for proper workup and management in a primary care setting 6
Treatment-Related Complications
- Severe diarrhea is a common side effect of antibiotic treatment, particularly with high-dose amoxicillin plus clavulanate 2, 3
- The risk of therapeutic failure and complications may be higher in patients with certain risk factors, such as recurrence of sinusitis or previous surgical sinus drainage 5