Complications of rhinosinusitis

Abstract

Rhinosinusitis is a common disease annually affecting one in eight individuals in the United States [1]. While the majority of rhinosinusitis cases are uncomplicated and can be managed successfully with outpatient medical therapy, in a small percentage of patients the infectious process may extend beyond the anatomic boundaries of the sinuses, thus mandating prompt initiation of more aggressive therapy. Complications typically occur in the setting of acute or acute-on-chronic rhinosinusitis; and the incidences tend to be highest in the winter months, echoing seasonal increases in the rates of upper respiratory infections [2]. Children and adolescent males, in particular, represent a vulnerable population that have a differentially higher incidence of rhinosinusitis-related complications, largely because of anatomic factors. Although patient outcomes have improved dramatically in the postantibiotic era, morbidity and mortality rates associated with intracranial complications remain as high as 40% [3], and thus early recognition and treatment of this disease process is critical. Complications of rhinosinusitis may be categorized as distant and local (Table 15.1). Distant complications include both pulmonary and systemic sequelae-such as asthma, bronchitis, and sepsis- and are beyond the scope of this chapter. Local complications can be broken down into intracranial, orbital, and bony processes. The pathophysiology of each of these subcategories may be understood in the context of anatomy of the paranasal sinuses and the site-specific barriers to infectious spread present in each sinus [1]. © 2008 Springer Science+Business Media, LLC. All rights reserved.