Journal Reading

THE COMPLICATIONS OF SINUSITIS

IN A TERTIARY CARE HOSPITAL:
TYPES, PATIENT CHARACTERISTICS, AND OUTCOMES

PETER DARMAATMAJA S. G99162143

APRILLA DWI UTAMI G99172042
GILANG SUKMA M. G99172081
JESSICA ADRIANE G99172094
SHANTY FITRIA ANDRIANI G99172152

KEPANITERAAN KLINIK KSM ILMU THT-KL

FAKULTAS KEDOKTERAN UNS/RSUD DR. MOEWARDI
SURAKARTA
2018
ABSTRACT
Abstract
Abstract
Abstract
INTRODUCTION
Introduction

• Sinusitis develops after a viral uppear respiratory tract

infection in 0-5-2% of patients.
• Its complication are unsual. Complication rates of the
patiens varied from 3,7-20%
• 3 type complication of sinusitis : orbital, the most
common complication (60-75%), intracranial (15-20%),
and local type (5-10%).
• In study of Thai patients 8,2% of the admitted sinusitis
patients had complication, but frontal sinusitis was not
a common cause of intracranial complication
Introduction
• In study of Thai patients 8,2% of the admitted sinusitis
patients had complication, but frontal sinusitis was not a
common cause of intracranial complication
• Cranial neuropathies didn’t occur with either meningitis or
brain abcess
• The objective in current study was to determine the
complication of sinusitis and the outcome of the treatment
according to the type of the complication
Introduction
MATERIALS & METHODS
Materials & Methods
• A retrospective study was performed on sinusitis
patients admitted to Chiang Mai University Hospital from
2003 to 2012.

1,655 sinusitis patients’

diagnosis screening

146 suspected complication

cases reviewed
61 excluded cases: 17 complication
cases of incomplete data,25 fungal
sinusitis cases, 13 mucocele
sinusitis), 6 tumor cases
85 complication cases
Materials & Methods
Complication Classifications

• The local complications : facial cellulitis, facial abscesses, osteomyelitis,

and mucocele/mucopyocele that occurred either after the sinus surgery
or following a previous history of sinusitis.

• The orbital complications : inflammatory oedema, orbital cellulitis,

subperiosteal abscesses, orbital abscesses, and cavernous sinus
thrombosis.

• The intracranial complications (IC) : meningitis, brain abscesses (e.g.,

epidural and subdural), intracerebral abscesses, and dural sinus
thrombosis (e.g., cavernous sinus and superior sagittal sinus).

• The cranial nerve (CN) palsy complication.

Materials & Methods

Data Analysis
• STATA program version 11.0

Data Collection • Exact probability test 

proportion of the
• patients’ characteristics,
complications between the
• the organisms involved,
age groups,
• the outcomes of treatment
• Multinomial logistic
regression  outcomes
RESULTS
Results

1,655 sinusitis patients’

diagnosis screening

146 suspected complication

cases reviewed
61 excluded cases: 17 complication
cases of incomplete data,25 fungal
sinusitis cases, 13 mucocele
sinusitis), 6 tumor cases

85 complication cases
Results

The diagnoses of the complications were made based on the

clinical findings and CT scans

Lumbar punctures and CSF examinations were performed

on the patients suspected of having meningitis

All of the cases were treated empirically with intravenous

antibiotics according to the organisms determined to be
involved.
Results

This study include :

Classification :
Fifty males
(58.8%) Mean age :
Fourteen of the
35 females (35%) patients were The mean age
children younger was 43.5 (±23.3),
than 15 years ranging from one
(16.5%) month to 81 years
71 were adults
(83.5%)
Results

Overall, 27 of the patients had more than one type of

complication

Twenty-five of the patients (29.4%) had at least one

known underlying condition diabetes mellitus (18.8%),
chronic renal failure (8.2%), malignancy (5.9%), chronic
liver disease (3.5%), and HIV infection (2.4%)

The most common type of complication

was orbital in nature
Results
• 15 Cases Cranial Nerve Palsy Complication

Nine of the patients had isolated unilateral or

bilateral sphenoiditis

Four patients had pansinusitis that also

involved the sphenoid sinus

One patient had ethmoiditis

One patient had both maxillary sinusitis and

frontal sinusitis
Results
Local Complications (29 Cases)

Osteomyelitis
2 cases)

Facial Cellulitis
Mucocele or an abscess
(12 cases) (15 cases)
Results
Orbital Complications (41 cases)

Cavernous Orbital
Sinus Abscess
Thrombosis (1 Cases)
(6 Cases) Subperiosteal
Abscess
Periorbital (16 cases)
Cellulitis
(8 Cases)

Orbital
Cellulitis
(10 Cases)
Results
Intracranial Complications

• 24 cases of intracranial (IC) complications

• Five of the patients had more than one intracranial complication.

• 13 cases of meningitis
• Five brain abscesses (temporal, frontal, midbrain and pons, epidural, and
along the superior sagittal sinus)

• Eleven cases with dural venous sinus thrombosis

• Eight cases of cavernous sinus thrombosis, two cases of transverse
sinus and sigmoid sinus thrombosis, and one superior sagittal sinus

• There were also other uncommon ICN findings, such as internal carotid
artery (ICA) thrombosis, intraventricular hemorrhaging, and
hydrocephalous
Results
Sinus involvement in intracranial complications

Sinus Frontal Data were

or combined unavailable on
with ethmoid the sinus
sinus involvement
(3 Cases) (1 Cases) Sinus
Sphenoid
(10 Cases)

Pansinusitis
(6 Cases)

Sinus
Sphenoid
combined with
posterior
ethmoid sinus
(4 Cases)
Results
• Other systemic findings included sepsis, disseminated
intravascular coagulation (DIC), acute respiratory failure,
and liver failure.
Results
Types of Complication Classified by Age Groups
120.00%
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
Age < 15 year (14 Age ≥ 15 years (71
Patients) Patients)
Local 35.70% 33.80%
Orbital 100% 38.00%
ICN 7.10% 32.40%
CN Palsy 21.40% 38.00%
Results
• After treatment, all of the 14 children (100%) and 45 of the
adults (63.4%) fully recovered.
• Eight of the adult patients died (11.3%), and 18 of the
adults were cured with residual morbidity (25.3%) upon
hospital discharge.
Results

Of all of the cases of morbidity, those with

limitations in extraocular movements recovered
within two months of the follow-up period (eight
cases)

The visual impairment (five cases), facial

deformity/weakness (two cases) and
hemiparesis (three cases) did not recover

Seven of the eight cases of mortality had

intracranial complications, such as venous
sinus thrombosis and meningitis with sepsis,
and the other case had orbital cellulitis and
sepsis.
Results
• The results of the blood cultures were available for five of
the eight deaths.
• Two of which did not identify an organism and three in
which the identified organisms were Chryseobacterium
indologenes, Staphylococcus aureus (MRSA), and
micrococcus spp
Results
• Among the different types of complications, the IC
complication alone had both significant morbidity (𝑃 =
0.042) and mortality (𝑃 = 0.020)
Results
• The pus culture reports were successfully obtained for 60
of the cases (70.1%).
• 24 of which showed no organisms.
• In the 36 cases with positive specimens, the organisms
were either single or multiple,
 The pus culture reports
14.00%
12.00%
10.00%
8.00%
6.00%
4.00%
2.00%
0.00%
Pus Culture
Coagulase Negative
11.70%
Staphylococcus
S.aureus 8.30%
MRSA 1.70%
Streptococcus spp. 11.70%
Pseudomonas aeruginosa 8.30%
Klebsiella 8.30%
Enteroccocus spp. 5%
Enterobacter spp. 5%
Diphteroid bacilli 5%
Acinetobacter spp. 6.70%
Results
o In addition to others, including Haemophilus influenza,
Neisseria spp., Corynebacterium spp., Pasteurella spp., E
coli, Citrobacter koseri, Proteus spp., Aeromonas
hydrophila, and Burkholderia pseudomallei.
DISCUSSION
Discussion
Common Complications of Sinusitis
No Complications Number Information
of cases
1 Orbital Complications 16 Most common in children,
depends on response to
antibiotic
2 Cranial Nerves Palsy 15 Depends on severity of
the disease, Surgical
Treatment

3 Local Complications 14
4 Intracranial Complications 13 Poor clinical outcomes
Discussion
• Intracranial complication has the most poor clinical
outcomes: 6% died and 23% Disabled
• Sphenoid Sinusitis is the most common cause of
Intracranial Complication

• Factors that Affected:

1. Poor hygiene
2. Craniofacial Complex and Cranial Base Orientation
Differences
Large Cranial Base Angle  affecting bone thickness 
Infection may spread through bone, vasculature, and nerve
Conclusion
• Orbital Complications is the most common complications
for both adults and children
• Cranial nerves palsy occurs in adult either alone or with
another complications
• Outcome of treatment depends on the number and types
of complications
• Intracranial Complication has the poorest outcome.
PICO ANALYSIS
VIA ANALYSIS
Validity
Importance
Applicability