Complications of Sinusitis

Updated: 4 days ago

Dr. K. R. Meghanadh



Any infection is the balance between bacterial virulence, i.e., the power of destroying the body and spreading its population and immunity, which produces antibodies to damage the bacterial wall and killer cells (polymorphs and macrophages) that engulf the bacteria and kill them. When the gross difference between these gets worse, the disease spreads faster and results in complications.


Complications of sinusitis are rare and do not occur if proper care and medication are taken on time.


Although most complications occur in untreated chronic sinusitis, there is a very low possibility of complications in acute sinusitis. The complications in acute sinusitis can also occur in "acute on chronic" sinusitis.




Complications in Acute Sinusitis & Acute on Chronic Sinusitis


When the immunity is down for acute sinusitis or acute on chronic sinusitis, the barriers to the infection produced by the body are broken, and the bacteria goes beyond the sinuses affecting adjacent structures like the eye, teeth, and brain.


Thankfully this generally happens in one in one lakh or hundred thousand of the population. But these complications occur during seasonal change or during the COVID-19 pandemic when the body's immunity gets affected. Anything that reduces immunity can cause these complications. This could include stress too.


Example of Sinusitis complications due to stress

A patient got into an accident where he had 2 to 3 fractures, and his immunity got down due to stress. He had pre-existing chronic sinusitis, which turned into "Acute on Chronic" sinusitis. He got acute sinusitis complications.


Similarly, even pregnancy can downgrade a person's immunity and turn their chronic into "acute on chronic."


There have been instances where people had complications after their exams too.


1. Eye Complications - Orbital cellulitis & orbital abscess


When the sinus infection attacks the eye, it is called orbital cellulitis.


Orbital cellulitis increases the infection and chemical mediators that create pain, swelling, and loss of function. This pain doesn't respond to regular painkillers.


This orbital cellulitis progresses to an orbital abscess, and an abscess is a space-occupying lesion. An orbital abscess is a collection of pus in a localized area. Space is occupied, restriction of eye movement is caused, and blood supply to the optic nerve drops due to the pressure created by an abscess. If the blood supply to the optic nerve is cut off, the nerve dies, resulting in loss of vision.


Dr. K. R. Meghanadh says, "Orbital cellulitis is like fire, and an orbital abscess is like smoke left by it. Both fire and smoke are dangerous. One burns and the other suffocates."


So, the complications that can occur in the eye can be summarized to

  • pain in the eye

  • swelling in the eye

  • loss of vision

  • restriction in eye movement

  • damage of the optic nerve


Complications of sinusitis acute stage - complications in eye - orbital abscess that is next stage after orbital cellulitis
orbital abscess in left eye


Complications of sinusitis acute stage - complications in eye - orbital abscess that is next stage after orbital cellulitis
Orbital abscess due to acute sinusitis


2. Brain Complications

The spread of infection from orbit to the brain is very easy due to proximity. The disease can even spread to the brain, directly surpassing the eye.


When it spreads to the brain, a person can experience

  • vomiting

  • the rise in blood pressure

  • drop in heart rate

  • high fever

  • seizures

  • coma

  • death

Meningitis

This can result in high-grade fever and a rise in pressure inside cranial contents, i.e., pressure in the skull. This results in vomiting, a rise in blood pressure, drop in heart rate as the infection spreads to the covering of the brain; it is called Meningitis.


Encephalitis

If it spreads to the contents of the brain, it becomes Encephalitis. Encephalitis causes seizures, a high fever, and coma followed by death.


Complications in chronic sinusitis


The thick bacterial phlegm in sinuses, when it goes into the throat or ear through the nasopharynx, i.e., the back of the nose, can cause complications.


During the day, when this phlegm or fluids go into our throat, we tend to swallow, and acids in our stomach kill this bacteria. But, during deep sleep, the absence of these swallowing movements will give these fluids way to the voice box, lungs, and ear.


Laryngitis

Infection in the voice box is called laryngitis. It results in

  • Hoarseness

  • Change in voice

  • Pain in throat

  • Pain while talking

  • Inaudible voice

  • Dry cough

  • Fever


Bronchitis & Pneumonia

Sinusitis complications include

If the phlegm in the sinuses goes into the lungs, it can cause bronchitis and pneumonia. This causes

  • severe dry cough

  • breathlessness

  • asthmatic attacks

  • noisy breathing

  • chest pain


Otitis media

When we lay down position, it is convenient for the phlegm to go from the nasopharynx to the middle ear through the auditory tube, causing a middle ear infection that can result in

  • ear block sensation

  • ear pain

  • mild deafness

  • ear discharge

Even then, if the middle ear infection is not treated, it can spread to the inner ear, causing symptoms like

  • vertigo

  • giddiness

  • abnormal sounds in the ear called tinnitus.



Dr. K. R. Meghanadh

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