[Prospective study of 43 severe complications of acute rhinosinusitis]

Incidence and distribution of severe infectious complications of bacterial rhinosinusitis are mostly unknown in adults. Our objective was to describe these complications, the patients clinical background, the relevant bacteria, their therapeutic management and their evolution.

From November 2001 to March 2003, this prospective and descriptive study recruited patients older than 13 years, immuno-competent and hospitalized in 6 French academic hospitals with severe acute complications of presumed-bacterial community acquired rhinosinusitis.

Fourty three patients (40 +/- 18 years) were included. Fourty four per cent had an ENT history: Infectious rhinosinusitis (23%) and/or chronic rhinosinusitis (14%) and/or sinonasal surgery (19%). The initial sinusitis was either pansinusitis (24 cases) or an isolated sinusitis in 17 cases (missing data 2). The complication was either initial (15), or followed an infectious acute rhinosinusitis in 27 cases (1 missing data). In 39 cases, complications were isolated: Meningo-encephalic (16), orbital (15) and sub-cutaneous abscess (8). Seventy per cent of the swabs were positive, particularly with Haemophilus Influenzae and Streptococcus Pneumoniae in meningitis, Staphylococcus et Streptococcus species in orbital complications, and Staphylococcus species in sub-cutaneous locations. The initial management of the complication, combining systematic antibiotic therapy with surgery (31 patients), resulted in cure for 31 patients. The subsequent management of the 12 initial failures cured 10 more patients (of which 9 after surgery).

This prospective study has shown the real risk of severe complications during any acute sinusitis and the need for early treatment often involving a surgery.