Paranasal sinusitis in burn patients following nasotracheal intubation

Paranasal sinusitis is a complication of nasotracheal intubation. Of 99 nasally intubated adult patients who survived 48 hours after being burned, 22 who were intubated for more than 7 days underwent a computed tomographic scan of all paranasal sinuses, with timing dictated by the patient's clinical condition. Eight patients had computed tomographic and clinical findings consistent with sinusitis. Treatment consisted of removal of all nasal tubes, oral and topical nasal decongestants, and, when appropriate, culture-specific antibiotics. A subgroup of patients with preexisting sinus disease made up 50% of the patients with sinusitis; early conversion to an oral airway or a tracheostomy should be considered in such patients. Only one patient required surgical drainage of the sinuses. The frequency and morbidity of sinusitis in nasotracheally intubated burn patients does not justify the risk of routine conversion to an oral airway.