Complications of Sinusitis

Jamie Litvack, MD

Infection is a common complication of sinusitis. Most infections are viral and will get better with time. Saline irrigations and oral decongestants may help improve your symptoms while the infection is resolving.

An infection that lasts more than 10 days or has “double worsening” (gets better and then worsens again) is assumed to be a bacterial infection. Your doctor may prescribe a broad-spectrum (to cover a lot of different bacteria) or culture-driven (using a culture swab to test exactly which bacteria is causing the infection) antibiotic and frequent saline irrigation. He/she may also prescribe an oral corticosteroid such as prednisone to reduce inflammation of the sinuses. Oral decongestants and mucolytics (medications that break up mucous) may help with symptoms but will not cure the infection. Nasal corticosteroid sprays may help control underlying chronic inflammation but will not treat the immediate infection.

Decreased sense of smell
Decreased sense of smell (hyposmia) or complete loss of smell (anosmia) may occur with sinusitis. Causes of decreased and/or loss of sense of smell are multifactorial (from lots of different reasons) and may be temporary or permanent. For example, nasal obstruction can cause decreased sense of smell. With opening of the sinuses, smell may improve. Chronic inflammation of the olfactory nerve (the nerve of smell) can cause damage to the nerve ending. Some patients notice temporary improvement with oral corticosteroids; however, others may not experience any improvement.

A mucocele is a complication of sinusitis caused by obstruction of drainage of mucous from the sinuses. It can become infected (called a mucopyocele) and if not treated, may extend into surrounding structures. CT scan or MRI can help make the diagnosis. Symptoms may temporarily improve with a course of antibiotics and/or oral corticosteroids, however surgical intervention is usually needed to open up the blocked sinuses.

Infection of surrounding structures
Infections of structures surrounding the sinuses are uncommon complications of sinusitis. These structures include the eye, nearby blood vessels, the brain, the bone, and overlying skin. An infection that extends to the eye can cause vision changes, infection of the eye tissue (orbital cellulitis), a collection of pus in the eye socket (subperiosteal or orbital abcess) or extend more posteriorly (further behind) and cause an infection and clotting of blood vessels (cavernous sinus thrombosis).

Infection may spread through the skull to involve the brain and spinal fluid, which can result in meningitis or a brain abcess. Infection can extend to the underlying bone and cause osteomyelitis. Infection of the sinuses can also spread to the overlying skin and cause cellulitis and/or an abcess. These complications are extremely uncommon, but require immediate attention and aggressive treatment including hospitalization, intravenous medication (put through a vein into your bloodstream) and/or surgical intervention.

Revised 01/20/2015
©American Rhinologic Society