eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Sinusitis, Sphenoid, Acute, Surgical Treatment: Follow-up

Author: Rami K Batniji, MD, Private Practice, Batniji Facial Plastic Surgery
Coauthor(s): Michelle S Marrinan, MD, Staff Physician, Department of Otolaryngology, Montefiore Medical Center, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Jan 2, 2009

Outcome and Prognosis

Outcome and prognosis for sphenoid sinusitis depend highly on early diagnosis. Lew concluded that treatment delay inevitably led to serious morbidity and mortality.2 In his study, 9 out of 15 patients had a delay in treatment. Four patients died, and 4 had irreversible cranial nerve injury. Kibblewhite et al came to similar conclusions.9 In their study of 14 patients with acute sphenoid sinusitis, 57% of the patients had signs of neurologic or ophthalmologic complications, and 29% of the patients were left with permanent disabilities. A delay in diagnosis led to an 80% morbidity rate. The conclusion is that early diagnosis is essential. If properly treated, patients with acute sphenoid sinusitis can improve without complications.

Future and Controversies

Controversies exist in several areas. Administration of broad-spectrum antibiotics is necessary. The choice of antibiotics is not clear. Suggestions in the literature have included gentamicin, chloramphenicol, nafcillin, penicillin, and metronidazole. Direct antibiotic therapy at the likely pathogens, including Staphylococcus aureus and Streptococcus pneumoniae. Consider a drug that crosses the blood-brain barrier if complications are present or seem likely. Adjust antibiotics to cultures when available. Steroid use is generally not indicated.

Acute sphenoid sinusitis can be a devastating disease if not diagnosed quickly. CT scans lead to earlier diagnosis and treatment. Endoscopic approaches to drainage are safe and effective. The combination of these 2 modalities should result in improved outcome and prognosis. In addition, image guidance systems are being used more frequently in sinus surgery. The use of image guidance systems in diseases of the sphenoid is especially helpful and adds an extra dimension of safety to the procedure.

 


More on Sinusitis, Sphenoid, Acute, Surgical Treatment

Overview: Sinusitis, Sphenoid, Acute, Surgical Treatment
Workup: Sinusitis, Sphenoid, Acute, Surgical Treatment
Treatment: Sinusitis, Sphenoid, Acute, Surgical Treatment
Follow-up: Sinusitis, Sphenoid, Acute, Surgical Treatment
References
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References

  1. Weisberger EC, Dedo HH. Cranial neuropathies in sinus disease. Laryngoscope. Mar 1977;87(3):357-63. [Medline].

  2. Lew D, Southwick FS, Montgomery WW, et al. Sphenoid sinusitis. A review of 30 cases. N Engl J Med. Nov 10 1983;309(19):1149-54. [Medline].

  3. Hnatuk LA, Macdonald RE, Papsin BC. Isolated sphenoid sinusitis: the Toronto Hospital for Sick Children experience and review of the literature. J Otolaryngol. Feb 1994;23(1):36-41. [Medline].

  4. Lawson W, Reino AJ. Isolated sphenoid sinus disease: an analysis of 132 cases. Laryngoscope. Dec 1997;107(12 Pt 1):1590-5. [Medline].

  5. Sethi DS. Isolated sphenoid lesions: diagnosis and management. Otolaryngol Head Neck Surg. May 1999;120(5):730-6. [Medline].

  6. Welbourn RB. The evolution of transsphenoidal pituitary microsurgery. Surgery. Dec 1986;100(6):1185-90. [Medline].

  7. Metson R, Gliklich RE. Endoscopic treatment of sphenoid sinusitis. Otolaryngol Head Neck Surg. Jun 1996;114(6):736-44. [Medline].

  8. Stankiewicz JA. The endoscopic approach to the sphenoid sinus. Laryngoscope. Feb 1989;99(2):218-21. [Medline].

  9. Kibblewhite DJ, Cleland J, Mintz DR. Acute sphenoid sinusitis: management strategies. J Otolaryngol. Jun 1988;17(4):159-63. [Medline].

  10. Abramovich S, Smelt GJ. Acute sphenoiditis, alone and in concert. J Laryngol Otol. Aug 1982;96(8):751-7. [Medline].

  11. Dale BA, Mackenzie IJ. The complications of sphenoid sinusitis. J Laryngol Otol. Jul 1983;97(7):661-70. [Medline].

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  15. Hsu YC, Su CY, Hsu RF, et al. Abducens palsy in acute isolated sphenoid fungal sinusitis. J Otolaryngol. Oct 2004;33(5):319-21. [Medline].

  16. Postma GN, Chole RA, Nemzek WR. Reversible blindness secondary to acute sphenoid sinusitis. Otolaryngol Head Neck Surg. Jun 1995;112(6):742-6. [Medline].

  17. Tan HK, Ong YK. Acute isolated sphenoid sinusitis. Ann Acad Med Singaore. 2004;33(5):656-659.

  18. Turgut S, Ozcan KM, Celikkanat S, et al. Isolated sphenoid sinusitis. Rhinology. Sep 1997;35(3):132-5. [Medline].

  19. Weiss RL, Bailey BJ. Approaches to the sphenoid. In: Bailey BJ, ed. Head and Neck Surgery - Otolaryngology. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 1998:485-495.

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Further Reading

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Keywords

sphenoid, sinusitis, acute sphenoiditis, sphenoid sinusitis, acute sinusitis, acute sphenoid sinusitis, sinus infection sphenoid

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Contributor Information and Disclosures

Author

Rami K Batniji, MD, Private Practice, Batniji Facial Plastic Surgery
Rami K Batniji, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, California Medical Association, and Triological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Michelle S Marrinan, MD, Staff Physician, Department of Otolaryngology, Montefiore Medical Center, Albert Einstein College of Medicine
Michelle S Marrinan, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jack A Coleman, MD, Consulting Staff, Franklin Surgical Associates
Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society for Laser Medicine and Surgery, and Association of Military Surgeons of the US
Disclosure: Influent  None Review panel membership; accarent, inc Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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