Comprehensive management is required to treat skullbase/orbital abscess and sinus infection
The transition of the disease process and definitive treatment applied for the sinus infection after No.5.
After months of headaches, loss of vision and recurring facial abscesses, comprehensive management and endoscopic drainage of a skull base abscess has given Savannah her life back again.
Twenty-one-year-old Savannah Mealing, living regionally in New South Wales at the time, developed what was initially a simple abscess on the bridge of her nose. She had it drained but the discharge continued, with a further abscess developing on the whole left side of her face. It was treated initially at an outside institution as a limited sinus infection.
“I was still getting a lot of headaches and the abscesses became so severe that the left side of my face blew up like a balloon,” said Savannah. “I couldn’t see well. The antibiotics didn’t do much after my hospital stay.”
Limited sinus infection changes on the first abscess presentation
The specialist she was seeing referred her to Macquarie University Hospital-based ENT surgeon Professor Richard Harvey.
When sinusitis is more than a sinus infection
“Savannah had osteomyelitis – a bacterial infection of the bone – rather than a simple sinus infection as the source of her ongoing abscesses.
“Our approach was to drain the abscess endoscopically and then, based on sampling, put her on an extended program of appropriate antibiotics to clear the underlying infection. Antibiotics were administered through a peripherally inserted central catheter via the upper arm.
The left orbital abscess arising 6weeks after the initial presentation and still on minor changes from the sinus infection
“This kind of infection with related recurring symptoms is important to treat effectively and completely,” said Professor Harvey. “This is best achieved by a thorough clinical diagnosis in a tertiary setting, where specialist teams, advanced endoscopic approaches, and comprehensive pathology services are on hand.”
Savannah has returned home and is symptom free.
“I am back to being active, working full-time and leading a normal life,” said Savannah. “I do have to do nose flusher to keep my sinuses clear, but other than that, I’m absolutely fine.”
It is imperative to treat the underlying infection, abscess can arise in the very young (<5yro) and be a result of infection spreading down venous channels (known as thrombophlebitis) but in older patients it is usually a sign of underlying osteitis or bone infection. Surgery on the sinuses them selves is really not what is required but a treatment of the abscess and underlying infection. Although such ’emergent surgery’ on the sinuses still occurs, it is not what is required nor supported by scientific evidence.
More about surgery for sinus infections and comprehensive management
visit Prof Richard Harvey’s you tube channel
Savannah kindly offered her details and images to help further educate us and hopefully help another future patient. Original article appears in MUH Frontiers Magazine.