PATHOGENESIS OF SINUSITIS IN INTENSIVE-CA RE PATIENTS

Acute sinusitis is a frequent complication in ventilated intensive car e patients and may be a possible source of pneumonia or septicemia. A study of 49 ventilated intensive care neurosurgical patients without p reviously known disease of the paranasal sinuses or midface fractures was conducted retrospectively from 1989-1990. The kind of intubation u sed (naso- or orotracheal) was taken into account and the period of ve ntilation examined in order to determine the genesis of inflammatory c hanges in the paranasal sinuses (as defined by computed tomography). I ntensive care patients suffering from sinusitis showed a characteristi c early opacity of the sphenoid sinuses, with lesser involvements in t he ethmoid and maxillary sinuses. Only in rare cases and after very lo ng periods of ventilation were the frontal sinuses found to be opaque. Nasotracheal ventilation was observed to produce an earlier attack on the intubated ipsilateral sinuses. These findings indicate that nasot racheal intubation should be avoided if possible or the method of intu bation changed as early as feasible. If conservative-measures fail sin usitis should best be treated by means of endonasal microsurgical open sinostomy.