Occurrence of acute otitis and sinusitis in patients hospitalized for influenza.

Introduction: Acute otitis and sinusitis are common complications in patients with influenza and are responsible for increased hospitalization rates. Methods: A five-year retrospective study (2018-2023) was conducted including all patients hospitalized for influenza (etiologic diagnosis by RT-PCR) to identify the incidence and characteristics of cases complicated with otitis and/or sinusitis. Cases associated with other viral co-infections were excluded from the analysis. Results: We identified a cumulative rate of 20.6% (324 cases) of acute otitis (AO) and acute sinusitis (AS) among patients with influenza. Of these, 62.3% had AO, 28.1% AS, and 9.6% concomitant AO and AS. Cases of AO were predominant in the pediatric population (97.0%), while cases of AS were more common in adults (56.1%). Influenza A viruses were identified in 67.2% of patients. The infection with influenza B viruses increased the risk of acute congestive otitis media 2.1-fold (p=0.020), and influenza A viruses increased the risk of acute maxillary sinusitis 2.7-fold (p=0.029). Late presentation to the hospital, with a median of 4 days from the onset of influenza symptoms, was identified as a factor in the occurrence of AO and AS. Conclusions: The risk of AO and AS is increased in patients with influenza, especially in the pediatric population and in late hospital presentations. These findings highlight the importance of proper monitoring and management of patients with influenza to prevent the development of complications, as well as the need to better understand the mechanisms whereby influenza viruses contribute to these secondary conditions.

Opportunities to Improve Antibiotic Prescribing for Adults With Acute Sinusitis, United States, 2016-2020.

Background: Better understanding differences associated with antibiotic prescribing for acute sinusitis can help inform antibiotic stewardship strategies. We characterized antibiotic prescribing patterns for acute sinusitis among commercially insured adults and explored differences by patient- and prescriber-level factors. Methods: Outpatient encounters among adults aged 18 to 64 years diagnosed with sinusitis between 2016 and 2020 were identified by national administrative claims data. We classified antibiotic agents-first-line (amoxicillin-clavulanate or amoxicillin) and second-line (doxycycline, levofloxacin, or moxifloxacin)-and ≤7-day durations as guideline concordant based on clinical practice guidelines. Modified Poisson regression was used to examine the association between patient- and prescriber-level factors and guideline-concordant antibiotic prescribing. Results: Among 4 689 850 sinusitis encounters, 53% resulted in a guideline-concordant agent, 30% in a guideline-discordant agent, and 17% in no antibiotic prescription. About 75% of first-line agents and 63% of second-line agents were prescribed for >7 days, exceeding the length of therapy recommended by clinical guidelines. Adults with sinusitis living in a rural area were less likely to receive a prescription with guideline-concordant antibiotic selection (adjusted risk ratio [aRR], 0.92; 95% CI, .92-.92) and duration (aRR, 0.77; 95% CI, .76-.77). When compared with encounters in an office setting, urgent care encounters were less likely to result in a prescription with a guideline-concordant duration (aRR, 0.76; 95% CI, .75-.76). Conclusions: Opportunities still exist to optimize antibiotic agent selection and treatment duration for adults with acute sinusitis, especially in rural areas and urgent care settings. Recognizing specific patient- and prescriber-level factors associated with antibiotic prescribing can help inform antibiotic stewardship interventions.

Clinical Management and Neurosurgical Approach of Pott's Puffy Tumor: A Case Report.

Pott's puffy tumors are assumed to be infrequent concomitant intra- and extracranial abscesses, mainly secondary to complicated frontal sinusitis during infancy. Due to the close proximity to the superior sagittal sinus, there is a risk of developing venous infections, thrombosis, and morbidity. In this case report, we present a case of an 11-year-old girl who presented with headache and face edema. After recognizing the Pott's puffy tumor pattern on the CT scan and brain MRI, the neurosurgical approach involved pus evacuation and frontal sinus blockage, and the patient received antibiotic therapy and was evaluated for total recovery. To our knowledge, the prompt diagnosis and treatment of such conditions are paramount to avoid complications, and differential diagnosis should be encouraged in medical practice.

Hospitalizations for Acute Otitis and Sinusitis in Patients Living with HIV: A Retrospective Analysis of a Tertiary Center in Romania.

Background/Objectives: Acute or chronic ear, nose and throat (ENT) conditions in people living with HIV can lead to hospitalization and affect their quality of life. The aim of our study was to determine the frequency and characteristics of hospitalizations for acute sinusitis (AS) and acute otitis (AO) in people living with HIV. Methods: We performed a retrospective analysis over the course of six years (from January 2018 to December 2023), assessing all hospitalizations for AS and/or AO occurring in patients living with HIV, at the largest infectious diseases hospital in Romania. Results: We identified a total of 179 cases, among which 149 cases (83.2%) were attributed to AS and 41 cases (22.9%) were due to AO. Among cases of AS, maxillary sinuses were most frequently involved (n = 140/149, 94.0%), and among cases of AO, acute congestive otitis media (n = 14, 34.1%) and acute purulent otitis media (n = 13, 31.7%) were the most common forms. The underlying HIV infection was classified as stage C3 in 57.5% of cases. In 19.6% of cases, it was possible to identify either the trigger or the etiological agent, and the most frequent bacterial pathogens were Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa. Conclusions: In conclusion, this study highlights that hospitalizations due to acute sinus and ear involvement are not isolated events in people living with HIV. A prospective follow-up is needed to gain a deeper and more dynamic understanding of how ENT health is affected in people with HIV infection. Furthermore, promoting prevention through vaccination may reduce to a certain extent the burden of ENT infections in this population.

B-cell Lymphoblastic Lymphoma Presenting as a Sinonasal Mass: A Case Report.

B-cell lymphoblastic lymphoma (B-LBL) is an abnormal proliferation of lymphocyte precursor cells located primarily outside of the bone marrow and peripheral blood, typically in the mediastinum or other lymph nodes. It is often a disease of childhood that presents with lymphadenopathy, fatigue, pallor, bone pain, and weight loss with laboratory findings of anemia and thrombocytopenia. Initial presentations prompted by head and neck manifestations are exceedingly rare. A five-year-old girl with no significant past medical history presented with right facial swelling and mild proptosis on ophthalmologic evaluation. She was referred to a tertiary care facility by her local otolaryngologist for further management after computed tomographic imaging revealed right maxillary sinus opacification and erosion of the anterior maxillary bone. Her symptoms were initially responsive to prednisone and amoxicillin-clavulanate, and only right unilateral nasal discharge persisted with a near-complete resolution of other sinonasal symptoms. Notably, laboratory values, including complete blood count, were within normal limits. Given concern for the etiology of the bony erosion, the patient presented for a second opinion, where imaging and biopsy resulted in flow cytometry findings consistent with B-ALL/LBL. After a bone marrow biopsy, the ultimate diagnosis was Murphy's stage III B-cell lymphoblastic lymphoma. Malignant neoplasms of the sinonasal region are rare in children, where primary sinonasal B-LBL is a unique occurrence. Clinical features of sinonasal B-LBL in the paranasal sinuses may masquerade as pathologies such as acute sinusitis, orbital cellulitis, and benign tumors or polyps that can lead to a confounding diagnosis. In this case presentation, an initial response to steroids and antibiotics should not provide false reassurance when other features and signs, such as maxillary bone erosion, may suggest the presence of malignancy.

Pott's Puffy Tumor: A Case Report on Diagnosis Through Imaging.

Pott's puffy tumor (PPT) is a rare but life-threatening complication of chronic sinusitis, although it can be secondary to other entities such as trauma or insect bites. It is characterized by circumscribed frontal swelling associated with a subperiosteal abscess. Imaging plays a crucial role in diagnosis and early identification of complications, some of which can be life-threatening, including intracerebral and intra-orbital complications. We present a case of a 14-year-old male with non-specific frontal pain and swelling, where the diagnosis of PTT was confirmed through imaging studies. Upon admission, the patient exhibited orbital and intracerebral complications, as shown in MRI and CT scans. Treatment involved a combination of antibiotics and sinus surgery, with close monitoring for orbital and intracranial complications.

Orbital complications of sinusitis in children - Retrospective analysis of an 8.5 year experience.

OBJECTIVE: Orbital complications account for approximately 74-85 % of all complications of acute sinusitis, affect the pediatric population more frequently, and can have devastating consequences. In the years following the COVID-19 pandemic (2022, 2023), a high number of children presented to our clinic with orbital complications. 1)Has there been an increase in orbital complications in the post-covid era? 2)To what extent has the use of MRI reduced radiation in pediatric patients? DESIGN: In our retrospective data analysis, all pediatric patients (age 0-16 years) treated at a university ENT clinic during the period 01/2014-06/2023 who presented with an orbital complication of rhinosinusitis were included. The analysis was descriptive. RESULTS: Forty-four children with orbital complications of rhinosinusitis were treated during the study period, 14 females and 30 males. Most patients (n = 23, 52 %) presented during the years of the waning Covid-19 pandemic (01/2022 to 06/2023). MRI was the initial imaging modality (n = 22,50 %); CT was performed in 17 of 44 cases (39 %) when surgery was indicated. The most common germ detected was of the Streptococcus species, and the predominant antibiotic administered was amipicillin/sulbactam. CONCLUSION: The standard operating procedure (SOP) established at our hospital in 2014 was followed in 42/44 cases. Except for 2 cases, CT was performed exclusively when surgery was indicated. Imaging-related radiation could be avoided in 27 patients (61 %). There was a 30 % increase in orbital complications related to sinus infections postpandemically.

Impact of COVID-19 on nationwide pediatric complicated sinusitis trends throughout 2018-2022.

OBJECTIVES: To describe and analyze the trends of pediatric sinusitis cases from 2018 to 2022 across the country utilizing the Pediatric Hospital Information System (PHIS) database focusing on volumes, socioeconomics, and severity of cases. STUDY DESIGN: Retrospective Cohort Study. METHODS: A retrospective cohort study using the Pediatric Health Information System (PHIS) database, which consists of 50 children's hospitals was performed. Regions were defined according to PHIS guidelines. We evaluated percentage of sinusitis cases demographic and socioeconomic information and subgrouped by region throughout 2018-2022. RESULTS: In all regions there were a greater number of sinusitis cases post-COVID compared to pre-COVID, with notable increases in major and extreme severity. The years 2020 and 2021 saw a decrease in total sinusitis cases in all locations. Both surgical intervention and severity of sinusitis were significant factors affecting length of stay. Age and severity were the most significant predictors regarding the odds of having sinus surgery. Age and insurance type were significant predictors of severity, with increasing age and government insurance associated with higher odds of major or extreme severity of sinusitis. CONCLUSIONS: There appears to be a trend of both increased number and worsening severity of acute sinusitis cases in the post-COVID era compared to pre-COVID. There was a decrease in cases in 2020-2021 during the pandemic, consistent with trends of other communicable diseases.

Trends and Frequencies of Antibiotic Prescriptions for Acute Sinusitis Outpatient Visits in Adults.

OBJECTIVE: The objective of this study was to analyze the trends and frequency in which recommended first-line therapy, amoxicillin with or without clavulanate, was prescribed for acute sinusitis based on current otolaryngology and other gold standard guidelines, as well as analyze differences in prescription behaviors of otolaryngologists compared with non-otolaryngologists for outpatient adult acute sinusitis visits. METHODS: Weighted patient data from the National Ambulatory Medical Care Survey were analyzed to calculate visit rates and trends of antibiotic prescriptions for adults diagnosed with acute sinusitis from 2007 to 2019. Visits with multiple prescribed antibiotics or concomitant diagnoses requiring antibiotics were excluded. Each visit was classified based on the type of antibiotic prescribed. RESULTS: Acute sinusitis was diagnosed in 0.63% of all outpatient visits from 2007 to 2019 (95% confidence interval: 0.56%-0.71%). Amoxicillin had the greatest increase in prescription frequency (13.4%), whereas macrolides had the largest decrease in prescription frequency (13.9%). Among adult acute sinusitis outpatient visits in which antibiotics were prescribed, recommended first-line antibiotic therapy of amoxicillin-clavulanate or amoxicillin alone was prescribed in 40.4% of visits. The most common antibiotic prescribed was amoxicillin-clavulanate at otolaryngologist visits (20.5%) and macrolides at non-otolaryngologist visits (26.0%). A greater proportion of otolaryngologist visits resulted in no antibiotics prescribed for acute sinusitis (36.8% vs. 22.5%, p < 0.001). CONCLUSION: Otolaryngologists engage in watchful waiting more than non-otolaryngologists. Broader dissemination of existing guidelines for acute sinusitis treatment to non-Otolaryngologist (ENT) primary care specialties that take care of acute sinusitis to improve antibiotic stewardship and appropriate antibiotic selection is needed. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:2622-2625, 2024.

Tumor de Pott y absceso cerebral secundario a sinusitis aguda de foco dentario en paciente pediátrico / Pott's tumor and cerebral abscess secondary to acute sinusitis of dental focus in a pediatric patient

El tumor de Pott es una entidad rara, definida como un absceso subperióstico asociado a osteomielitis del hueso frontal. Suele presentarse como complicación de sinusitis aguda o crónica del seno frontal, y se describe con mayor incidencia en población pediátrica, siendo una complicación grave por su alta morbimortalidad. Se presenta a un paciente pediátrico con tumor de Pott y absceso cerebral posterior a una sinusitis aguda de foco odontogénico, en la que los pilares de tratamiento son drenaje quirúrgico precoz y antibioticoterapia prolongada. Se describe la clínica, manejo médico-quirúrgico y seguimiento posterior, ya que, en ausencia de antecedentes, se debe buscar dirigida- mente enfermedad periodontal y realizar un estudio de inmunodeficiencia primaria.

Pott's tumor is a rare entity, defined as a subperiosteal abscess associated with osteomyelitis of the frontal bone. It usually presents as a complication of acute or chronic sinusitis of the frontal sinus and it is described with a higher incidence in the pediatric population, being a serious complication due to its high morbidity and mortality. We present a pediatric patient with Pott's tumor and brain abscess after acute sinusitis of odontogenic focus, in which the pillars of treatment are an early surgical drainage and prolonged antibiotic therapy. The clinic, medical-surgical management and subsequent follow-up are described, since in the absence of antecedents, periodontal disease should be sought directly and a study of primary immunodeficiency performed.

Frontal Headache and Swelling: A Case Report of Pott's Puffy Tumor.

Pott's puffy tumor, a rare complication of frontal sinusitis, poses a diagnostic challenge due to its infrequency and diverse clinical manifestations. Recognizing this condition promptly is crucial due to the potential for severe neurological compromise. We present the case of a 32-year-old male who presented with a one-week history of frontal headache, tenderness, and swelling following an upper respiratory tract infection. The physical examination revealed a tense, erythematous swelling over the frontal region. Laboratory results showed elevated inflammatory markers. Computed tomography revealed an epidural abscess secondary to frontal sinusitis. An emergent craniotomy was performed to evacuate the collection, followed by intravenous antibiotic therapy. The patient recovered with no neurological deficits. This case emphasizes the importance of considering Pott's puffy tumor in patients with frontal swelling and associated symptoms. Despite its rarity, a multidisciplinary approach involving imaging, microbiological analysis, and surgical intervention enables an accurate diagnosis and successful management. Timely recognition and appropriate treatment, including surgical drainage and targeted antibiotics, are critical for achieving favorable outcomes.

Multi-center clinical trial of Biyuan Pills in treating acute sinusitis syndrome with wind-evil invading lung / 中草药

Objective To observe the efficacy and safety of Biyuan Pills in treating acute sinusitis with syndrome of wind pathogen invading lung. Methods A method with randomized, positive-drug, parallel-controlled, doubled-blind, double-dummy, and multi-center trial was designed in the clinical study. The 330 cases were served as treatment group, taking Biyuan Pills for 10 d, 110 cases as control group, receiving Xiangju Capsule for 10 d. The curative effectiveness clinical diseases were the main observing parameter. Results Markedly effective rate and total effective rate of test group was 59.87% (58.93%) and 92.04% (90.60%), and that of control group was 51.40% (50.93%) and 84.11% (83.33%). Two groups total effective comparative differences were statistically significant (P < 0.05), the experimental group was better than the control group. The healing rate of TCM syndromes was 64.65% (63.64%) in the experimental group and 51.40% (50.93%) in the control group. The difference between the two groups was statistically significant (P < 0.05), and the experimental group was superior to the control group. After treatment, the symptoms of TCM in the two groups were significantly improved, and the improvement of nasal congestion and headache in the experimental group was better than that in the control group (P < 0.05). In the experiment, there were nine adverse events in the experimental group and one adverse event in the control group. No abnormal changes in clinical laboratory indicators related to the study drugs were found in either group. Conclusion Biyuan Pills is safe and effective in treating acute sinusitis with syndrome of wind pathogen and invading lung.

Chuanxiong-Chatiao powder and Cangerzi powder combined with routine treatment for acute rhinosinusitis / 国际中医中药杂志

Objective@#To evaluate the efficacy of Chuanxiong-Chatiao powder and Cangerzi powder combined with routine treatmentfor the patients with acute rhinosinusitis.@*Methods@#A total of 104 patients with acute rhinosinusitis were enrolled and divided into the treatment group (52 patients) and the control group (52 patients) by random number table method. Patients in the control group were treated with routine treatment of western medicine, while those in the treatment group with Chuanxiong-Chatiao powder and Cangerzi powder plus routine treatment of western medicine. All the treatments lasted 30 days, with follow-up of 6 months. The total symptom scores (TSS), nasal obstruction, nasal discharge, dizziness, and nasal secretion improvement time, and the clinical curative effect of the two groups were observed and recorded.@*Results@#The total effective rate in the treatment group was significantly higher than that in the control group [86.5% (45/52) vs. 69.2% (36/52); χ2=4.522, P=0.034]. After treatment, the TSS of the treatment group were significantly lower than the control group (3.9 ± 0.5 vs. 5.9 ± 0.6; t=18.466, P<0.01). The nasal obstruction, nasal discharge, dizziness, and nasal secretion improvement time in the treatment group was superior to those in the control group (t were 5.367, 8.034, -7.525 ,-6.757, P<0.01). In the follow-up of 6 months, the recurrence rate in the treatment group was significantly higher than that in the control group [33.3% (9/27) vs. 11.4% (4/35); χ2=4.413, P=0.036].@*Conclusions@#Chuanxiong-Chatiao powder and Cangerzi powder combined with routine treatment can improve the clinical symptoms in patients western medicine with acute rhinosinusitis.

Changes in prescription of antibiotics based on Gram stains in an otorhinolaryngology outpatient clinic : A pilot study / 日本プライマリ・ケア連合学会誌

<b>Purpose</b> : This preliminary study was aimed to investigate potentially beneficial changes in prescription of antibiotics by use of Gram staining in an otorhinolaryngology outpatient clinic.<br><b>Methods</b> : This study was done in a single clinic. Changes in the type and amount of antibiotics prescribed, in addition to the clinical outcomes prior to and following introduction of Gram staining, were analyzed retrospectively.<br><b>Results</b> : Following introduction of Gram staining in 2005, the costs for antibiotics per person per year decreased to about one-fifth. The number of prescriptions per 100 patients decreased from 20.9 in 2006 to 3.6 in 2012 for macrolides, from 7.9 in 2005 to 2.4 in 2012 for third-generation cephalosporins, and increased from 1.6 in 2004 to 3.9 in 2012 for penicillins. In addition, for every 50 pediatric cases of acute sinusitis, the number of patients to whom no antibiotics were prescribed increased 9-fold and the number of patients to whom 2 or more types of antibiotics were prescribed decreased from 26 to 9 cases, while the mean period in days until resolution was shortened by 6 days.<br><b>Conclusion</b> : The results of this pilot study suggest that the use of Gram staining for diagnosis and prescription of antibiotics in an otorhinolaryngology outpatient clinic may lead to significantly improved antibiotic prescription practices. Further study through proper controlled studies are felt to be neceesary.

Relativity between Deviation of Nasal Septum and Acute Sinusitis / 浙江中医药大学学报

[Objective] To discuss the relativity between the deviation of nasal spetum and acute sinusitis ’offering relative theoretic base for clinical perven-tion, causa morbi, diagnosis and treatment.[Method] Select 1 case of deviation of nasal spetum from Hangzhou City First People Hospital, make pair com-parison 2 sides of the sinus, record the attack of 2 flanks of sinus with deviation of septum(frontal sinus, maxil ary sinus, frontal and back ethmoidal cellules, sphenoid sinus) for the sinusitis, and make quantitative analysis to the severity, evalulate susceptivity and severity. [Result] There ’s no difference of statistical meaning on the occurrence rate and sinusitis scores for the 2 flanks of the patient.[Conclusion]For such patient of acute sinusitis, the susceptivity and severi-ty are the same for 2 flanks of nasal cavity; the pure correction of the deviation can ’t effectively prevent or treat acute sinusitis; for such patient, we shal correspondingly evaluate and treat the compensatory change caused by deviated spetum.

Acute Severe Eye Pain and Epistaxis in a 16-year-old Male Teenager ‐ What Clinical Clues May Aid a GP In Diagnosing Acute Sinusitis?

A 16-year-old teenager presented with acute severe eye pain and mild epistaxis. The family physician diagnosed an ophthalmologic emergency requiring evaluation. Acute sinusitis was not entertained. Subsequently, ENT evaluation and CT scan confirmed maxillary and anterior ethmoidal sinusitis. This lead to a search for criteria to improve diagnosis of acute sinusitis in the GP setting. Two or more of these symptoms ‐ mucopurulent rhinorrhoea, nasal obstruction/congestion, facial pain/pressure and decreased sense of smell increase its likelihood. Other important issues discussed include differential diagnosis of eye pain associated with epistaxis, potential orbital complications of sinusitis and causes of the quiet, non-red eye.

Simultaneous Subperiosteal and Subdural Abscesses Occurred as Complications of Acute Sinusitis

Acute sinusitis is a common medical problem which can result in serious complications if it is not managed appropriately. The most common complication of acute sinusitis is orbital complication, followed by intracranial complications. Concomitant involvement of the orbit and the brain as complications of acute sinusitis is very rare. We were presented with a case of a 27-year-old woman who suffered from subperiosteal abscess in the orbit and subdural abscess in the frontal area. Endoscopic sinus surgery, drainage of the subperiosteal abscess through eyebrow incision and drainage of the subdural abscess through craniotomy were performed. The postoperative course was uneventful, and the patient was free of ocular and neurologic symptoms at the eight month follow-up.

A Ten Year Retrospective Review of Orbital Complications Secondary to Acute Sinusitis in Children

Acute sinusitis is most often a mild self-limiting disease. However, it may progress into severe and life threatening complications. One of the commonest being orbital complication of which visual loss is a direct consequence. In this 10 year retrospective study, the nature of orbital complication, clinical presentation and treatment modalities and outcome seen in children with acute sinusitis in a tertiary referral institute were reviewed. Of six patients, there was a case of preseptal cellulitis, 4 cases of subperiosteal abscess and one case of orbital abscess. Periorbital swelling was a common presenting feature. In 5 cases this was associated with proptosis with one case of impending optic nerve compression. The value of computed tomography and opthalmological examination as a component in the management plan is highlighted. All patients were treated with intravenous antibiotics but evidence of abscess collection warranted urgent surgical drainage in 5 patients, 3 being endoscopic drainage while external approach was done for the remaining 2 patients. Thus a child exhibiting orbital complication of acute sinusitis, prompt diagnosis and treatment is essential in obtaining the best outcome for the child.

A Case of Simultaneous Orbital Cellulitis and Intracranial Complication

PURPOSE: To report a case of simultaneous orbital cellulitis and intracranial complications of acute sinusitis in a young patient. CASE SUMMARY: The 11-year-old male presented with a one-day history of left periorbital erythematous swelling, fever and headache. He was diagnosed with acute sinusitis at the department of otorhinolaryngology, and endoscopic sinus drainage of pus was performed. However, the patient's symptoms did not improve. The next day, a subdural abscess was found on brain computed tomography. He was treated by external drainage of the periosteal abscess via a subbrow incision and systemic antibiotics, as well as anticonvulsant medication. CONCLUSIONS: Twenty days after external drainage and beginning systemic antibiotics and anticonvulsant treatment, he was discharged with improved orbital cellulitis symptoms and a resolved subdural abscess.

A Case of Sinusitis-Induced Intracranial Complication / 대한이비인후과학회지

Sinusitis is a common problem that is routinely diagnosed and treated by most primary care physicians. Although most cases usually respond to appropriate therapy, some occasionally progress to the development of intracranial complications, including meningitis, osteomyelitis, epidural and subdural empyema, intracranial mucocele or polyps, and frank brain abscess. It is important to develop a rational approach to the diagnosis and treatment of these conditions. Intracranial complications are pathologically caused by direct extension of the disease through the bony defect or hematogenous spread. Radiologic evaluation must include computerized tomography for accurate diagnosis and surgical planning. Therapy includes surgical drainage and high doses of intravenous antibiotics. Recently we have experienced one subdural abscess secondary to acute sinusitis.