Sinusitis Can Lead To Brain Abscess, But This Is Rare

Question: Our daughter caught a cold several weeks ago, and she is still sick. Her nose is congested, and from time to time, she would blow out some thick yucky mucus. I am wondering whether she may have a sinus infection. We did call the health helpline, and were told that she will get better, but she is not. If anything, she is getting worse; she can’t breathe through her nose, and occasionally she has a headache, but no fever. We have been giving her a steroid nose spray that her doctor gave her last year when she had similar symptoms, but it is not helping. I just read in the news about two children who had brain infection that required surgery, this terrifies me. Should I be concerned?

Answer:

I don’t think you need to be concerned that your daughter has a brain infection at this moment.  However, what you described is a sinus infection that needs treatment to prevent it from getting worse and spreading.

Sinus infection is a common complication of colds.  When we get a cold virus, our nose and throat become inflamed, initially with clear running nose and sore throat.  The mucus membrane there is swollen with mucus, partially blocking the nostrils and making it harder to breathe.  For many, this can last a few days to a week or so, and they get better.

However, for some, these symptoms can linger and get worse.  The nostrils continue to be congested, with thick and cloudy mucus blocking the sinuses.  This can lead to sinus infection.  Some can go onto develop chronic sinus infection that is hard to clear.

Sinus infection is not totally benign.  It can make us very uncomfortable when we cannot breathe through the nose, and sometimes even have sinus headaches.  The infection can spread to the eyes, especially in young children, causing swelling of the eyelids.  This is called peri-orbital cellulitis that requires antibiotic treatment.

Another more serious complication happens when the infection goes into the eye socket, behind the eyeball.  This is called orbital cellulitis.  There is limited space in the eye socket; infection there will stretch the optic nerve that goes from the eye to the brain, this nerve carries visual images that allows us to see.  Stretching of the optic nerve can lead to blindness.

Orbital cellulitis is an urgent medical condition that requires immediate diagnosis and treatment with intravenous antibiotics.  Occasionally, emergency surgery is needed to release the pressure and prevent permanent blindness.  This is a serious, although uncommon, complication of sinusitis.

Very rarely, sinus infection can spread to the brain.  Some of our sinuses are very close to the brain, separated by a delicate piece of bone at the base of the skull.  When sinus infection is severe and untreated, bacteria in the sinuses can erode the bone and enter the brain, resulting in brain abscess.  These children are usually much sicker; they can have high fever, lethargy, vomiting, severe headache, and sometimes seizures.

In my decades of work as a consultant paediatrician, I have seen only a few children with this complication.  Most family doctors would not have encountered it in their experience.  It requires a high degree of suspicion and vigilance to make the diagnosis.

However, these complications can be prevented.  The steroid spray that you use is ineffective because the nostrils are swollen, the medicine cannot get through.  You need to use a topical decongestant called xylometazoline (Otrivin) nose drop or spray to clear the nostrils first before you administer the steroid sprays about 15 minutes later.  You may have to do this at least twice a day, for a number of days.

By reducing the swelling and removing the mucus, sinusitis often clear after a week or two.  Sometimes antibiotics are needed at the same time, and you should consult with your primary care provider.