The incidence of sinusitis and the use of ultrasound in early diagnosis of sinusitis in patients with head injury

Introduction

Sinusitis, complication of the head injury in critically ill patients, is an important cause of sepsis and may well be difficult to be diagnosed. In this study, we assayed the sensitivity and specificity of ultrasonography (USG) by comparing it with the computerized tomography (CT) and we determined the incidence of maxillary sinusitis with existing fluid in the maxillary sinuses.

Materials and methods

In an 8 month period, 41 patients with head injury that requires CT for diagnosis and control were admitted to the ICU. The paranasal CT was performed along with the routine cranial control CT in these patients. After paranasal CT scanning, a B-mode USG was performed blindly. Radiological maxillary sinusitis (RMS) is defined by an air-fluid level or a complete opacification of the maxillary sinus area in the CT. Absence of RMS was defined as a normal sinus. Total opacity or air-fluid level, larger than half of the sinus area, defined important RMS. Air-fluid levels inferior to the half of the sinus area defined moderate RMS. In an ultrasonographic procedure, if the acoustic shadow rises from the front wall, the image is defined normal. Moderate form was defined as the hyperechogenic visualization of the whole posterior wall. Severe form was defined as the hyperechogenic visualization of both the posterior and internal wall of the sinus as a border of hypoechogenic sinus cavity. The indication of the punction includes moderate and/or severe RMS, fever (temperature ≥ 38°C), leukocytosis (white blood cell > 12,000/mm³) and an increase in CRP values. When the maxillary sinusitis developed we performed a punction of the maxillary sinus using a sinoject. All aspirated material was cultured for aerobic and anaerobic agents. Antibiotics were modified according to the sensitivity of the cultures.

Results

In an 8 month period we performed 100 CT and USG examinations at the same time. Sensitivity and specificity of USG compared with CT were, respectively, 92.15% and 81.63%. We performed a punction in 35 of 47 sinuses, which show medium and/or severe fluid existence in both CT and USG. Using appropriate microbiological techniques 22 bacterial strains were isolated in 19/35 aspirates (40.42%). The most frequently isolated species were Pseudomonas sp. (n = 8, 36.36%) and E. coli (n = 5, 22.72%).

Conclusions

The incidence of sinusitis is indicated high in patients with head injury. USG may be proposed in first-line diagnosis of radiological maxillary sinusitis.