[Sinusitis caused by nasotracheal intubation]

Abstract

Sinusitis following nasotracheal intubation (NTI) is an almost overlooked complication. The pathogenesis is believed to be development of oedema of the nasal mucosa due to irritation by the tube in the nasal cavity. The size of the tube is probably not important, whereas the duration of intubation is of major importance. The infection is often caused by Gram-negative microorganisms. The frequency is found to be 0.3% in short term intubation (less than 5 days) and 40.4% in long term intubation (greater than 5 days). In neurosurgical patients treated with NTI sinusitis is found in 52% and 100% of the patients. In adults the indications for prolonged NTI instead of orotracheal intubation and early tracheostomy should be considered carefully. If fever or sepsis develops in patients treated with NTI, investigations for sinusitis should be included in the search for focus. When sinusitis has developed, the tube should be removed, and the patient tracheostomised. If this treatment fails, surgical drainage should be performed.