Additional Points

Letters to the Editor Sinogenic Orbital Complications by Prof. Dr. Dr. med. Hans J. Welkoborsky, Prof. Dr. med. Susanne Pitz, Dr. med. Sylvia Graß, Dr. med. Boris Breuer, Dr. med. Anja Pähler vor der Holte, Dr. med. Oliver Bertram, and Prof. Dr. med. Burkhard Wiechens in issue 3/2022

The review article (1) discusses complicated sinusitis in an excellent way. Precise terminology is important since clinical jargon often does not differentiate between (orbital) abscess and orbital cellulitis. In our opinion, three points require discussion:

• The authors deviate from the current S2k guideline of the Association of the Scientific Medical Societies in Germany (AWMF) (2). The guideline recommends computed tomography (CT) scanning as the best imaging modality for the sinus system, which—in contrast to digital volume tomography (DVT)—allows for the diagnostic evaluation of soft tissues as well as bones and which is reportedly “comparable regarding spatial resolution in the high-contrast range (bone imaging) as well as radiation exposure. DVT is exclusively suited for imaging high-contrast structures (3). Furthermore, intravenous application of contrast medium for the certain diagnosis of complicated sinusitis and possible differential diagnoses makes sense, but this is reserved for CT and magnetic resonance imaging (MRI).
• The radiation dose from a CT scan does not depend on the age or generation of the scanner, but in particular on the technical protocol. It is correct that modern equipment uses noise suppression algorithms, pre-filtering, and detector technologies based on artificial intelligence, which allow for investigating high-contrast and low-contrast structures even in the head and neck area at a significantly lower radiation exposure with an unchanged high image quality.
• Unfortunately, MRI as a diagnostic option especially in children was not mentioned. From school age onwards, a diagnostic investigation can be undertaken in the appropriate care setting without any problems, which enables the correct diagnosis entirely without necessitating radiation exposure. Intracranial complications such as dural involvement or empyema formation can even be overlooked if the diagnostic evaluation is restricted to CT scanning (4).

DOI: 10.3238/arztebl.m2022.0187

Prof. Dr. med. Mathias Cohnen

Institut für Klinische Radiologie, Rheinlandklinikum Neuss GmbH, Lukaskrankenhaus

Prof. Dr. med. Randolf Klingebiel

Institut für diagnostische und interventionelle Neuroradiologie, Ev. Klinikum Bethel gGmbH, Bielefeld

Prof. Dr. med. Sönke Langner

Radiologische Gemeinschaftspraxis, Greifswald-Wolgast-Anklam

Prof. Dr. med. Michael Lell

Institut für Radiologie und Nuklearmedizin, Klinikum Nürnberg, Paracelsus Medical University

Prof. Dr. med. Stefan Rohde

Klinik für Radiologie und Neuroradiologie, Klinikum Dortmund gGmbH

The signatories are board members of the working group for the diagnostic evaluation of head and neck within the German Radiological Society (DRG).

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Welkoborsky HJ, Pitz S, Graß S, Breuer B, Pähler vor der Holte A, Bertram O, Wiechens B: Sinogenic orbital complications. Dtsch Arztebl Int 2022; 119: 31–7

2. Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin: S2k-Leitlinie Rhinosinusitis. http://www.awmf.org/uploads/tx_szleitlinien/017-049_und_053-012l_S2k_Rhinosinusitis_2019-04.pdf (last accessed on 5 April 2022).

3. Dammann F, Bootz F, Cohnen M, Haßfeld S, Tatagiba M, Kösling S: Diagnostic imaging modalities in head and neck disease. Dtsch Arztebl Int 2014; 111: 417–23

4. Velayudhan V, Chaudhry ZA, Smoker WRK, Shinder R , Reede DL: Imaging of intracranial and orbital complications of sinusitis and atypical sinus infection: What the radiologist needs to know. Curr Probl Diagn Radiol 2017; 46: 441–51