Early Pott’s Puffy Tumor Syndrome Due to Barotrauma Treated Successfully With Oral Antibiotic and Corticosteroid Therapy

Acute rhinosinusitis is a common diagnosis within the military, resulting in high healthcare utilization. Barotrauma caused by "sinus squeeze" can increase morbidity associated with rhinosinusitis and can lead to complications such as Pott's Puffy Tumor (PPT). Pott's Puffy Tumor is a rare but serious complication of bacterial rhinosinusitis that is typically treated with intravenous antibiotics and surgical drainage. Herein, we present a case of early PPT that occurred following barotrauma from a plane flight. The patient had sequential healthcare visits during which time he developed the classic "doughy" forehead swelling associated with PPT. Computed tomography demonstrated pansinusitis with ostiomeatal unit obstruction and trans-osseus extension of the underlying sinusitis consistent with early PPT. Importantly, no abscess or bony dehiscence had developed. Given his stability and lack of comorbidities, he was discharged on oral antibiotics with 24-hour specialist outpatient follow-up. Oral corticosteroid therapy was subsequently initiated to promote sinus drainage. At ensuing follow-up, the patient reported development of nasal drainage and resolution of his pain and swelling. This case report demonstrates the feasibility of outpatient treatment with oral medication in the setting of early PPT in select patients. This is of particular utility in the military operational setting, where occupational exposure to barotrauma is frequent, and austere scenarios often limit access to parenteral antibiotics or specialty consultation.