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Fungal infections of the paranasal sinuses
B Karci1, D Burhanoglu, T Erdem
1Ege University, Medical Faculty, ENT Department, Izmir, Turkey.
Abstract:
Fungal infections can be mainly grouped into four types. The invasive forms are acute sinusitis (fulminant), chronic sinusitis (indolent), whereas the non-invasive forms are mycetoma and allergic fungal sinusitis. From December 1993 to December 1997, 27 cases of fungal sinusitis, 22 of which were noninvasive forms, and 5 of which were invasive forms, were treated and are presented in this study. When we classified the patients with fungal sinusitis, 11 were diagnosed as mycetoma, 9 as allergic fungal sinusitis, 3 as acute fulminant sinusitis and 2 as chronic indolent sinusitis, while 2 patients were not included in our four groups of sinusitis. In all mycetoma cases the active agent was Aspergillus. Patients with non invasive forms of sinusitis were all treated with endoscopic sinus surgery. 2 of the patients with invasive forms of sinusitis underwent maxillectomy and they were given Amphotericin-B. With a mean follow up of 20 months, only 3 recurrences were seen. The infection recurred in 2 patients with allergic fungal sinusitis and 1 patient with chronic invasive sinusitis. However, 2 patients with acute fulminant invasive sinusitis died before they were operated on, and 1 patient died postoperatively.
Insights
This study analyzed 27 fungal sinusitis cases, finding endoscopic sinus surgery effective for non-invasive types. Invasive fungal sinusitis presented higher risks, with some fatalities despite treatment.
Area of Science:
- Otolaryngology
- Mycology
- Infectious Diseases
Background:
- Fungal sinusitis encompasses four main types: invasive (acute fulminant, chronic indolent) and non-invasive (mycetoma, allergic fungal sinusitis).
- Accurate classification is crucial for determining appropriate treatment and prognosis.
Purpose of the Study:
- To present the treatment and outcomes of 27 fungal sinusitis cases.
- To evaluate the efficacy of different treatment modalities for invasive and non-invasive fungal sinusitis.
Main Methods:
- Retrospective analysis of 27 fungal sinusitis patients treated between December 1993 and December 1997.
- Classification into mycetoma, allergic fungal sinusitis, acute fulminant sinusitis, and chronic indolent sinusitis.
- Treatment included endoscopic sinus surgery for non-invasive forms and maxillectomy with Amphotericin-B for invasive forms.
Main Results:
- 22 non-invasive and 5 invasive cases were identified.
- Aspergillus was the causative agent in all mycetoma cases.
- Overall recurrence rate was low (3/27) after a mean follow-up of 20 months.
- Two patients with acute fulminant invasive sinusitis died before surgery, and one died postoperatively.
Conclusions:
- Endoscopic sinus surgery is effective for non-invasive fungal sinusitis.
- Invasive fungal sinusitis carries a significant risk of mortality, necessitating aggressive management.
- Fungal sinusitis management requires tailored approaches based on disease type and invasiveness.