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Paranasal sinus aspergillosis: its categorization to develop a treatment protocol.

N K Panda1, P Balaji, A Chakrabarti

  • 1Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Changigarh, India. npanda@satyam.net.in

Mycoses
|August 18, 2004
PubMed
Summary

This study categorizes paranasal sinus aspergillosis into three types. Early detection and treatment, including adjuvant chemotherapy for non-invasive destructive disease, are crucial for preventing recurrence and progression.

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Area of Science:

  • Otolaryngology
  • Mycology
  • Infectious Diseases

Background:

  • Paranasal sinus aspergillosis presents diverse clinical forms.
  • Accurate categorization is essential for effective management.

Purpose of the Study:

  • To categorize paranasal sinus aspergillosis based on definitive criteria.
  • To evaluate treatment outcomes using a fixed protocol.
  • To identify risk factors for recurrence.

Main Methods:

  • Prospective study of 25 patients with paranasal sinus aspergillosis.
  • Classification into chronic invasive, non-invasive (fungus ball), and non-invasive destructive types.
  • Treatment with surgery, ketoconazole, or itraconazole, with adjuvant chemotherapy where indicated.

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Main Results:

  • Two patient recurrences observed, both from the non-invasive destructive group progressing to invasive disease.
  • Adjuvant chemotherapy (ketoconazole/itraconazole) with surgery demonstrated effectiveness.
  • Mean follow-up of 11 months revealed low recurrence rates.

Conclusions:

  • Categorization of paranasal sinus aspergillosis guides appropriate treatment strategies.
  • Non-invasive destructive disease requires vigilant follow-up including endoscopic examination, CT, and fungal serology.
  • Adjuvant chemotherapy is effective in preventing recurrence and progression in non-invasive destructive and chronic invasive aspergillosis.