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[Managements and prognostic analyses in patients with invasive fungal rhinosinusitis]
1Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
Objective:
To evaluate the survival outcomes of invasive fungal rhinosinusitis by analyzing the clinical features.
Methods:
A retrospective analysis was performed for cases of invasive fungal sinusitis proved by histological analysis between March 2006 and November 2015. All relevant factors including interval from the onset of symptoms to initiation of diagnosis, clinical characteristics, features of CT and MRI, treatment and prognosis were collected. A total of 18 patients (10 males; 8 females) were identified. The median age was 54 years old. Three patients suffered from acute invasive fungal sinusitis, while the other 15 suffered from chronic invasive fungal sinusitis.
Results:
The mean duration between onset of symptoms and diagnosis was 5 months. The most common symptom was headache (10/18), followed by visual disturbance (7/18), nasal obstruction (4/18), facial numbness and pain (2/18) and diplopia(2/18). Two patients had diabetes mellitus; one patient had ankylosing spondylitis receiving immunosuppressive drugs treatment for one year. Four patients had the disease confined in the sinus. Complications of this disease included orbital apex involvement in 6 patients, intraorbital and optic nerve involvement in 3 patients, cavernous sinus involvement in 5 patients, pterygopalatine fossa and infratemporal fossa involvement in 5 patients, intracranial extension involvement in 3 patients. Fungal species included aspergillus (15 cases) and mucor (3 cases). Seventeen patients received intravenous antifungal therapy after surgery. The duration of follow-up ranged from 1 to 60 months. Two patients reoccurred and one patient died of the disease.
Conclusion:
Endoscopic debridement combined with intravenous antifungals is efficacious in the management of invasive fungal sinusitis.
Insights
Invasive fungal sinusitis can be effectively managed with endoscopic debridement and intravenous antifungal therapy. This approach improves survival outcomes for patients with this serious fungal infection.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Radiology
Background:
- Invasive fungal sinusitis (IFS) presents diagnostic and therapeutic challenges.
- Understanding clinical features and outcomes is crucial for effective management.
Purpose of the Study:
- To evaluate survival outcomes of invasive fungal sinusitis.
- To analyze the clinical features, diagnostic intervals, and treatment efficacy.
Main Methods:
- Retrospective analysis of 18 patients with histologically proven IFS (2006-2015).
- Data collected included symptom onset to diagnosis interval, clinical presentation, CT/MRI findings, treatment, and prognosis.
- Patients were categorized into acute (3) and chronic (15) IFS.
Main Results:
- Mean delay from symptom onset to diagnosis was 5 months.
- Common symptoms: headache (10/18), visual disturbance (7/18).
- Complications included orbital apex (6/18), cavernous sinus (5/18), and intracranial extension (3/18). Aspergillus (15) and Mucor (3) were identified. Two patients recurred, one died.
Conclusions:
- Endoscopic debridement combined with intravenous antifungals demonstrates efficacy.
- Prompt diagnosis and multidisciplinary management are key for improving patient survival in IFS.
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