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Systematic Review of Granulomatous Invasive Fungal Sinusitis Management
Abdulsalam Baqays1, Sarah Almutawa2, Razan Alsabti3
1Otolaryngology-Head & Neck Surgery Department, College of Medicine King Saud University Riyadh Saudi Arabia.
Laryngoscope Investigative Otolaryngology
|January 27, 2025
Summary
Granulomatous invasive fungal sinusitis (GIFS) in immunocompetent individuals has varied treatment outcomes. Combined medical and surgical approaches show promise, with endoscopic debulking yielding high recovery rates.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Surgical Pathology
Background:
- Granulomatous invasive fungal sinusitis (GIFS) primarily affects immunocompetent patients.
- Optimal management strategies for GIFS, including surgery, antifungal medication, or combined approaches, remain debated.
- This review synthesizes current evidence on GIFS and its treatment outcomes.
Purpose of the Study:
- To review and summarize existing literature on the diagnosis and management of granulomatous invasive fungal sinusitis (GIFS).
- To evaluate the effectiveness of different treatment modalities for GIFS.
- To identify factors associated with mortality and recovery in GIFS patients.
Main Methods:
- A comprehensive literature search was conducted across eight search engines and gray literature.
- Eligibility screening of identified articles was performed by two independent reviewer groups.
- Data extraction focused on studies reporting on GIFS management, with specific exclusion criteria applied.
Main Results:
- Forty-one studies comprising 89 patients were included in the analysis.
- Sinonasal GIFS with skull-base/intracranial extension significantly increased mortality risk (OR=14.083, p=0.002).
- Treatment achieved an 87.2% remission rate; combined medical-surgical approach yielded a 74.2% recovery rate, with endoscopic debulking showing the highest surgical recovery (52.5%).
Conclusions:
- Skull-base/intracranial extension in sinonasal GIFS is linked to poorer survival.
- The combination of endoscopic debulking and voriconazole warrants further investigation for superior GIFS management.
- Further research is needed to establish definitive treatment protocols for GIFS.
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