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Mycotic sinusitis

P Eloy1, B Bertrand, P Rombeaux

  • 1Catholic University of Louvain (UCL), Cliniques Universitaires UCL de Mont-Godinne, Department of Otorhinolaryngology and Head and Neck Surgery, Yvoir, Belgium.

Acta Oto-Rhino-Laryngologica Belgica
|January 1, 1997
PubMed
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Extramucosal Fungal Sinusitis (EFS) involves fungal presence in sinuses without tissue invasion. Two types, mycetoma and atopical fungal sinusitis (AFS), require distinct diagnostic and treatment approaches for optimal patient outcomes.

Area of Science:

  • Otolaryngology
  • Pathology
  • Mycology

Background:

  • Extramucosal Fungal Sinusitis (EFS) in immunocompetent individuals is gaining attention.
  • EFS is characterized by fungal hyphae within the sinus lumen, excluding tissue invasion.
  • EFS encompasses mycetoma and atopical fungal sinusitis (AFS).

Purpose of the Study:

  • To differentiate between mycetoma and AFS.
  • To outline diagnostic criteria and treatment strategies for each EFS subtype.
  • To discuss the prognosis and recurrence rates associated with EFS management.

Main Methods:

  • Histopathological examination of sinus contents.
  • Bacteriological analysis for mycetoma diagnosis.
  • Fungal culture for causative agent identification in AFS.

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  • Review of clinical presentations, CT findings, and treatment outcomes.

    • Main Results:

    • Mycetoma presents as unilateral, painful chronic sinusitis, often resistant to medical treatment, with surgery as the primary intervention.
    • AFS occurs in atopic patients with a history of chronic sinusitis or nasal polyposis, characterized by allergic mucin and scanty fungal hyphae.
    • Culture is essential for identifying the fungal agent in AFS, which requires extensive sinus surgery and long-term nasal steroid use.

    Conclusions:

    • Mycetoma management involves surgery; antifungal therapy is reserved for invasive cases.
    • AFS requires aggressive surgical and medical management, including nasal steroids, but recurrence is common.
    • Accurate diagnosis and tailored treatment are crucial for managing EFS subtypes effectively.