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Paranasal sinus mycoses in north India
N K Panda1, S C Sharma, A Chakrabarti
1Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abstract:
Recognizing the high incidence of paranasal sinus mycoses in north India, we analysed retrospectively the clinical, mycological and management aspects of 178 patients with proven disease attending our institute. On the basis of clinical, radiological, histopathological and mycological findings, the patients could be categorized into those with allergic (8), non-invasive (92) and invasive (78) disease types. Bony erosion without mucosal invasion by fungi was seen in 16 patients with non-invasive disease. Young men from rural areas were the most commonly affected. Rhinorrhoea with nasal polyposis (45.8%) and proptosis (46.4%) was the most common presentation. Concurrent involvement of the maxillary and ethmoid sinuses was common in these patients, whereas isolated sphenoid and frontal sinuses were involved in the invasive variety only. Orbital and intracranial extensions were detected in 100% and 13.2%, respectively, of patients with the invasive type of disease. Aspergillus flavus (79.7%) was the most common isolate. Surgical debridement and sinus ventilation were adequate for the effective management of the non-invasive disease. However, adjuvant medical therapy was included in treatment of the semi-invasive and invasive varieties of the disease. Itraconazole was found to be most useful in prevention of recurrence in the invasive type. Mortality was highest (33.3%) among patients with zygomycotic infection. Invasive fungal granuloma with orbital and intra-cranial invasion is a distinct entity in terms of its clinical course and treatment compared with non-invasive fungal sinusitis, and it needs to be treated aggressively with surgical excision and postoperative itraconazole.
Insights
This study highlights the prevalence and characteristics of fungal infections affecting the paranasal sinuses in North India. Invasive fungal sinusitis requires aggressive treatment, including surgery and antifungal medication, to prevent recurrence and improve outcomes.
Area of Science:
- Otolaryngology
- Mycology
- Infectious Diseases
Background:
- Paranasal sinus mycoses present a significant health concern in North India.
- A retrospective analysis of 178 patients with proven fungal sinusitis was conducted.
Purpose of the Study:
- To analyze the clinical, mycological, and management aspects of paranasal sinus mycoses.
- To categorize disease types and identify risk factors and common presentations.
Main Methods:
- Retrospective analysis of 178 patients.
- Classification based on clinical, radiological, histopathological, and mycological findings.
- Identification of causative fungal species and assessment of treatment outcomes.
Main Results:
- Patients were categorized into allergic (8), non-invasive (92), and invasive (78) types.
- Young men from rural areas were most commonly affected; rhinorrhoea with nasal polyposis and proptosis were frequent symptoms.
- Aspergillus flavus was the most common isolate (79.7%); orbital and intracranial extensions were noted in invasive cases.
Conclusions:
- Non-invasive fungal sinusitis is manageable with surgical debridement and sinus ventilation.
- Invasive fungal sinusitis requires aggressive management with surgery and adjuvant medical therapy, such as itraconazole, for prevention of recurrence.
- Zygomycotic infections had the highest mortality rate (33.3%).