Prevalence of Noninvasive Fungal Sinusitis in South Australia

2003 ◽  
Vol 17 (3) ◽  
pp. 127-132 ◽  
Author(s):  
Melanie M. Collins ◽  
Salil B. Nair ◽  
Peter-John Wormald
Keyword(s):  
Prospective Study ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Chronic Sinusitis ◽  
South Australia ◽  
Sinus Surgery ◽  
Fungal Culture ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Skin Prick Tests

Background The aim of this study was to document the prevalence of noninvasive fungal sinusitis in patients with chronic sinusitis and thick viscous secretions in South Australia. Methods We studied of 349 patients with chronic rhinosinusitis undergoing endoscopic sinus surgery in a specialized rhinology practice. Patients with nasal polyposis and thick fungal-like sinus mucin had operative samples sent for microscopy and fungal culture. Evidence of atopy was taken as positive radioallergosorbent or skin-prick tests to fungi. Results One hundred and thirty-four (38%) patients were noted to have thick, viscid sinus mucin, raising suspicion of fungal disease. Ninety-three patients had positive fungal cultures or microscopy (26.6%). It was possible to classify 95.5% of the patients into subgroups of noninvasive fungal sinusitis or nonfungal sinusitis: 8.6% of patients with allergic fungal sinusitis, 1.7% of patients with allergic fungal sinusitis–like sinusitis, 15.2% of patients with chronic fungal sinusitis, one patient with a fungal ball, and the remaining 69% of patients with nonfungal chronic sinusitis. Conclusion This is the first prospective study to evaluate the prevalence of these increasingly widely recognized conditions. It highlights the need for otolaryngologists to be alert to these not uncommon diagnoses in order for early, appropriate medical and surgical management to be instituted.

Diagnosis of Allergic Fungal Sinusitis

1994 ◽  
Vol 111 (5) ◽  
pp. 580-588 ◽  
Author(s):  
John P. Bent ◽  
Frederick A. Kuhn
Keyword(s):  
Nasal Polyposis ◽  
Bone Erosion ◽  
Skin Tests ◽  
Type I ◽  
Fungal Culture ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
High Attenuation ◽  
Fungal Invasion ◽  
History Of

Allergic fungal sinusitis is a noninvasive disease first recognized approximately one decade ago. It accounts for approximately 6% to 8% of all chronic sinusitis requiring surgical intervention and has become a subject of increasing interest to otolaryngologists and related specialists. Although certain signs and symptoms, as well as radiographic, intraoperative, and pathologic findings, may cause the physician to suspect allergic fungal sinusitis, no standards have been defined for establishing the diagnosis. It is extremely important to recognize allergic fungal sinusitis and differentiate it from chronic bacterial sinusitis and other forms of fungal sinusitis because the treatments and prognoses for these disorders vary significantly. To delineate a set of diagnostic criteria, we prospectively evaluated our most recent 15 patients with allergic fungal sinusitis. An allergy evaluation confirmed atopy through a strong history of inhalant mold allergies, an elevated total immunoglobulin E level, or a positive result of a skin test or radioallergosorbent test to fungal antigens in 100% of patients. All 15 patients had nasal polyposis, and 8 of 15 had asthma. There was a unilateral predominance in 13 of 15 cases. A characteristic computerized tomography finding of serpiginous areas of high attenuation in affected sinuses was seen in all patients, and 12 of 15 patients had some degree of radiographic bone erosion. Pathologic examination uniformly revealed eosinophilic mucus without fungal invasion into soft tissue; Charcot-Leyden crystals and peripheral eosinophilic were each observed in 6 of 15 patients. Every patient had fungus identified on fungal smear, although only 11 of 15 fungal cultures were positive. Therefore, for the diagnosis of allergic fungal sinusitis to be established, the following criteria should be met: (1) type I hypersensitivity confirmed by history, skin tests, or serology; (2) nasal polyposis; (3) characteristic computed tomography signs; (4) eosinophilic mucus without fungal invasion into sinus tissue; and (5) positive fungal stain of sinus contents removed during surgery. Radiographic bone erosion does not necessarily imply invasive disease, and a positive fungal culture, although desirable, is not necessary to confirm the diagnosis. Unilateral predominance of disease, a history of asthma, Charcot-Leyden crystals, and peripheral eosinophilla corroborate the diagnosis but are not always present. Perhaps because of the novelty of the disease, much misunderstanding surrounds allergic fungal sinusitis. Misdiagnosis is common, recurrence rates are high, and proper treatment remains elusive. Before proceeding with other advances, a common understanding of the diagnosis of allergic fungal sinusitis is mandatory.

The Effect of the Total Intravenous Anesthesia Compared with Inhalational Anesthesia on the Surgical Field during Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (5) ◽  
pp. 514-520 ◽  
Author(s):  
Peter J. Wormald ◽  
Graham van Renen ◽  
Jonathon Perks ◽  
Janine A. Jones ◽  
Claire D. Langton-Hewer
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sinus Surgery ◽  
Controlled Trial ◽  
Total Intravenous Anesthesia ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Inhalational Anesthesia ◽  
Intravenous Anesthesia ◽  
Allergic Fungal Sinusitis ◽  
Surgical Field

Background Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed. Methods Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses offentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system. Results The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001). Conclusion In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.

Schizophyllum commune Sinusitis: A Case Report and Radiologic Findings

1995 ◽  
Vol 9 (3) ◽  
pp. 149-154 ◽  
Author(s):  
Brian E. Emery ◽  
Arnold D. Oberle ◽  
Fleurette Abreo ◽  
Terry A. Day ◽  
Fred J. Stucker
Keyword(s):  
Chronic Sinusitis ◽  
Schizophyllum Commune ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Mri Findings ◽  
Allergic Fungal Sinusitis ◽  
Common Chronic Disease ◽  
Radiologic Findings ◽  
Magnetic Resonance Imaging Mri ◽  
First Time

Chronic sinusitis is now considered the most common chronic disease seen in this country.1 The infections are commonly polymicrobial and include aerobes and anaerobes.2 Fungal sinusitis accounts for up to 10% of cases of chronic sinusitis, and the disease ranges from allergic fungal sinusitis through fungus balls to invasive fungal sinus disease.3,4 We report the case of a 19-year-old black female with nasal obstruction, clear rhinorrhea, and nasal polyps. She underwent endoscopic sinus surgery after medical management failed to eradicate her symptoms. Cultures from her paranasal sinuses grew S. commune, a mushroom, a member of the Basidiomycetes. There have been four prior reports of S. commune sinusitis described in the literature. Presented is a review of the literature, a description of the histologic, mycologic, and radiologic findings and suggested treatment. The magnetic resonance imaging (MRI) findings are presented here for the first time.

Pediatric Endoscopic Nasal and Sinus Surgery

1995 ◽  
Vol 113 (3) ◽  
pp. 204-210 ◽  
Author(s):  
James A. Stankiewicz
Keyword(s):  
Patient Selection ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Chronic Sinusitis ◽  
Subjective Evaluation ◽  
Choanal Atresia ◽  
Sinus Surgery ◽  
Term Objective

A total of 83 children and teenagers underwent endoscopic nasal and sinus surgery. Six patients had surgery for choanal atresia (4) and adenoid hypertrophy (2) and will only be briefly mentioned. Seventy-seven children and teenagers underwent endoscopic sinus surgery for acute and chronic sinusitis, choanal polyposis, and nasal polyposis with a minimum 2-year follow-up. One hundred thirty-three ethmoidectomies, 37 sphenoidotomies, and 119 maxillary antrostomies were performed. Subjective evaluation of the sinus surgery patients indicated that 38% of patients were cured and 55% improved during an average of 3.5 years of follow-up. The number cured and number improved are lower and higher, respectively, than in other reports of results because of the longer follow-up and patient selection. In addition, objective data were obtained on 34 patients with a second- or third-look procedure 2 weeks to 2 months after surgery. These examinations found significant granulation tissue, and almost 50% of patients had at least one maxillary ostia closed. Long-term objective results, however, are not available to determine whether the ostia remained closed. Problems with healing in children's endoscopic sinus surgery are unpredictable compared those in adult surgery because postoperative debridement and examination are often difficult to perform, thus allowing tissue to heal without control. In this series, other factors such as the increased risks of cystic fibrosis, allergy, and immunodeficiency were also more prevalent and compromised healing. The best way to achieve good results in pediatric endoscopic sinus surgery requires appropriate patient selection, careful techniques, spacers or stents that don't cover the antrostomy, appropriate second- or third-look procedures for debridement and examination, and judicious postoperative medical therapy.

Orbital Volumetric Analysis of Allergic Fungal Sinusitis Patients with Proptosis before and after Endoscopic Sinus Surgery

2005 ◽  
Vol 19 (3) ◽  
pp. 302-306 ◽  
Author(s):  
Angela Chu Stonebraker ◽  
Rodney J. Schlosser
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Computer Software ◽  
Volumetric Analysis ◽  
Sinus Surgery ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Orbital Involvement ◽  
Computed Tomography Images ◽  
Normal Ranges ◽  
Before And After

Background The aim of this study was to examine the changes of orbital volumes in allergic fungal sinusitis (AFS) patients with proptosis who undergo endoscopic sinus surgery. Methods A retrospective study of operative patients with proptosis due to AFS was performed. Normative data were obtained using patients with chronic sinusitis without orbital involvement. Orbital volume measurements were obtained using digitized images and computer software to calculate volumes (cm3) of outlined regions on 1.3-mm axial computed tomography images. Orbital volumes were measured as total volumes and volumes within the bony orbit. Bony orbits were defined using two techniques: (1) the region posterior to a line from ipsilateral zygoma to contralateral zygoma and (2) the region posterior to a line from zygoma to ipsilateral lacrimal bone. Four affected orbits in three AFS patients with proptosis were evaluated. Twenty-eight unaffected orbits in 14 patients were used as normal comparisons. Results Orbital involvement by AFS resulting in proptosis decreased orbital volumes within the bony orbit to a mean of 70% of normal. After successful endoscopic sinus surgery, bony orbital volumes normalize or approach normal ranges to a mean 90% of normal with resolution of clinically apparent proptosis. Total volumes remained stable before and after surgery. Conclusion Massive AFS may affect the orbit resulting in proptosis. Spontaneous orbital remodeling with clinical resolution of proptosis and normalization of bony orbital volumes can be seen in AFS patients several months after sinus surgery and aggressive medical treatment. Surgical orbital reconstruction typically is not needed once the sinus disease is adequately addressed.

Treatment of Allergic Fungal Sinusitis with High-Dose Itraconazole

2003 ◽  
Vol 17 (1) ◽  
pp. 1-8 ◽  
Author(s):  
B. Manrin Rains ◽  
Corey W. Mineck
Keyword(s):  
Low Dose ◽  
Treatment Protocol ◽  
Sinus Surgery ◽  
High Dose ◽  
Fungal Culture ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Radiographic Findings ◽  
Topical Corticosteroids ◽  
Oral Corticosteroids

Background Since its original description in the early 1980s, our understanding of allergic fungal sinusitis (AFS) has continued to evolve. The goal of this research was to characterize the typical AFS patient and describe a treatment protocol using endoscopic sinus surgery, high-dose itraconazole, low-dose bursts of oral corticosteroids, and topical corticosteroids. Methods A 12-year retrospective chart review was conducted to extract demographic and management data on 139 patients meeting the AFS criteria of atopy, characteristic radiographic findings, eosinophilic mucin, nasal polyposis, and a positive fungal culture or stain. Results The typical AFS patient presented at 42.8 years of age, was female, and had 3.5 positive fungal cultures over an average of 31.4 months of follow-up. Although 69 patients (50.3%) experienced recurrence, reoperation was required in only 17 (20.5%) of 83 patients initially managed by our protocol. There were no serious adverse effects attributed to itraconazole over the 36,000 doses prescribed. Conclusion The use of itraconazole, short-burst low-dose oral corticosteroids, topical corticosteroids, and endoscopic surgery is a safe and clinically effective regimen in the management of AFS. Our clinical experience suggests medical management of recurrent AFS with itraconazole may avoid revision surgery.

scholarly journals A comprehensive study on complications of endoscopic sinus surgery

2017 ◽  
Vol 3 (3) ◽  
pp. 472 ◽  
Author(s):  
Jude Anselm Shyras D. ◽  
Mohana Karthikeyan S.
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Chronic Sinusitis ◽  
Tertiary Care ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
Care Hospital ◽  
Factors Influencing ◽  
Major Complications ◽  
Management Of Complications

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">In recent years, functional endoscopic sinus surgery has become the standard of care in the surgical management of chronic sinusitis and sino nasal polyposis. Because of highly variable anatomy and closely related vital structures, it has many potential complications. This study aims to evaluate the complications of FESS, factors influencing its occurrence and management of complications. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This is a prospective study done in a tertiary care hospital over a period of one year. The first 100 patients diagnosed as chronic sinusitis or sino nasal polyposis, planned for FESS were included in the study and they were followed up for three months, post operatively. The occurrence of complications and factors associated with that were studied. </span></p><p class="abstract"><strong>Results:</strong> We had <span lang="EN-GB">1% of major complications and 12% of minor complications in this study. Major factors influencing the occurrence of complications are extension of the disease pathology and anatomical variations of the paranasal sinuses</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">FESS is one of the commonly performed surgeries in Rhinology, and the occurrence of major complications is less and extensive disease with altered anatomy is the major factor in the occurrence of complications.</span></p>

Sign in / Sign up

Export Citation Format

Share Document