Feasibility of Minimal Inferior Meatal Antrostomy and Fiber-Optic Sinus Exam for Fungal Sinusitis

Background/objective The aim of this study was to evaluate the usefulness of simultaneous middle and inferior meatal antrostomies (SMIAs) as a treatment modality in patients with maxillary fungal sinusitis and to compare the efficacy of SMIA with that of conventional middle meatal antrostomy (MMA). Methods A retrospective study was performed on consecutive patients with noninvasive fungal maxillary sinusitis. Twenty-one patients underwent endoscopic sinus surgery with SMIA group and the remaining 24 patients were treated with the conventional MMA group. Medical records were reviewed for history, clinical presentation, radiographic findings, surgical intervention, complications, and outcomes. Outcomes consisted of the visual analog scale (VAS) for the main symptoms and maxillary sinus endoscopic scores. The stenosis or obstruction of the antrostomy site and postoperative mucociliary function was also evaluated. Results VAS scores for facial pain and nasal discharge/postnasal drip were significantly improved in the SMIA group. The maxillary endoscopic score was also significantly reduced in the SMIA group. There were no significant differences between 2 groups with respect to the preoperative Lund–Mackay score, VAS score of nasal obstruction, nasal bleeding, postoperative mucociliary function, and MMA patency. Conclusions The SMIA technique is useful for identifying and removing fungal debris that cannot be reached through the MMA and could bring better surgical outcomes.

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Allergic fungal rhinosinusitis with skull base and orbital erosion

The Journal of Laryngology & Otology ◽

10.1017/s0022215109991253 ◽

2009 ◽

Vol 124 (2) ◽

pp. 161-165 ◽

Cited By ~ 16

Author(s):

M S Marfani ◽

M A Jawaid ◽

S M Shaikh ◽

K Thaheem

Keyword(s):

Skull Base ◽

Sinus Surgery ◽

Common Finding ◽

Nasal Discharge ◽

Topical Steroids ◽

Fungal Sinusitis ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis ◽

Postnasal Drip ◽

Imaging Results

AbstractIntroduction:Allergic fungal rhinosinusitis is a benign, noninvasive sinus disease related to hypersensitivity to fungal infection having bony skull base and orbital erosion as common finding.Patients and method:This descriptive study was conducted at the department of otorhinolaryngology, Dow University of Health Sciences, Karachi, Pakistan, from April 2003 to March 2006. In forty-seven proven cases of allergic fungal sinusitis the following information was recorded: demographic data, signs and symptoms, laboratory investigation results, imaging results, pre- and post-operative medical treatment, surgery performed, follow up, and residual or recurrent disease. The Statistical Package for the Social Sciences version 10.0 software was used for data analysis.Results:Findings indicated that allergic fungal rhinosinusitis usually occurred in the second decade of life (51.06 per cent) in males (70.21 per cent), allergic rhinitis (100 per cent) and nasal polyposis (100 per cent). Nasal obstruction (100 per cent), nasal discharge (89.36 per cent), postnasal drip (89.36 per cent), and unilateral nasal and paranasal sinus involvement (59.57 per cent) were significant features. Aspergillus (59.57 per cent) was the most common aetiological agent. Combined orbital and skull base erosion was seen in 30.04 per cent of cases, with male preponderance 6.8:1. Endoscopic sinus surgery was performed in all cases, and recurrent or residual disease was observed in 19.14 per cent.Conclusion:Allergic fungal rhinosinusitis is a disease of young, immunocompetent individual. Skull base and orbital erosion are seen in one-third of cases. Bone erosion is 6.8 times more common in males than females. Orbital erosion is 1.5 times more common than skull base erosion. Endoscopic surgical debridement and drainage combined with topical steroids leads to resolution of disease in the majority of cases, without resorting to systemic antifungal agents, craniotomy or dural resection.

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Schizophyllum Communea Causative Agent of Fungal Sinusitis: A Case Report

Case Reports in Infectious Diseases ◽

10.1155/2011/821259 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

T. Premamalini ◽

B. T. Ambujavalli ◽

S. Anitha ◽

L. Somu ◽

Anupma J. Kindo

Keyword(s):

Maxillary Sinus ◽

Maxillary Sinusitis ◽

Schizophyllum Commune ◽

Sinus Surgery ◽

Banana Peel ◽

Nasal Discharge ◽

Fungal Sinusitis ◽

Maxillary Bone ◽

Cotton Blue ◽

The Right

We present a case of maxillary sinusitis caused bySchizophyllum commune, in a 50-year-old female. The patient presented with nasal obstruction, purulent nasal discharge from right side of the nose, cough, headache, and sneezing. Computed tomography revealed extensive opacity of the right maxillary sinus as well as erosion of the nasal wall and maxillary bone. Functional endoscopic sinus surgery was done, and fungal debris present on right side of the maxillary sinus was removed and sent to laboratory. Potassium hydroxide (KOH) examination of the nasal discharge showed hyaline, septate hyphae. Primary isolation on Sabouraud's dextrose agar (SDA) yielded a white woolly mould. Banana peel culture after 8 weeks showed macroscopically visible fan-shaped fruiting bodies. Lactophenol cotton blue (LPCB) mount of the same revealed hyaline septate hyphae, often with clamp connections. Identification was confirmed by the presence of clamp connections formed on the hyphae and by vegetative compatibility with known isolates.

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Allergic fungal rhinosinusitis: an overview on pathogenesis, early diagnosis and management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181853 ◽

2018 ◽

Vol 4 (3) ◽

pp. 694 ◽

Cited By ~ 1

Author(s):

Neeraj Suri ◽

Bhavya B. M.

Keyword(s):

Nasal Obstruction ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Histological Evaluation ◽

Nasal Discharge ◽

Fungal Sinusitis ◽

Surgical Specimen ◽

Specimen Handling ◽

Fungal Rhinosinusitis ◽

Allergic Fungal Rhinosinusitis

Background: The objective of the study was to evaluate the criteria for diagnosing allergic fungal rhinosinusitis and to maintain permanent drainage and ventilation, while preserving the integrity of the mucosa.Methods: This is a prospective study of 50 patients with allergic fungal sinusitis with or without polyposis all of whom were treated with endoscopic debridement. Mucous sample collection, nasal secretion culture, surgical specimen handling, and histological evaluation of surgical specimens are described. All patients treated with endoscopic sinus surgery, debridement, post-operative use of steroids and antifungal therapy. Results: Fungal mucin was found in all 50 cases, histology and fungal cultures confirmed the diagnosis. Out of 50 patients, 29 were females and 21 were males, with a mean age of 32 years. The most common symptom was nasal discharge 41 (82%) cases, nasal obstruction in 38 (76%) cases, headache and facial pain in 32 (72%) cases, 7 (14%) patients had bronchial asthma. Symptoms of nasal obstruction and nasal discharge were improved in 46 (92%) cases. All preoperative versus postoperative changes in AFRS associated complaints reached statistical significance of p value <0.001 except in patients with asthma.Conclusions: Comprehensive management with endoscopic sinus surgery, oral steroids and antifungals reduces the recurrence or need for revision surgery. Long term follow up is very important.

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Sinusitis in Infants and Children

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894921010s108 ◽

1992 ◽

Vol 101 (1_suppl) ◽

pp. 37-41 ◽

Cited By ~ 17

Author(s):

Ellen R. Wald

Keyword(s):

Respiratory Tract ◽

Maxillary Sinusitis ◽

Bacterial Species ◽

Clinical Signs ◽

Signs And Symptoms ◽

Clinical Problem ◽

Nasal Discharge ◽

Upper Respiratory Tract ◽

Radiographic Findings ◽

Upper Respiratory

The major clinical problem in considering a diagnosis of sinusitis is differentiating uncomplicated upper respiratory tract infection from a secondary bacterial infection of the paranasal sinuses that may benefit from antimicrobial therapy. A diagnosis of sinusitis is suggested by presentation with protracted upper respiratory tract symptoms or a cold that is more severe than usual with fever and purulent nasal discharge. Confirmatory tests of sinus disease are transillumination (useful in adolescents if interpretation is confined to the extremes — normal or absent); radiographic findings of opacification, mucous membrane thickening, or an air-fluid level; and sinus aspiration (indicated for severe pain, clinical failures, or complicated disease). When clinical signs and symptoms are accompanied by abnormal radiographic findings, bacteria in high colony count are recovered from the maxillary sinus aspirate in 70% of patients. The common bacterial species recovered from children with acute maxillary sinusitis are Streptococcus pneumoniae, Moraxella (Branhamella) catarrhalis, and Hemophilus influenzae.

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Diagnosis and Treatment of an Odontogenic Maxillary Sinusitis: A Case Report Study

Thrita ◽

10.5812/thrita.108248 ◽

2021 ◽

Vol 9 (2) ◽

Author(s):

Negin Soghli ◽

Maryam Johari ◽

Mehrdad Panjnoush

Keyword(s):

Maxillary Sinusitis ◽

Treatment Strategies ◽

Surgical Approaches ◽

Nasal Discharge ◽

Fungal Sinusitis ◽

Delay In Diagnosis ◽

Odontogenic Origin ◽

Affected Tissue ◽

Odontogenic Sinusitis ◽

Left Maxillary Sinus

Introduction: Given the improvements of diagnostic equipment, including new imaging modalities, the diagnosis of odontogenic sinusitis cases has been growing rapidly in recent years. The disorder is mainly caused by Aspergillus species since this species, as the most common pathogen, usually appears asymptomatic, leading to a delay in diagnosis. In this regard, the common manifestations involve headache, cough, nasal discharge, and facial pain. Clinicians usually disregard the odontogenic origin while seeking the etiology of symptomatic rhinosinusitis. Case Presentation: In this paper, we report a case of odontogenic maxillary sinusitis in the left maxillary sinus of a patient complaining about intermittent pain, post-nasal discharge, anosmia, and oral malodor. According to the clinical examinations and radiographs, the maxillary sinusisitis was diagnosed, and the patient was treated with the surgical debridement of the affected tissue. Conclusions: Odontogenic sinusitis is most commonly the result of periodontitis or iatrogenesis. Although no antifungal treatment is necessary for fungal sinusitis, a variety of surgical approaches are adopted. The accurate diagnosis of odontogenic sources improves both treatment strategies and postoperative outcomes.

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Modified Endoscopic Medial Maxillectomy for Chronic Maxillary Sinusitis

American Journal of Rhinology ◽

10.2500/ajr.2006.20.2850 ◽

2006 ◽

Vol 20 (3) ◽

pp. 317-319 ◽

Cited By ~ 37

Author(s):

Bradford A. Woodworth ◽

Ryan O. Parker ◽

Rodney J. Schlosser

Keyword(s):

Inflammatory Disease ◽

Maxillary Sinusitis ◽

Demographic Data ◽

Nasolacrimal Duct ◽

Sinus Surgery ◽

Alternative Technique ◽

Middle Meatal Antrostomy ◽

Medial Maxillectomy ◽

Chronic Maxillary Sinusitis

Background Recently, modified endoscopic medial maxillectomy (MEMM) has been described as an alternative technique to open maxillectomy for benign sinonasal neoplasms. However, few reports discuss the efficacy of MEMM for treatment of inflammatory disease of the maxillary sinus. We evaluate the efficacy of MEMM in treating chronic maxillary sinusitis. Methods A retrospective review of patients who underwent MEMM for refractory inflammatory disease between December 2002 and September 2004 was performed. All patients were treated with MEMM alone or as part of an endoscopic sinus surgery procedure. Standard demographic data, operative technique, and postoperative follow-up times were collected. Results Nineteen patients (average age, 57 years) underwent 24 EMMs for chronic maxillary sinusitis refractory to middle meatal antrostomy. All patients failed prior sinus surgery, including 14 Caldwell-Luc procedures. Average follow-up was 19.5 months (range, 10–27 months). One patient has persistent hyperplastic sinusitis that currently requires monthly follow-up and medical treatment. Our only complication was one nasolacrimal duct injury. Conclusion MEMM is both a safe and an effective treatment for chronic maxillary sinusitis refractory to standard medical and endoscopic surgical management.

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Radiofrequency-Induced Thermotherapy on Nasal Polyps: Preliminary Results

American Journal of Rhinology ◽

10.2500/ajr.2006.20.2864 ◽

2006 ◽

Vol 20 (3) ◽

pp. 300-304 ◽

Cited By ~ 2

Author(s):

Yvonne Fischer ◽

Silke Gronau ◽

Ajnacska Rozsasi ◽

Gerhard Rettinger ◽

Philipp M. Gruen

Keyword(s):

Nasal Polyps ◽

Postoperative Outcome ◽

Sinus Surgery ◽

Nasal Discharge ◽

Day Case ◽

Endoscopic Appearance ◽

Likert Scales ◽

Postnasal Drip ◽

Subjective Complaints ◽

Active Anterior Rhinomanometry

Background The aim of this study was to determine the effects of radiofrequency-induced thermotherapy (RFITT) in patients with nasal polyps. Methods A retrospective analysis was performed of prospectively collected data from 17 consecutive patients (11 men and 6 women; mean age, 51.7 ± 16.9 years) treated with RFITT from 2002 to 2003. The postoperative outcome was assessed using active anterior rhinomanometry, “sniffin’ stick” test, and endoscopic nasal examination preoperatively and 4 weeks postoperatively. Subjective complaints were assessed with Likert scales. Results Transnasal airflow increased by 40.3% 4 weeks postoperatively (p = 0.029). Endoscopic appearance of nasal polyps indicated a nonsignificant reduction of 37.1%. Subjective complaints such as impaired nasal ventilation (p = 0.014), nasal discharge (p = 0.0007), postnasal drip (p = 0.0002), and hyposmia (p = 0.048) improved significantly 4 weeks after surgery. Conclusion RFITT is well tolerated as a day case procedure under local anesthesia and might be a procedure for treating recurrence of NP after sinus surgery. It remains unclear at this point whether RFITT for nasal polyps results in a permanent reduction.

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Predictor of Recurrence of Allergic Fungal Rhinosinusitis

10.21203/rs.3.rs-498948/v1 ◽

2021 ◽

Author(s):

yanmin Chen ◽

Hongtao Zhen

Keyword(s):

Evaluation System ◽

Age Of Onset ◽

Clinical Manifestations ◽

Sinus Surgery ◽

Chinese Patients ◽

Management Approach ◽

Nasal Discharge ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Duration Of Symptoms

Abstract ObjectivesBy analyzing the clinical manifestations related to allergic fungal sinusitis (AFRS), the aim of this study was to try to make the first step to establish a prognostic evaluation system for predicting the recurrence of AFRS patients after operating.MethodsA descriptive and retrospective study of 19 AFRS out of 272 chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery were enrolled from April 2011 to April 2019. ResultsThe incidence of AFRS was 7.0% (19/272) in this study. The postoperative recurrence rate was 26.3% (5/19). Nasal discharge (73.7%) and nasal obstruction (57.9%) were the most common clinical manifestations. There were significant differences in the age of onset, preoperative duration of symptoms and a total Lund-MacKay CT score between the relapsing group and non-relapsing group.ConclusionsAFRS is less prevalent and high recurrent in Chinese patients. Our preliminary data support that age, duration and Lund-MacKay CT scores as the focus of preoperative clinical evaluation of AFRS: a long duration of symptoms (≥15 months) and a high Lund-MacKay CT score (≥11) are at a high risk of relapse, in further prospective and larger investigations as part of the preoperative work-up for patients with AFRS in order to develop a personalized and effective management approach.

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Evaluation of Recurrent Maxillary Sinusitis due to Middle Meatal Antrostomy Site Stenosis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420929365 ◽

2020 ◽

Vol 129 (10) ◽

pp. 964-968

Author(s):

Hyo Jun Kim ◽

Ji Ho Choi ◽

Jae Yong Lee

Keyword(s):

Maxillary Sinusitis ◽

Rare Condition ◽

Sinus Surgery ◽

Mucosal Inflammation ◽

Contributing Factors ◽

Canine Fossa ◽

Middle Meatal Antrostomy ◽

Preoperative Ct ◽

Sinus Mucosa ◽

Mucosal Hypertrophy

Objective: This study was performed to evaluate the incidence, timing, and factors contributing to recurrent maxillary sinusitis due to middle meatal antrostomy (MMA) site stenosis after endoscopic sinus surgery (ESS). Methods: The medical records and endoscopic photographs of 288 patients with chronic rhinosinusitis who underwent ESS were evaluated. Patients visited the clinic with similar schedule after ESS; recurrent maxillary sinusitis due to MMA site stenosis was investigated, including in terms of the incidence and timing. The preoperative computed tomography (CT) scans, intraoperative findings, and possible factors contributing to MMA site stenosis were examined. Results: Recurrent maxillary sinusitis due to MMA site stenosis occurred in 10 patients. Most had unilateral sinusitis and stenosis was observed within 6 months postoperatively. All patients had severe inflammation, pus retention, and thick mucosal hypertrophy in the maxillary sinus on preoperative CT; intraoperative findings confirmed these conditions. In most patients, extensive trimming of the hypertrophied mucosa was performed intraoperatively through canine fossa trephination. Conclusions: MMA site stenosis is a rare condition after ESS. We hypothesized that rapid shrinkage and fibrosis of the sinus mucosa after extensive trimming thereof may be the main causes of stenosis. Residual mucosal inflammation, granulation formation, and persistent sinus crust and debris may also be contributing factors. Therefore, conservative trimming, meticulous dressing, and removal of sinus crust and granulation tissue near the MMA site should be performed in patients with MMA site stenosis.

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Treatment of Allergic Fungal Sinusitis with High-Dose Itraconazole

American Journal of Rhinology ◽

10.1177/194589240301700101 ◽

2003 ◽

Vol 17 (1) ◽

pp. 1-8 ◽

Cited By ~ 72

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.

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