Fungus ball paranasal sinuses: pattern of histopathology and culture characteristics

2019 ◽  
Vol 49 (20) ◽  
Author(s):  
Nugroho Suharsono
Keyword(s):  
Aspergillus Niger ◽  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Histopathological Examination ◽  
Morphological Characteristics ◽  
Sinus Surgery ◽  
Nasal Discharge ◽  
Fungus Ball ◽  
Methenamine Silver ◽  
Fungus Balls

Background: Fungal infection of the nose and paranasal sinuses is an uncommon condition which is now being increasingly recognized. The clinical presentation is not specific with various symptoms such as nasal obstruction, purulent nasal discharge, facial pain, and chronic cough. Only unilaterality may alert the clinician. Purpose: To find the morphological characteristics of the fungus in patients with paranasal sinus fungus ball. Methods: A retrospective study of 13 paranasal sinus fungus balls cases which underwent endoscopic sinus surgery at Department of Otorhinolaryngology Head and Neck Surgery St. Vincentius A Paulo Hospital Surabaya from March, 2012 until December, 2013. Age, sex, histopathology and fungal cultur were analysed. Histopathologic sections of all the patients were stained with hematoxylin and eosin (H&E), and Gomori methenamine silver (GMS). The specimens were then cultured on Sabouraud dextrose agar plates and incubated at 30°C for 1 month. At the end of the incubation period, the samples were evaluated microscopically to detect fungi and identify their species. Results: The age reported of the 13 patients, was ranging from 36 to 63 years old. There was a significant female predominance, 10 female patients (76.92%) and 3 male patients (23.08%). Histopathological examination showed that most causative agents were Aspergillus species 92.31% (12/13). Culture test was positive for 69.23% (9/13). Aspergillus niger (61.54%, 8/13) is the most frequent fungus reported to cause fungus balls. Conclusion: Pattern of histopathologic on HE and GMS is very helpful and sensitive to identify fungi. The most common isolated mould in our study was Aspergillus niger.Keywords: fungus ball, histopathology and culture, Aspergillus nigerABSTRAK Latar Belakang: Infeksi jamur di hidung dan sinus paranasal merupakan kondisi yang jarang terjadi, namun kini lebih sering ditemukan. Gejala klinisnya tidak spesifik dapat berupa obstruksi hidung, sekret dari hidung, nyeri wajah, dan batuk kronis. Bila terjadi unilateral, patut diwaspadai oleh para klinisi. Tujuan: Untuk mengetahui karakteristik morfologi fungus yang didapati pada pasien sinusitis jamur yang kami teliti. Metode: Dilakukan penelitian retrospektif pada 13 pasien sinusitis jamur yang menjalani bedah sinus endoskopi di Departemen Otorinolaringologi-Kepala Leher Rumah Sakit St. Vincentius A Paulo Surabaya dari bulan Maret 2012 sampai dengan Desember 2013. Dilakukan analisis usia, jenis kelamin, histopatologi dan kultur jamur. Pewarnaan preparat histopatologi menggunakan Hematoxylin dan eosin (H&E) dan Gomori Methenamine Silver (GMS). Kemudian spesimen diletakkan pada piring agar Sabouraud dextrose, dan dilakukan inkubasi pada suhu 30°C selama satu bulan. Pada akhir masa inkubasi, sampel dievaluasi dengan mikroskop untuk mendeteksi jamur dan spesiesnya. Hasil: Didapati usia 13 penderita berkisar dari 36-63 tahun. Wanita lebih dominan sebanyak 10 penderita (76,92 %) dan 3 penderita laki-laki (23,08%). Hasil pemeriksaan histopatologi menunjukkan spesies Aspergillus sebagai penyebab utama (92,31%) pada 12 penderita (12/13).Tes kultur positif pada 69,23% (9/13). Jamur yang paling sering menyebabkan bola jamur pada sinus adalah Aspergillus niger (61,54%, 8/13). Kesimpulan: Pewarnaan preparat histopatologi menggunakan Hematoxylin dan eosin (H&E) dan Gomori Methenamine Silver (GMS) sangat berguna dan sensitif dalam mendeteksi adanya jamur. Jenis jamur yang paling banyak ditemukan pada penelitian kami adalah Aspergillus niger.

Development of the Paranasal Sinuses in Children: Implications for Paranasal Sinus Surgery

1993 ◽  
Vol 102 (9) ◽  
pp. 705-711 ◽  
Author(s):  
Gerald Wolf ◽  
Wolfgang Anderhuber ◽  
Frederick Kuhn
Keyword(s):  
Nasal Cavity ◽  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Age Groups ◽  
Clinical Importance ◽  
Sinus Surgery ◽  
Clinical Anatomy ◽  
Surgical Interventions ◽  
Stage Of Development ◽  
Paranasal Sinus Surgery

The pediatric nasal cavity and paranasal sinuses, when compared to those in adults, differ not only in size but also in proportion. Knowledge of the unique anatomy and pneumatization of children's sinuses is an important prerequisite to understanding the pathogenesis of sinusitis and its complications. It is also important in evaluation of radiographs and in planning surgical interventions. In order to study the development of the paranasal sinuses in children and relate clinical anatomy to sinus surgery, the sinuses in 102 pediatric skulls and cadaver heads were measured. The results were classified by stage of development into 4 different age groups: newborn and 1 to 4, 4 to 8, and 8 to 12 years. The characteristics of each group and their clinical importance for paranasal sinus surgery are described.

Paranasal Sinus Mucoceles in Cystic Fibrosis

1993 ◽  
Vol 7 (1) ◽  
pp. 31-35 ◽  
Author(s):  
William E. Davis ◽  
Giulio J. Barbero ◽  
William R. LaMear ◽  
Jerry W. Templer ◽  
Peter Konig
Keyword(s):  
Cystic Fibrosis ◽  
Paranasal Sinus ◽  
Computerized Tomography ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
The Other ◽  
Sinus Surgery ◽  
Lateral Nasal Wall ◽  
Osteomeatal Complex

Six patients between the ages of 6 and 22 years old with cystic fibrosis were found to have mucoceles of the paranasal sinuses. Four were male and two were female. They experienced nasal obstruction, purulent rhinorrhea, and anosmia, but none had fever or pain. Nasal endoscopy and coronal computerized tomography scans revealed the lateral nasal wall to be displaced medially against the septum. Functional endoscopic sinus surgery revealed large cystic spaces filled with thick yellow-green mucus. Postoperatively most patients are able to smell and breathe through their noses. The mucocele probably begins as an obstructed anterior ethmoid cell, which then enlarges and obstructs the osteomeatal complex, which further impairs drainage of the other sinuses into this area.

scholarly journals There Is No Structural Relationship between Nasal Septal Deviation, Concha Bullosa, and Paranasal Sinus Fungus Balls

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Tung-Lung Tsai ◽  
Ming-Ying Lan ◽  
Ching-Yin Ho
Keyword(s):  
Paranasal Sinus ◽  
Goodness Of Fit ◽  
Final Diagnosis ◽  
Septal Deviation ◽  
Sinus Surgery ◽  
Concha Bullosa ◽  
Goodness Of Fit Test ◽  
Ipsilateral Side ◽  
Nasal Septal Deviation ◽  
Fungus Balls

This study aims to determine the relationship between nasal septal deviation, concha bullosa, and chronic rhinosinusitis by using a definitive pathological and simplified model. Fifty-two consecutive sinus computed tomography scans were performed on patients who received endoscopic sinus surgery and whose final diagnosis was paranasal sinus fungus balls. The incidences of nasal septal deviation and concha bullosa for patients diagnosed with paranasal sinus fungus balls among the study group were 42.3% and 25%, respectively. About 63.6% sinuses with fungus balls were located on the ipsilateral side of the nasal septal deviation, and 46.2% were located on the ipsilateral side of the concha bullosa. When examined by Pearson’s chi-square test and the chi-squared goodness-of-fit test, no significant statistical difference for the presence of paranasal sinus fungus balls between ipsilateral and contralateral sides of nasal septal deviation and concha bullosa was noted (P=0.292andP=0.593, resp.). In conclusion, we could not demonstrate any statistically significant correlation between the location of infected paranasal sinus, the direction of nasal septal deviation, and the location of concha bullosa, in location-limited rhinosinusitis lesions such as paranasal sinus fungal balls. We conclude that the anatomical variants discussed herein do not predispose patients to rhinosinusitis.

scholarly journals Sinus Fungus Ball in the Japanese Population: Clinical and Imaging Characteristics of 104 Cases

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Kazuhiro Nomura ◽  
Daiya Asaka ◽  
Tsuguhisa Nakayama ◽  
Tetsushi Okushi ◽  
Yoshinori Matsuwaki ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Japanese Patients ◽  
Sinus Surgery ◽  
Nasal Discharge ◽  
Fungus Ball ◽  
Fungal Rhinosinusitis ◽  
Imaging Characteristics ◽  
Female Predominance ◽  
Causative Agents ◽  
Causative Fungus

Sinus fungus ball is defined as noninvasive chronic fungal rhinosinusitis occurring in immunocompetent patients with regional characteristics. The clinical and imaging characteristics of paranasal sinus fungus ball were retrospectively investigated in 104 Japanese patients. All patients underwent endoscopic sinus surgery. Preoperative computed tomography (CT), magnetic resonance (MR) imaging, age, sex, chief complaint, causative fungus, and clinical outcome were analyzed. Patients were aged from 25 to 79 years (mean 58.8 years). Female predominance was noted (58.7%). Most common symptoms were nasal discharge and facial pain. CT showed high density area in 82.0% of the cases (82/100), whereas T2-weighted MR imaging showed low intensity area in 100% of the cases (32/32). Histological examination showed that most causative agents wereAspergillusspecies (94.2% (98/104)). Culture test was positive for 16.7% (11/66). Recurrence was found in 3.2% (3/94). Older age and female predominance were consistent with previous reports. MR imaging is recommended to confirm the diagnosis.

scholarly journals Two Case Reports of Antrorhinoliths

2014 ◽  
Vol 6 (3) ◽  
pp. 118-120 ◽  
Author(s):  
Santosh Kumar Swain ◽  
Ranjan Kumar Sahoo ◽  
Mahesh Chandra Sahu
Keyword(s):  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Histopathological Examination ◽  
Case Reports ◽  
Radiological Examination ◽  
Sinus Surgery ◽  
Nasal Discharge ◽  
Ostiomeatal Complex ◽  
Bony Mass

ABSTRACT Antrorhinolith is an uncommon nasal mineralized mass of nasal cavity invading into maxillary sinus. Most antrorhinoliths are small and asymptomatic, caused by calcification of a nidus and are detected incidentally on radiological examination. Sometimes they present symptoms like pain and foul smelling nasal discharge. Here, we are presenting two cases of antrorhinoliths. One was found after endoscopic sinus surgery and second one was seen in patient with prolonged use of topiramate medication. In all these two cases, radiological examination revealed a discrete bony density in the nasal cavity and maxillary sinus which was blocking the ostiomeatal complex. The bony mass was removed endoscopically from the nasal cavity and maxillary sinus with drainage of discharge and debris from the sinuses. Histopathological examination revealed an antrolith with bony nidus and calcium deposited around it. How to cite this article Swain SK, Sahoo RK, Sahu MC. Two Case Reports of Antrorhinoliths. Int J Otorhinolaryngol Clin 2014;6(3):118120.

Frontal Recess Mucocele Associated with Osteoma: Case Report

2012 ◽  
Vol 29 (4) ◽  
pp. 199-203
Author(s):  
Aleksandar Perić ◽  
Milan Erdoglija ◽  
Nenad Mladenović ◽  
Biserka Vukomanović Đurđević
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Cystic Lesion ◽  
Histopathological Examination ◽  
Primary Condition ◽  
Frontal Recess ◽  
Bony Lesion ◽  
The Right

SUMMARY The paranasal sinus mucocele is an epithelized cystic lesion containing fluid and is characterized by non-neoplastic expansion of the paranasal sinus due to its capacity to erode the overlying bone. Etiology of these lesions is still under debate. In this report, we described a case of a patient with frontal recess mucocele, associated with contralateral frontal recess osteoma. A 55-year-old man was admitted to the Department of Otorhinolaryngology of our hospital with the complaints of a headache affecting the fronto-ethmoidal region, left-sided nasal obstruction, and postnasal discharge. Computed tomography (CT) scan of the paranasal sinuses showed a dense bony lesion in the left and a cystic hypodense mass in the right-sided frontal recess. The patient was treated surgically, with a combined endoscopicexternal approach, bilaterally. Histopathological examination showed that the wall of the cyst was mucocele, and the bony formation was osteoma. The frontal recess osteoma is regarded as the primary condition. Thus, better ventilation and drainage of the frontal sinus were reestablished.

An unusual location for a fungus ball: the concha bullosa

2012 ◽  
Vol 126 (8) ◽  
pp. 844-846 ◽  
Author(s):  
E Ciger ◽  
U Demiray ◽  
K Onal ◽  
M Songu
Keyword(s):  
Computed Tomography ◽  
Unusual Case ◽  
Histopathological Examination ◽  
Middle Turbinate ◽  
Fungus Ball ◽  
Concha Bullosa ◽  
Healthy Individuals ◽  
Non Invasive ◽  
The Right ◽  
Fungus Balls

AbstractObjective:We report an unusual case of a fungus ball in the concha bullosa, without involvement of the paranasal sinuses.Case report:A 29-year-old woman presented complaining of nasal obstruction and postnasal discharge. Paranasal computed tomography demonstrated that the concha bullosa in the right middle turbinate was filled with a high-density material. The patient underwent endoscopic resection of the concha bullosa, during which a dark brown, cheese-like material was found. Histopathological examination of the excised specimen revealed a fungus ball.Conclusion:Fungus balls are non-invasive accumulations of dense fungal concretions that generally affect healthy individuals. In the sinonasal region, they occur most frequently in the maxillary sinus. Although fungus ball formation in the concha bullosa is unusual, it should be considered in the differential diagnoses of middle turbinate and sinonasal pathology.

Washout of 133-Xenon as an Objective Assessment of Paranasal Sinus Ventilation in Endoscopic Sinus Surgery

2002 ◽  
Vol 111 (8) ◽  
pp. 710-717 ◽  
Author(s):  
BO Paulsson ◽  
Sven Lindberg ◽  
Per Ohlin
Keyword(s):  
Nitric Oxide ◽  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Objective Assessment ◽  
Sinus Surgery ◽  
Symptom Improvement ◽  
Postoperative Evaluation ◽  
Nasal Nitric Oxide ◽  
Xenon Washout

Endoscopic sinus surgery (ESS) is today a common method for the treatment of chronic rhinosinusitis. Assessment of the results has been based mainly upon subjective evaluation, and only a few reports present objective measurements. In the present study, the 133-xenon washout technique was used for preoperative and postoperative evaluation of paranasal sinus ventilation in 12 patients selected for ESS. The postoperative half-times (T1/2) of 133-xenon washout were lower in the sinuses with abnormal preoperative half-times (T1/2), especially in the maxillary sinuses, where the postoperative T1/2 was 44 (22 to 150) minutes (median and quartiles, Q1–Q3) as compared with a preoperative T1/2 of 202 (94 to 278) minutes. The postoperative evaluation included a questionnaire and a follow-up visit with endoscopy and measurements of nasal nitric oxide. The results showed that patients who declared a marked reduction in symptoms exhibited significantly improved sinus ventilation. However, no direct correlation was found between improvement in ventilation and symptom improvement. Nine of the 12 patients showed improvement on endoscopy, and these patients also exhibited improved sinus ventilation. The postoperative nasal nitric oxide levels were within the normal range in 11 of the 12 patients; the other patient showed pathological T1/2 values for all paranasal sinuses. The 133-xenon washout technique is thus a method that can be used for objective evaluation of the ventilation of the paranasal sinuses before and after ESS procedures. However, the technique cannot be used to evaluate sinuses with totally obstructed ostia or postoperative sinuses with very wide neo-ostia, as rapid washout may lead to no activity remaining at the time of measurement.

scholarly journals Bilateral concha bullosa with right sided extensive rhinolith: a case report

2019 ◽  
Vol 5 (4) ◽  
pp. 1122
Author(s):  
Sumit Prinja ◽  
Jailal Davessar ◽  
Gurbax Singh ◽  
Simmi Jindal ◽  
Alisha Bali
Keyword(s):  
Computed Tomography ◽  
Paranasal Sinus ◽  
Nasal Obstruction ◽  
Paranasal Sinuses ◽  
Endoscopic Sinus Surgery ◽  
Anatomical Variations ◽  
Sinus Surgery ◽  
Anatomic Variations ◽  
Concha Bullosa ◽  
Medical College

<p class="abstract">Anatomic variations of the paranasal sinuses can lead to various diseases per se. The paranasal sinus anatomy should be carefully examined prior to performing endoscopic sinus surgery in terms of both existent pathologies and anatomic variations. The anatomy of the paranasal sinuses and its variations have gained importance, along with advances in coronal paranasal sinus computed tomography and extensive use of endoscopic sinus surgery. Rhinolith is a mass resulting from calcification of an endogenous or exogenous nidus within the nasal cavity. It is an uncommon disease that may present asymptomatically or cause symptoms like headache and nasal obstruction. A 24 year old woman was admitted in ENT department of GGS Medical College and Hospital, Faridkot with complaints of nasal obstruction, anosmia and headache persisting for 5 years. Right sided rhinolith was detected on anterior rhinoscopy. Bilateral concha bullosa with right sided rhinolith was reported on preoperative paranasal computed tomography scan. It is known that the paranasal sinuses have a number of anatomical variations. Sometimes severe anatomic variations predispose to rhinosinusitis. Herein we report a rare case, along with a review of the literature, to emphasize that severe anatomical variations should not be ignored.</p>

scholarly journals Comparative evaluation of paranasal sinus volumes between maxillary deficiency requiring Le Fort osteotomy patients and control patients

2021 ◽  
Author(s):  
Poyzan BOZKURT ◽  
Kaan Orhan ◽  
Çağıl VURAL
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Sinus Surgery ◽  
Le Fort ◽  
Management Of Complications ◽  
And Control ◽  
Le Fort Osteotomy ◽  
Maxillary Deficiency

Introduction: The anatomy of the paranasal sinuses is important for many surgeon groups. The precise knowledge of such structures with variable anatomy will be important for the preservation of these structures and the management of complications in surgeries such as endoscopic sinus surgery and osteotomies involving the maxilla. Objective: The purpose of the present study is to investigate volumetric differences between ethmoid, sphenoid and maxillary sinus volumes in patients with maxillary deficiency requiring Le Fort osteotomy and healthy patients, by employing computed tomography imaging. Methods: Computed tomography scans of 120 patients (59 maxillary deficiency patients and 61 control patients) were included in the study. Images were processed, the paranasal sinuses were sculpted out from 3D images and measured. All measurements were taken twice by the same observers. The observers performed the study twice with an interval of 2 weeks to detect intra-observer variability. Results: Ethmoid and left and right maxillary sinus volumes were smaller in the Le Fort group, although no differences were observed for sphenoid sinus volumes. Conclusion: Paranasal sinus volumes varied between maxillary deficiency patients and control patients. This condition may be crucial for the surgeon operating in these areas and should be taken into consideration during surgeries.

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