A Case of Allergic Bronchopulmonary Aspergillosis that Improved with Endoscopic Sinus Surgery for Fungal Sinusitis

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.

Download Full-text

Functional Endoscopic Sinus Surgery in the Immunocompromised Child

Otolaryngology ◽

10.1177/019459989110500608 ◽

1991 ◽

Vol 105 (6) ◽

pp. 818-825 ◽

Cited By ~ 31

Author(s):

Brian J. Wiatrak ◽

Paul Willging ◽

Charles M. Myer

Keyword(s):

Endoscopic Sinus Surgery ◽

Fatal Outcome ◽

Chemotherapeutic Agents ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Fungal Sinusitis ◽

Sinus Disease ◽

Immunocompromised Child ◽

Surgical Modality ◽

Sinonasal Disease

Fungal sinusitis in the immunocompromised child is an aggressive, invasive process that may result in a fatal outcome if not diagnosed early. As a result of increasing use of bone marrow transplantation and new cytotoxic chemotherapeutic agents resulting in severe agranulocytopenia, more patients have become susceptible to fungal sinus disease. Functional endoscopic sinus surgery has emerged recently as an important surgical modality in the treatment of sinus disease in adults and children. Use of this technique in immunosuppressed children has allowed early diagnosis of fungal sinonasal disease, resulting in earlier surgical intervention. The high-quality fiberoptic capability of nasal endoscopes allows very detailed visualization of the internal anatomy of the nose and detects early mucosal changes as a result of intranasal fungal disease. Our experience using functional endoscopic sinus surgery in immunocompromised children over an 18-month period is reviewed. Our philosophy for diagnosis and management of immunocompromised children with suspected fungal sinonasal disease is discussed.

Download Full-text

Outcomes of endoscopic sinus surgery for sinusitis-induced intracranial abscess in patients undergoing neurosurgery

Neurosurgical FOCUS ◽

10.3171/2019.5.focus1947 ◽

2019 ◽

Vol 47 (2) ◽

pp. E12 ◽

Cited By ~ 1

Author(s):

Megumi Koizumi ◽

Miho Ishimaru ◽

Hiroki Matsui ◽

Kiyohide Fushimi ◽

Tatsuya Yamasoba ◽

...

Keyword(s):

Blood Transfusion ◽

Length Of Stay ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Neurosurgical Procedures ◽

Fungal Sinusitis ◽

Intracranial Abscess ◽

Diagnosis Procedure Combination ◽

Intracranial Complications ◽

Orbital Complications

OBJECTIVEAlthough sinusitis-induced intracranial complications rarely occur in the current era of antibiotics, they can induce neurological symptoms or death. The authors of this study investigated the association between endoscopic sinus surgery (ESS) and outcomes in patients who had undergone neurosurgical procedures for sinusitis-induced intracranial abscess.METHODSThe authors obtained data on patients with sinusitis-induced intracranial abscess from the Japanese Diagnosis Procedure Combination inpatient data for the period from 2010 to 2017. They excluded patients with fungal sinusitis, orbital complications, immunodeficiency, and malignant disease. They also excluded patients who had received antifungal agents, chemotherapy, immunosuppressants, and antidiabetic drugs. Eligible patients were divided into those with and those without neurosurgical procedures. Propensity score–adjusted regression analyses were performed to examine the association between ESS within the same hospitalization and outcomes (mortality, blood transfusion, readmission, revision neurosurgery, and length of stay).RESULTSOf the 552 potentially eligible patients, 255 were treated with neurosurgical procedures, including 104 who underwent ESS within the same hospitalization and 151 who did not. ESS was not significantly associated with mortality (OR 0.54, 95% CI 0.05–5.81, p = 0.61), blood transfusion (OR 1.95, 95% CI 0.84–4.51, p = 0.12), readmission (OR 0.86, 95% CI 0.34–2.16, p = 0.75), revision neurosurgery (OR 0.65, 95% CI 0.24–1.74, p = 0.39), or length of stay (percent difference −10.8%, 95% CI −24.4% to 5.1%, p = 0.18).CONCLUSIONSThe present study suggests that ESS may not have significant benefits with respect to reducing mortality, blood transfusion, readmission, revision neurosurgery, or length of stay.

Download Full-text

Correlation between Preoperative Clinical Diagnosis and Histopathological Findings in Patients with Rhinosinusitis

American Journal of Rhinology ◽

10.1177/194589240501900207 ◽

2005 ◽

Vol 19 (2) ◽

pp. 153-157 ◽

Cited By ~ 8

Author(s):

Nicolas Y. Busaba ◽

Luciano Vilela de Oliveira ◽

David L. Kieff

Keyword(s):

Chronic Rhinosinusitis ◽

Clinical Diagnosis ◽

Endoscopic Sinus Surgery ◽

Preoperative Diagnosis ◽

Case Series ◽

Sinus Surgery ◽

Histopathological Diagnosis ◽

Fungal Sinusitis ◽

Chronic Invasive ◽

Type Of Surgery

Background The diagnosis of chronic rhinosinusitis (CRS) or chronic rhinosinusitis with polyposis (CRSP) is typically clinical and based on the combination of medical history, physical examination, and imaging. The recommendation to perform surgery and the type of surgery is tailored to the diagnosis. The objective of this study is to determine the accuracy of preoperative clinical CRS or CRSP diagnosis in patients who underwent endoscopic sinus surgery. Methods This is a retrospective review of a case series of 380 consecutive patients who underwent endoscopic sinus surgery for the preoperative clinical diagnosis of CRS or bilateral CRSP. Data regarding symptoms, nasal endoscopy, computed tomography findings, preoperative diagnosis, and postoperative histopathology results were collected. Results The preoperative diagnoses were CRS (n = 180) and CRSP (n = 200). Two of the 180 patients (1.1%) with the preoperative diagnosis of CRS had a different postoperative histopathological diagnosis. The histopathology in both patients showed noncaseating granulomata, leading to a diagnosis of sarcoidosis. Nine of the 200 patients (4.5%) with the preoperative diagnosis of CRSP had a different postoperative histopathological diagnosis. Of these nine patients, five had inverted papilloma (bilaterally in one instance); one had adenocarcinoma; one had squamous-cell carcinoma; one had chronic invasive granulomatous fungal sinusitis; and one had sinonasal sarcoidosis. Conclusion The preoperative clinical diagnosis can be inaccurate in patients with CRS and bilateral CRSP. The misdiagnosis is more common in CRSP, including patients with recurrent polyposis.

Download Full-text

Allergic Fungal Sinusitis Associated with Allergic Bronchopulmonary Aspergillosis: An Uncommon Sinobronchial Allergic Mycosis

American Journal of Rhinology ◽

10.2500/ajr.2007.21.3051 ◽

2007 ◽

Vol 21 (4) ◽

pp. 412-416 ◽

Cited By ~ 19

Author(s):

Jean Jacques Braun ◽

Gabrielle Pauli ◽

Philippe Schultz ◽

André Gentine ◽

David Ebbo ◽

...

Keyword(s):

Allergic Bronchopulmonary Aspergillosis ◽

Specific Ige ◽

Antifungal Drugs ◽

Sinus Surgery ◽

Skin Tests ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Positive Skin ◽

Oral Corticosteroids ◽

Blood Eosinophils

Background The identification of allergic fungal sinusitis (AFS) is still controversial and much more recent than that of allergic bronchopulmonary aspergillosis (ABPA). Their association has been reported very rarely in the literature. Methods The aim of this study was to present a review of 6 cases of AFS associated with ABPA from a series of 12 cases of AFS and to compare AFS associated with ABPA and isolated AFS. Results All cases of AFS presented with chronic rhinosinusitis. The six cases with AFS and ABPA were atopic, asthmatic, with pulmonary infiltrates (five cases), central bronchiectasis (four cases), and both (three cases). The mycological and immunoallergological features of isolated AFS and AFS associated with ABPA were similar: eosinophilic allergic mucin with noninvasive fungi hyphae, high levels of blood eosinophils, total IgE, specific IgE, IgG, and positive skin tests to Aspergillus. The association of AFS and ABPA was concomitant (two cases) or remote in time (four cases). The treatment with oral corticosteroids and sinus surgery (six cases) associated with antifungal drugs (four cases) led to resolution in three cases, considerable improvement in one case, and therapeutic failure in two cases (follow-up longer than 5 years in all cases). Conclusion Independently of the signs linked to the organs involved (sinuses and bronchi) the mycological and immunoallergological features were similar for AFS and AFS associated with ABPA. AFS and ABPA can be isolated or associated in a sinobronchial allergic mycosis.

Download Full-text

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

American Journal of Rhinology ◽

10.1177/194589240501900516 ◽

2005 ◽

Vol 19 (5) ◽

pp. 514-520 ◽

Cited By ~ 111

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.

Download Full-text

Radical endoscopic sinus surgery for allergic fungal sinusitis

Otolaryngology ◽

10.1016/s0194-5998(97)80397-x ◽

1997 ◽

Vol 117 (2) ◽

pp. P186-P186

Author(s):

A HANDOUSSA

Keyword(s):

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis

Download Full-text

A Case of Relapse of Invasive Fungal Sinusitis after Endoscopic Sinus Surgery

Practica Oto-Rhino-Laryngologica ◽

10.5631/jibirin.106.115 ◽

2013 ◽

Vol 106 (2) ◽

pp. 115-121

Author(s):

Kenji Noda ◽

Satoru Kodama ◽

Hideaki Mabuchi ◽

Kanako Noda ◽

Masashi Suzuki

Keyword(s):

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Fungal Sinusitis ◽

Invasive Fungal Sinusitis

Download Full-text

Efficacy of Different Modalities of Treatment in Management of Different Types of Fungal Sinusits

QJM ◽

10.1093/qjmed/hcab094.018 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

AbdElhamid AbdElhamid Al-Nashar ◽

Waleed Farag Ezzat ◽

Mohammed Abdelaleem Mohammed ◽

Mohammed Al-Shahat Ibrahim Al-Bahet

Keyword(s):

Antifungal Therapy ◽

Endoscopic Sinus Surgery ◽

Endoscopic Technique ◽

Sinus Surgery ◽

Fungal Sinusitis ◽

Fungal Ball ◽

Non Invasive ◽

Invasive Fungal Sinusitis ◽

Canine Fossa ◽

Different Types

Abstract Background Fungal sinusitis is generally classified into invasive and non invasive fungal sinusitis based on histological features, invasive fungal sinusitis divided into acute, chronic and chronic granulomatous invasive fungal sinusitis. While non invasive fungal sinusitis include saprophytic fungal infestation, fungal ball, and fungus-related eosinophilic. Distinguishing invasive disease from noninvasive disease is important because the treatment and prognosis are different for each. AIM A systemic review of effective and safe method in management of different types of fungal sinusitis either by medical or surgical approaches or even combined. Be up to date with the different upcoming new modalities. Methodology A meta-analysis study is done to evaluate the medical and surgical outcomes of patients with invasive and noninvasive Fungal Sinusits. Results Finally, forty-five studies were included in the present systematic review and metaanalysis. Fifteen included studies (No = 539 patients) assessed different modalities for management of fungal ball, via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach for FB of the maxillary sinus. The results showed that functional endoscopic sinus surgery has led to success rate of 98.1%. Twenty included studies (No = 806 patients) have assessed the efficacy and safety of different modalities for the management of allergic fungal sinusitis via,Endoscopic Sinus Surgery, Post-ESS Systemic steroids, Antifungals and immunotherapy. The results showed that ESS represents the firstline management strategy of AFRS, followed by aggressive medical therapies, the recurrence rate after postoperative steroids was 20.6%, postoperative antifungals was 40% and after immunotherapy was 9.1%. Ten studies (No = 327 patients) for Invasive Fungal Sinusitis.the results showed that combination of systematic antifungal therapy and aggressive surgical debridement are the treatment of choice. Conclusion FESS is the treatment of choice of fungal ball via classic endoscopic technique, Canine-fossa approach, gauze technique and osteoplastic approach. AFS treatment consists of surgical extirpation of the allergic mucin and polyps with maintenance of adequate sinus drainage followed by medical therapy consists of topical steroids, anti fungal therapy, Immunotherapy, and systemic corticosteroids. Treatment of invasive fungal sinusitis includes surgical resection of necrotic tissues, systemic antifungal therapy and reversal of immune dysfunction.

Download Full-text

A CASE OF SPHENOID SINUS MUCOCELE FOLLOWING ENDOSCOPIC SINUS SURGERY FOR FUNGAL SINUSITIS

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703716 ◽

2013 ◽

Vol 03 (04) ◽

pp. 117-119

Author(s):

Satheesh Kumar Bhandary B. ◽

Vadisha Srinivas Bhat

Keyword(s):

Paranasal Sinus ◽

Endoscopic Sinus Surgery ◽

Frontal Sinus ◽

Sphenoid Sinus ◽

Sinus Surgery ◽

Fungal Sinusitis ◽

Common Site ◽

Maxillary Sinuses

AbstractParanasal sinus mucoceles are common in frontal sinus, followed by ethmoid and maxillary sinuses. Sphenoid sinus is the least common site of mucocele, representing less than 2% of all paranasal sinus mucoceles. Here we present a case of sphenoid sinus mucocele, developing in a patient, who underwent endoscopic sinus surgery for fungal sinusitis involving the sphenoid sinus, presented with headache as the only complaint. The mucocele was diagnosed radiologically and was treated surgically by endoscopic sinus surgery.

Download Full-text