Fungal rhinosinusitis between regular infection and aggressive life-threatening disease
Fungal rhinosinusitis between regular infection and aggressive life-threatening disease

Summary/Abstract: Introduction Fungal rhinosinusitis is an acute or chronic disease that implies an inflammatory response or allergic reaction of rhinosinusal mucous membrane, due to the presence of fungi at this level. Methods We present a retrospective study on patients diagnosed with chronic fungal rhinosinusitis based on endoscopic and radiologic criteria and treated surgically by endoscopic approach in the ENT&HNS Department “Sfânta Maria” Hospital, Bucharest. The aim of the study was to determine the type of fungal sinusitis (non-invasive sinusitis - fungus ball or acute invasive sinusitis), the complications and treatment difficulties. Results After selection of the patients according to the inclusion criteria, there were 72 patients with non-invasive fungal sinusitis and two patients with invasive fungal sinusitis. The incidence among female patients was more than double than in males. Maxillary sinus was the most involved sinus, followed by sphenoid sinus. Most complications occurred due to sphenoid fungal sinusitis (4.05%), while both patients with invasive sinusitis presented major rhino-orbital and endocranial complications. Management of the patients included endoscopic sinus surgery: middle meatal antrostomy (78.37%), sphenoidotomy (17.56%), ethmoidectomy (1.35%) and extended sinus surgery – sinuses, orbit, endocranial (2.70%). Conclusions The most frequent form of fungal sinusitis was the non-invasive one (fungus ball) while invasive sinusitis was fortunately a rare condition. Surgical treatment is the main option. Medical treatment is adjuvant mainly in severe cases, as there are no proofs regarding its efficacy in regular cases such as fungus ball. Although the incidence of complications is low, when they occur they could be life-threatening. Extended endoscopic sinus surgery is required in order to remove all the necrotic tissue.

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