"Gauze Technique" in the Treatment of the Fungus Ball of the Maxillary Sinus: A Technique as Simple as It Is Effective.

Pietro Garofalo,Georges Dumas,Alessandro Griffa,Flavio Perottino

doi:10.1155/2016/4169523

Abstract

Fungus ball of maxillary sinus generally affects immunocompetent and nonatopic subjects. Although endoscopic removal is the current gold standard treatment, removal is at times difficult due to an accumulation of fungal elements in the anterior ad inferior recesses. Aim. To present our experience of maxillary fungus ball treated by the “gauze technique” that avoids these removal difficulties. Materials and Methods. A retrospective, cross-sectional, and descriptive study of 25 patients affected by maxillary fungus ball was carried out: 19 were treated by the “gauze technique” and 6 were treated without “gauze technique.” Results. A comparison was made between the two groups for surgery procedure time, length of hospitalization, time from surgery to nasal unpacking, complications, and postsurgical patient satisfaction. The only statistically significant difference observed was a shorter surgical procedure time (p < 0.05) for the “gauze technique.” Conclusions. The data obtained in this study demonstrated that the “gauze technique” is a safe, simple, and quick technique, able to reduce surgery procedure time whilst providing excellent functional outcomes and patient satisfaction.

Highlights

The term fungus ball (FB) refers to a noninvasive mycosis of the paranasal sinuses that affects immunocompetent hosts and frequently affects one single sinus
The study variables were the general characteristics of the patients, the surgical procedures, length of hospitalization, time-lapse to nasal unpacking, duration of the follow-up, postoperatory events and evaluation of objective outcomes, and postsurgical patient satisfaction, which was evaluated by the SNOT-20 (20-Item Sinonasal Outcome Test) [10]
A total of 25 patients were given a diagnosis of fungus ball of the maxillary sinus, from 2006 to 2014, at the Otorhinolaryngologic Unit of the “Centre Hospitalier des Escartons”

Summary

Introduction

The term fungus ball (FB) refers to a noninvasive mycosis of the paranasal sinuses that affects immunocompetent hosts and frequently affects one single sinus. Fungi are normal saprophytes of the nasal cavities and paranasal sinuses, under particular conditions, they may lead to specific sinonasal diseases These conditions are favoured by hypoxia and low intrasinusal pH values due to ventilation disturbance and impairment of mucociliary clearance, where the closure of the natural ostium of paranasal sinus is the underlying pathogenesis [1]. Paranasal fungal sinusitis have been classified into two categories, according to DeShazo classification (1998) which takes into consideration the presence/absence of sinonasal mucosa invasion: the noninvasive forms and the invasive forms [2]. The former include the sinus fungus ball (once called mycetoma or aspergilloma) and allergic fungal rhinosinusitis which typically affect immunocompetent subjects. Colonisation is mostly caused by Aspergillus spp. and has been found in the maxillary or sphenoid sinus in more than 80% of FB patients, whilst ethmoidal, frontal, or multiple localizations are rarer [3, 4]

Methods

Results

Conclusion