Chronic Fungal Sinusitis Research Articles

Relationship Between Maxillary Fungal Sinusitis and Odontogenic Infection, Dental Implant

Background and Objectives One of the common causes of chronic bacterial sinusitis is odontogenic infection, which has recently attracted attention and many studies are being conducted. However, studies on the relationship between chronic fungal sinusitis and odontogenic infection, which are commonly encountered in clinical practice, are still lacking. In this study, we investigated the association between chronic fungal sinusitis, odontogenic infection and dental implant.Subjects and Method We retrospectively reviewed medical records and paranasal sinus (PNS) CT scans of 198 patients who were treated in our institution for maxillary fungal sinusitis between March 2010 and October 2020.Results We defined two groups of maxillary sinuses (MS) according to the presence of fungal ball (fungal group; n=204 vs. normal group; n=192). Fungal sinusitis was diagnosed in all 204 cases of the fungal group. In the normal group, the mean MS volume was 17.0±6.2 mL, and in the fungal group, the mean MS volume was 13.8±5.2 mL. The volumes of MS were statistically small in the fungal group (<i>p</i><0.001). In 141 (69.1%) of 204 sinuses in the fungal group, findings suggestive of odontogenic infection were confirmed on the PNS CT scans and were statistically significant (<i>p</i><0.001, odds ratio=2.537). Of 204 sinuses in the fungal group, 26 (12.7%) had dental implants and were not statistically significant (<i>p</i>=0.107, odds ratio=1.724).Conclusion This study suggests odontogenic infection to be a risk factor for developing fungal sinusitis in the ipsilateral maxillary sinus.

219 Chronic Fungal Sinusitis: Pre and Post COVID-19, A single UK Tertiary Centre study

Abstract Aims Anecdotal evidence suggests an increase in the incidence of cases of Chronic Fungal Sinusitis pre- and post-Covid 19 Pandemic. We aimed to audit our patient incidence of fungal sinusitis pre- and post-COVID-19 pandemic, alongside auditing our management of these cases against national guidelines. Objectives: 1. To assess the incidence of Chronic Fungal Sinusitis pre- and post-COVID-19 pandemic at a single UK Tertiary centre 2. To audit the management of Chronic Fungal patients against national guidelines pre- and post- COVID-19 pandemic. Methods All Chronic Fungal Sinusitis patients at a UK Tertiary centre NHS Trust from the years 2018 to 2022 were collected. 2. Incidence of Chronic Fungal Sinusitis pre- and post-COVID-19 pandemic was assessed. 3. Patient notes were assessed for demographic, species of fungi, management, and patient outcomes. 4. Patient management was audited against national guidelines. Results Post-COVID-19 pandemic there was a higher incidence of patients presenting with Chronic Fungal Sinusitis 2. National guidelines were adhered to at the Hospital Trust pre/post-COVID-19. Conclusion Based on limited data from a single tertiary UK centre there appears to be a relationship between COVID-19 and the increase in the incidence of Chronic Fungal Sinusitis. However, larger multi-centre studies with a greater sample size need to be assessed to accurately assess this trend

Cladosporium tenuissimum-induced sinusitis in a woman with immune-deficiency disorder.

Fungal sinusitis is a widespread infection that affects both healthy and immunocompromised individuals. Reports of sinus fungal infections have increased due to recent advances in diagnosis. Furthermore, susceptible and immune-compromised patients play an important role in increasing the number of reported cases. Infections with lesser-known fungi have been reported infrequently around the world. This paper describes a Cladosporium tenuissimum infection caused by chronic fungal sinusitis in a woman who had traveled to several countries. We used morphological and molecular methods to confirm the infection. The infection is most likely caused by the use of sulfasalazine, which is related to the patient's rheumatism. Sulfasalazine inhibits neutrophilic chemoattractant lipid synthesis in neutrophils, which play a key role in antifungal immunity. The patient is also undergoing root canal therapy and has several upper jaw implants, which may have contributed to the development of sinusitis.

Chronic fungal sinusitis caused by Schizophyllum commune

Treatment of patients with fungal sinusitis, in some cases, does not lead to complete sinus sanitation, which may be due to insufficient surgical intervention and/or incorrectly selected antimycotic therapy. Treatment of such patients must necessarily include the complete removal of fungal masses from the affected sinus and the further use of antimycotics that ensure complete elimination of the pathogen. A clinical case of chronic fungal operated isolated sphenoiditis caused by the fungus Schizophyllum commune is presented. For extensive drainage of the sphenoid sinus, the patient underwent translamellar sphenoidotomy on the right with further antifungal therapy.

Varied Clinical Presentations of Allergic Fungal Rhinosinusitis-A Case Series.

Fungal sinusitis is broadly classified into invasive and non invasive types. Invasive type presents with fungal hyphae within the mucosa, submucosa, bone, or blood vessels of the paranasal sinuses and includes Acute Invasive Fungal Sinusitis, Acute Fulminant, Chronic Invasive Fungal Sinusitis, Chronic Granulomatous Fungal Sinusitis. Invasive forms of fungal rhinosinusitis are rare and confined to groups of patients who are immunocompromised (Key in Fungal rhinosinusitis). Noninvasive type shows absence of fungal hyphae within the mucosa paranasal sinuses. It includes Allergic Fungal rhinosinusitis, Fungus Ball (fungus mycetoma). The study was performed on a total of 30 patients, in Department of Otorhinolaryngology, at our hospital after getting approved by theInstituitional Human Ethical Committee. We selected 30 patients diagnosed with allergic fungal sinusitis and studied their varied clinical presentations and treatment for a period of 1year. It was a prospective case series type of study. Patients who presented with symptoms of allergic fungal rhinosinusitis were included. Patients who were referred with complaints of proptosis, diplopia were also included to rule out allergic fungal rhinosinusitis and its complications. Patients diagnosed with chronic granulomatous infection of nose and invasive fungal sinusitis were excluded. Evaluation of patients involved a detailed case history followed by clinical examination and radiologic investigation. After getting proper consent, we did a study of 30 patients who presented to our outpatient department with complaints of sinusitis. Our study included 12 male and 18 female patients. Among these patients, all of them had complaints of frequent allergic rhinosinusitis, nose block, facial heaviness. 12 among them had olfactory disturbances, reduced perception of smell. 4 patients presented with visual disturbances and proptosis which subsided after endoscopic sinus surgery was done.24 among these patients had presence of allergic fungal mucin in their nasal secretions and 10 patients had history of associated atopy and asthma and elevated Ig E levels. And 20 of these patients showed high eosinophil counts. All these patients in our case series were under the age group 22-70years. These patients were treated with a course of nasal sprays and preoperative steroids in case of extensive polyposis and were taken up for functional endoscopic sinus surgery. Polypoidal mucosa was removed, diseased tissue was cleared, sinus blockage was released and fungal mucin/tissue bits were sent for histopathological analysis, KOH mount and fungal culture. This study included a series of cases which showed a wide range of the various clinical presentations that occur in cases of allergic fungal rhinosinusitis, its diagnosis and treatment. The advantage of this study was we had analyzed a good number of cases with varied presentations. Since AFRS is closely related with EMRS, CRS a proper clinical, radiological and immunological evaluation of the cases help in knowing the correct diagnosis and treatment.

A case of fungal conjunctivitis manifested by a conjunctival mass

A 71-year-old man presented with a history of persistent redness and swelling in the left eye accompanied by an enlarging mass in the conjunctiva. He denied any history of trauma. Local anti-inflammatory treatment was ineffective. Slit lamp examination demonstrated a tough and immobile grayish broad basal mass at the corneal limbus and bulbar conjunctiva and a local bulge of 3 mm × 2 mm at the medial and lateral side of the upper palpebral conjunctiva near the eyelid margin. The excisional biopsy showed granulomatous inflammation with irregular and atypical squamous epithelial hyperplasia. Histopathology and immunohistochemical staining revealed a fungal infection. The secretion smear examination was performed to clarify the pathogen as Candida albicans, and chronic fungal maxillary sinusitis was found through imaging tests. Thus a diagnosis of conjunctival candidiasis was made. The conjunctival mass subsided after systemic and local antifungal therapy.

Role of mitomycin-C to reduce post FESS adhesion and ostial stenosis

The aim of this study is to determine adhesion formation rate and antrostomy closure rate after the use of Mitomycin-C in patients underwent FESS. This is a prospective case control study conducted at ENT Department Lyari General Hospital, Karachi, Pakistan. Fifty one patients included with diagnosis of bilateral chronic rhinosinusitis or allergic fungal sinusitis and were the surgical candidate, underwent bilateral Functional Endoscopic Sinus Surgery (FESS). The patients were evaluated using Lund-Mackay staging system prior to surgery. At the completion of surgery Mitomycin-c (MMC) was applied in one nasal cavity the other nasal cavity served as a control. Among fifty one patients both nostrils were used hence we have 51 cases and 51 controls. The patients were followed for a minimum period of three months after surgery. Subjective improvement of symptoms were recorded as well as rigid nasoendoscpic examination was also performed regularly. The adhesion formation rate in MMC applied nasal cavities was 11.7% as compared to 64.7% of controls. The middle meatal antrostomy closure rate was 41% and 5% in controls and MMC applied group respectively. Hence mitomycin-c application has shown benefit in reducing post FESS ostial stenosis and adhesion formation between middle turbinate and lateral nasal wall. Application of Mitomycin-C has impact on reducing post FESS adhesion formation and middle meatal antrostomy closure.

Isolated sphenoid sinus disease; a retrospective review of underlying pathologies and their clinicopathological implications

<p><strong>Background: </strong>Isolated sphenoid sinus disease (ISSD) includes a small cohort of patients evaluated for sinus disease which tend to be diagnostically challenging and may lead to devastating complications. This study aims to evaluate the spectrum of etiological factors and to analyze clinic-radiological characteristics of ISSD<strong> </strong></p><p><strong>Methods: </strong>It is a<strong> </strong>retrospective review of cases of ISSD managed by the department of otolaryngology of a tertiary care medical centre between January 2017 and December 2019. A total of 21 patients were included and their demographic details, co-morbidities, symptomatology, cross-sectional imaging, treatment received and follow-up details were retrieved from medical records for analysis and comparison.</p><p><strong>Results:</strong> The most common diagnoses in our cohort were invasive fungal sinusitis (n=9), chronic non-specific sinusitis (n=7) and allergic fungal sinusitis (n=3) in that order, with mean duration of symptoms 58.2 days, 300 days and 260 days respectively. Cases of invasive disease had a shorter course, more frequent cranial nerve involvement, with radiological features of heterogenous soft tissue densities and bone erosion. Cases of chronic non-specific sinusitis and allergic fungal sinusitis had more long-standing disease with a milder course and less ominous radiological features. Biopsy report from one of the patient’s was that of squamous cell carcinoma while the other patient was diagnosed with a sphenoid mucocoele.</p><p><strong>Conclusions: </strong>ISSD is an uncommon entity in clinical practice with non-specific symptoms and a potential for grave complications. Therefore, the condition must be borne in mind by clinicians and prompt treatment must be initiated.</p><p><strong> </strong></p>

Mass-forming chronic invasive fungal sinusitis; an uncommon mimicker of head & neck malignancy

Abstract Introduction/Objective Invasive fungal sinusitis is a progressive infection affecting the nasal cavity and associated sinus spaces. Acute forms affect immunocompromised patients with debilitating systemic diseases while chronic forms usually occur in immunocompetent individuals. Methods/Case Report A 26-year-old immunocompetent male with daily Marijuana smoking consulted for acute swelling of the right eye with dull pain, photophobia, loss of vision and pressure of 4 day duration. He reported nasal congestion for approximately one year and over the previous 2 months developed exophthalmos. Imaging demonstrated a 4.9 x 4.3 x 4.1 cm invasive soft tissue mass in the right lamina papyracea with involvement of the paranasal sinus, right orbit, and intracranial space. The mass was presumed to represent a high-grade malignancy. Biopsy was performed and demonstrated granulomatous invasive fungal sinusitis. The patient underwent right orbitotomy and right extranasal ethmoidectomy. He was begun on empiric amphotericin B. After culture and sequencing identification of Curvularia species, voriconazole was added. Follow up imaging studies after two month of treatment still demonstrated residual mass forming lesion with 10-20% decrease in size. The patient has regained his vision after 4 month of treatment and he is expected to complete a six months course. If the mass forming lesion persists, a second round of surgical debridement will be performed. Results (if a Case Study enter NA) N/A Conclusion Curvularia is a dematiaceous fungus most commonly associated with allergic sinusitis, but can rarely become invasive in immunocompetent individuals. Histopathologically large fungal elements are easily recognizable but specific identification requires culture or ribosomal DNA sequencing by PCR. Mass-forming chronic fungal sinusitis overlaps clinically and radiologically with head and neck malignancies. Our report brings attention to this uncommon clinical variant of invasive fungal sinusitis that affects immunocompetent individuals.

The Prevalence Of Allergic Fungal Sinusitis Among Patients With Nasal Polyps Presenting In A Tertiary Care Hospital

Background: Nasal polyp are pediculate overgrowths of sino nasal mucosa in the nasal cavity. Association of nasal polyps and allergic fungal sinusitis has been narrated in literature. This research has been conducted with a rationale of finding nasal polyps with fungal sinusitis. Aim: To find the generality between both chronic nasal polyps and chronic fungal sinusitis in tertiary hospital of capital province. Methods: Our study was conducted in a random pattern. It included 100 patients of nasal polyps who reported to ENT unit-II Jinnah Hospital Lahore from 1st Decmemcer,2019 to 31st August 2020. The interpretation of the data was done though 18th version of statistical software SPSS. Results: In our study, out of 100 cases of nasal polyps, 72(72%) cases were segregated between age group of 15 years to age group of 50 years while 28%(n=28) were segregated between the age group of 5th decade to 7th decade, the value of mean standard deviation +sd was measured and narrated as 41.1+12.67 years, 55(55%) were females while 45(45%) were male patients, however the final analysis of polyps in the nose with presence of fungal sinusitis was gathered around 18(18%) of the cases. Conclusion: The net analysis of our research helped us to device a rationale that nasal polyps and fungal sinusitis were inter related. There was a vast majority of nasal polyposis diseased patients having fungal sinusitis at the same time. This observation in a tertiary care hospital is an important landmark for analysis of all patients with nasal polypoidal disease to be scanned for fungal sinusitis at the same time. Keywords: Nasal polyps, allergic fungal sinusitis, frequency

Role of diffusion-weighted imaging in the discrimination of purulent intrasinusal content: A retrospective study.

The objective of this study was to analyse MRI with morphological (T1, T2) and diffusion sequences (DWI, b1000) in patients presenting non-aggressive patterns of sinus opacity and operated on by functional endoscopic sinus surgery (FESS). A retrospective study. Diffusion imaging in paranasal sinus pathology remains little known. To date, no imaging system is capable of determining the purulent content of a non-enhanced sinus filling. We included consecutive patients having undergone FESS in whom MRI of the paranasal sinuses was performed. Subjects were allocated to Case (pus) or Control (no pus) groups depending on sinus content found intraoperatively. FESS was performed for bacterial acute rhinosinusitis, acute exacerbations of chronic rhinosinusitis, non-purulent sinusitis, naso-sinusal polyposis, antrochoanal polyp, isolated polyp, angiomatous polyp and eosinophilic fungal sinusitis. Tumours, mucoceles and fungus balls were excluded. We analysed T1, T2, b1000 and MRI sequences and ADC map. On univariate analysis, intermediate signal in T2 and high signal in b1000 were associated with Cases (P<0.001) as were low ADC values (P<0.001). The difference in mean ADC values between Cases and Controls was statistically significant (respectively, 0.518 vs 2.041×10-3 mm2 /sec, P<0.01). On multivariate analysis, MRI with ADC<0.725×10-3 mm2 /sec and b1000_SI>brain was significantly associated with the case group. MRI with b1000_SI<brain and ADC>1.450×10-3 mm2 /sec was significantly associated with the control group. Diffusion MRI offers extremely promising results regarding content characterisation of infectious sinus diseases.

Prevalence and clinical profile of patients with chronic fungal maxillary sinusitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fungal paranasal sinus disease is considered to be rare but there has been a marked increase in the number and diversity of reported cases of fungal infections of maxillary sinus in recent years. Objectives were to study the incidence of fungal infection in case of chronic maxillary sinusitis, to identify specific type of fungus involved in maxillary sinus infection and to study clinical profile of the patients with fungal infections of maxillary sinus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study of was conducted involving the patients attending outpatient department of Otorhinolaryngology, who were clinically and radiologically proved cases of chronic maxillary sinusitis. Patients diagnosed with underlying paranasal sinus malignancies were excluded from the study. 70 patients of chronic maxillary sinusitis were included in the study. Isolates were identified based on colonial and microscopical morphology. Subcultures were done and slide cultures were prepared to identify the fungi. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Fungus was cultured from 12.8% of patients suffering from chronic maxillary sinusitis. The most frequent victims of the disease were young persons in the second decade of life. All patients found positive for fungus had unilateral maxillary sinusitis. &lt;em&gt;Aspergillus niger, Aspergillus fumigatus, Candida albicans&lt;/em&gt; and &lt;em&gt;Mucormycosis&lt;/em&gt; were the various fungi isolated from cultures of antral washings.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The results of the study emphasise the role of fungi as important pathogens of chronic maxillary sinusitis. There must be high index of suspicion of fungal infection when a young adult with a unilateral antral opacity on X-ray with frank pus in antral washings.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Fungal sinusitis among patients with chronic rhinosinusitis who underwent endoscopic sinus surgery.

Fungal paranasal sinusitis can be either invasive or non-invasive. Saprophytic infections, fungus balls (FB) and allergic fungal rhinosinusitis are non-invasive (AFR). The present study examined 521 patients who underwent endoscopic sinus surgery between January 2016 and April 2017 due to chronic paranasal sinusitis at the Department of Laryngology and Laryngological Oncology of the Upper Silesian Medical Centre in Katowice. The aim of the study was to analyse the histopathological and microbiological material collected intraoperatively and to determine the incidence and type of fungal infections among patients treated for chronic sinusitis. Chronic fungal sinusitis was confirmed in 10 of 521 operated patients. The study group consisted of 9 females and 1 male. Histopathological examination revealed dead mycelium in 5 patients and colonies of Aspergillus spp. in 4, while microbiological examination revealed Candida albicans infection in 1 case. Allergy to inhalant allergens of fungal spores of Alternaria and Penicillinum was confirmed in a 73-year-old patient, which, based on the whole clinical presentation, enabled to diagnose chronic allergic fungal sinusitis. The most common location of mycelium was the maxillary sinus, followed by the sphenoid sinus. The most common form of non-invasive fungal sinusitis is the so-called fungus ball, which was also confirmed in our report (95% of the test subjects). AFRS is more likely to occur in warm, moist climates that favour the growth of fungi.

A paradigm for evaluation and management of the maxillary sinus before dental implantation.

To determine a paradigm for evaluating and managing maxillary sinus conditions before dental implantation via preoperative sinonasal assessment. Prospective cohort study. Eighty-four patients who underwent dental implantation with or without sinus augmentation were included. Maxillary sinus conditions were classified into groups 1 to 6 according to cone-beam computed tomography (CT) findings: 1) nonspecific findings, 2) solitary polyp or cyst, 3) mucosal thickening, 4) air-fluid level or fluid accumulation, 5) near-total opacification of the maxillary or other paranasal sinus, and 6) calcification spots in the maxillary sinus. Dental implantation with or without sinus augmentation was suggested with postoperative sinus observation (groups 1-3), after medication for acute sinusitis (group 4), and after comprehensive treatment of chronic or fungal sinusitis (groups 5-6). Intraoperative and postoperative sinus-related complications were recorded. Two patients (groups 1 and 3) developed acute rhinosinusitis after sinus augmentation; both recovered completely with medical treatment. Schneiderian membrane perforation occurred during sinus lift surgery in six patients (group 1): five recovered after conservative medical therapy and close observation, whereas one required endoscopic sinus surgery and recovered well. No chronic rhinosinusitis developed after dental implantation. Craniofacial CT is crucial for pre-dental implantation sinonasal evaluation. The risk of dental implant-related chronic rhinosinusitis is low for patients with cysts, polyps, or mucosal thickening in the maxillary sinus. However, preventive endoscopic sinus surgery is recommended for patients with incurable chronic rhinosinusitis, fungal sinusitis, and large polyps or cysts. 4. Laryngoscope, 128:1261-1267, 2018.

Current therapeutic protocols for chronic granulomatous fungal sinusitis.

The treatment of chronic granulomatous fungal sinusitis (CGFS), a rare form of invasive fungal sinusitis, is controversial. To assess the response to postoperative antifungal therapy in patients with CGFS and suggest an effective treatment protocol. Clinical records of patients with CGFS who had undergone excisive surgery followed by antifungal therapy were reviewed to assess current disease status. Fourteen male and 4 female patients were diagnosed with CGFS, based on typical histopathological and fungal smear/ culture results. Aspergillus flavus was isolated from 88.9% cases. Stage 1 patients had resectable sinonasal disease, stage 2 had additional spread to orbit/palate and stage 3 had extensive disease. Follow-up ranged from 6 months to 8 years. Residual disease was seen in all but one patient who received amphotericin B as first line therapy and in none of those who received itraconazole or voriconazole. Even those who received azoles as second line therapy were disease free at last follow-up. Surgery followed by itraconazole or voriconazole for Stage 1 and 2 disease and voriconazole for stage 3 disease is recommended for a good outcome. Amphotericin B is not recommended as first line therapy for CGFS.

Current therapeutic protocols for chronic granulomatous fungal sinusitis

The treatment of chronic granulomatous fungal sinusitis (CGFS), a rare form of invasive fungal sinusitis, is controversial. To assess the response to postoperative antifungal therapy in patients with CGFS and suggest an effective treatment protocol. Clinical records of patients with CGFS who had undergone excisive surgery followed by antifungal therapy were reviewed to assess current disease status. Fourteen male and 4 female patients were diagnosed with CGFS, based on typical histopathological and fungal smear/ culture results. Aspergillus flavus was isolated from 88.9% cases. Stage 1 patients had resectable sinonasal disease, stage 2 had additional spread to orbit/palate and stage 3 had extensive disease. Follow-up ranged from 6 months to 8 years. Residual disease was seen in all but one patient who received amphotericin B as first line therapy and in none of those who received itraconazole or voriconazole. Even those who received azoles as second line therapy were disease free at last follow-up. Surgery followed by itraconazole or voriconazole for Stage 1 and 2 disease and voriconazole for stage 3 disease is recommended for a good outcome. Amphotericin B is not recommended as first line therapy for CGFS.

Fungal Sinusitis: Fact or Fiction?

Objectives: Participants should be able to: (1) Recognize chronic fungal sinusitis based on clinical examination and radiologic imaging; (2) Analyze the implications of nasal flora contents in suspected chronic fungal sinusitis patients; and (3) Implement surgical and medical treatment of chronic fungal sinusitis. Methods: A retrospective review of the senior author’s patients from 1990 to 2014 was completed in which 50 immunocompetent patients thought to have evidence of fungal sinusitis were identified by the following criteria: Classic “high density” material seen on computed tomography (CT), fungal mycelium seen at surgery/fungal smears, and “Fig Newton” material visualized endoscopically in sinuses. Endoscopic surgery was performed on patients with emphasis to widely open sinuses and trim turbinates, allowing postoperative access to affected areas. Intraoperatively, material from sinus cavities was sent for microbiological and pathological analysis. Postoperatively, patients used saline irrigations to remove debris and potent topical steroids to reduce mucosal reactivity and edema. Antifungal agents were not employed. Regular debridements were carried out in the clinic until healing was complete. Results: Fungus was present in 29% of cultures/smears, while staphylococcus, pseudomonas, and other organisms were present in 44%. Nasal sinus mucosa returned to normal appearance in the majority of patients with topical treatment. Some patients with a strong allergy history had persistence of hypertrophic mucosa. A pulsed course of oral prednisone generally resolved this. Conclusions: Wide surgical drainage of affected sinus areas in combination with saline/acetic acid irrigations and topical steroids were successful in nearly all patients without the use of antifungal agents.

Usefulness of partial uncinectomy in patients with localized maxillary sinus pathology

PurposeConventional total uncinectomy may be unnecessary in localized maxillary sinus lesion. Partial removal of the uncinate process and middle meatal antrostomy would be sufficient to eradicate the pathological condition. Therefore, we aimed to evaluate the efficacy of partial uncinectomy versus total removal of the uncinate process in patients with localized maxillary sinus disease. MethodsIn total, 25 patients were assigned randomly to partial and total uncinectomy groups. Preoperative computed tomography established that all patients had localized pathology in the maxillary sinus. The lower half of the uncinate process was removed in the partial uncinectomy group, while the total uncinectomy group underwent the conventional surgery. Time required for the uncinectomy, healing period for the uncinectomy site, incidence of lamina papyracea or nasolacrimal duct injury, obstruction or stenosis of the frontal recess, and incidence of synechia formation in the middle meatus were compared between the groups. ResultsAll patients completed the follow-up and were included in the analysis. Surgical indications included chronic maxillary sinusitis, fungal sinusitis, antrochoanal polyp, and odontogenic sinusitis. Operation durations and healing periods were significantly shorter in the partial uncinectomy group. One patient had a minor injury to the lamina papyracea and two patients showed partial synechia formations in the total uncinectomy group. However, other parameters did not differ significantly between the groups. ConclusionsPartial uncinectomy may be useful in patients with pathological conditions confined to the maxillary sinus. Shorter operation duration, more rapid healing, and lower incidence of complications are advantages over a conventional total uncinectomy.

Pretreatment of sinus aspirates with dithiothreitol improves yield of fungal cultures in patients with chronic sinusitis

Mold pathogens are a leading cause of chronic rhinosinusitis. Successful isolation of mold on culture is helpful in establishing a diagnosis and guiding therapy. Though mucolytic agents are commonly used in European countries, they are not part of everyday use in North America. In this case-control prospective study, we investigated the yield of fungal culture before and after treatment of sinus aspirates with the mucolytic agent dithiothreitol in a United States hospital. Over a 5-month period during 2011-2012, 359 sinus aspirates from 294 patients with symptoms suspicious for chronic sinusitis or allergic fungal sinusitis were collected. Aspirates were cultured on fungal medium before and after treatment with dithiothreitol. Of the 359 pairs of cultures, 62 (17.3%) demonstrated mold growth on at least 1 of the plates, 9 (14.5%) of which grew more than 1 species of mold. A total of 75 molds were identified, 41 (54.7%) of which were successfully cultured only when the mucus was pretreated with dithiothreitol (p < 0.0001). Quantitatively, more colonies grew from dithiothreitol-treated mucus than from direct-inoculation (p < 0.0001). This study confirms improved recovery of mold from sinus cultures after pretreatment of samples with dithiothreitol. Further studies are needed to correlate these findings with clinical outcome.

Different types of fungal sinusitis occurring concurrently: implications for therapy

The purpose of this study is to describe the clinical and histopathological features, management and outcome of a series of patients with simultaneous occurrence of invasive and non-invasive fungal sinusitis (mixed fungal sinusitis). The histopathological records of patients with fungal sinusitis seen over the last 6 years were reviewed. The clinical, histopathological, treatment and follow up details of all cases with mixed fungal sinusitis were noted. Six cases of mixed fungal sinusitis with concurrent occurrence of chronic granulomatous fungal sinusitis and allergic fungal sinusitis (AFS) were seen during the study period. Most (83.3 %) had bilateral disease. All patients had undergone prior endoscopic sinus surgery at least once within the previous 2 years. Histopathological features showed predominance of invasive disease in half the patients. Except for one patient who did not report for follow up, all patients with predominant chronic granulomatous fungal sinusitis received systemic antifungal therapy and inhaled steroids. Those with predominant features of AFS received oral and inhaled steroids. Five patients with mixed fungal sinusitis who had follow up ranging from 6 months to 5 years were disease free following treatment. Mixed fungal sinusitis should be recognized by the surgeon and pathologist as a separate category of fungal sinusitis whose treatment depends on accurate histological diagnosis. A good outcome may be expected with appropriate therapy.