Fungal sinusitis in the immunocompetent patient: risk factors and surgical management.
BACKGROUND
Fungal sinusitis has been reported increasingly in immunocompetent patients. However, the most effective, appropriate mode of therapy has not been determined.


METHODS
In this retrospective study, we examined the records of 110 immunocompetent patients with chronic sinusitis who had undergone sinus surgery at our institution between 1983 and 1994. Five patients (4.5%) with fungal sinusitis were identified. Information on those patients was compared with that of the 105 patients with nonfungal sinusitis.


RESULTS
Prolonged use of topical steroids was no more common in patients with fungal sinusitis (20%) than it was in patients with nonfungal sinusitis (4.8%) (p = 0.25). Differentiating features of fungal sinusitis were the presence of a metallic density and areas of high- and low-density on radiologic examination (p < 0.01). All five of the patients with fungal sinusitis were cured by surgical intervention, primarily endoscopic sinus surgery, without undergoing anti-mycotic therapy. Four of the five patients were followed up for at least 3 years without any recurrence.


CONCLUSIONS
Endoscopic sinus surgery is and should remain the mainstay of treatment for fungal sinusitis in immunocompetent patients. Adjunctive anti-mycotic therapy may not be necessary.
Hadi
Usamah
U
University of Beirut School of Medicine, Beirut, Lebanon.
Bitar
Mohammed
M
Hachem
Ray
R
Saade
Raja
R
Husni
Rola
R
Raad
Issam
I
D000328:Adult; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012852:Sinusitis / Q000209:etiology* / Q000601:surgery*