Acute invasive fungal rhinosinusitis: evaluation of 26 patients treated with endonasal or open surgical procedures.
OBJECTIVE
Acute invasive fungal rhinosinusitis (AIFRS) is a serious disease with a high mortality and morbidity rate, which almost always affects immunocompromised patients and/or patients with diabetes mellitus. Our purpose was to present the diagnostic and therapeutic management and outcome of these patients.


METHODS
Case series with chart review.


METHODS
Tertiary care university hospital.


METHODS
Twenty-six patients, who were operated on because of AIFRS between September 1999 and June 2009, were retrospectively evaluated in this study. Endoscopic surgery was used in 19 patients, and open surgical debridement was performed in seven patients.


RESULTS
Overall survival rate of the patients in the open surgery group (4 of 7; 57.1%) was similar to that of the endoscopically treated group (9 of 19; 47.3%). Thirteen patients (50%) died of complications related to the underlying disease (9 of 13; 69.2%) and AIFRS (4 of 13; 30.7%). AIFRS-specific survival rate is 76.5 percent; 90 percent (9 of 10) and 57.1 percent (4 of 7) for endoscopic and open surgery groups, respectively. Four patients who died had pathological diagnosis of mucormycosis (P = 0.52).


CONCLUSIONS
AIFRS can be successfully treated with a combination of endonasal surgical debridement and antifungal medications. Endonasal approach is suitable for patients diagnosed in the early stages of the disease and provides a less traumatic option in those patients who already have a poor health status. Open surgery should be preferred in the presence of intraorbital extension, palatinal, and/or intracerebral involvement. Reversing the underlying disease process and immunosuppression is as important as the surgical and antifungal treatment.
Faculty of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Uludağ University, Bursa, Turkey. fkasapoglu@uludag.edu.tr
Fikret
F
Kasapoglu
Hakan
H
Coskun
Omer Afsin
OA
Ozmen
Halis
H
Akalin
Beyza
B
Ener
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D001230:Aspergillus / Q000302:isolation & purification; D002648:Child; D003646:Debridement / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D009091:Mucormycosis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010256:Paranasal Sinuses / Q000382:microbiology; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D012852:Sinusitis / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult