[Managements and prognostic analyses in patients with invasive fungal rhinosinusitis].
OBJECTIVE
To evaluate the survival outcomes of invasive fungal rhinosinusitis by analyzing the clinical features.


METHODS
A retrospective analysis was performed for cases of invasive fungal sinusitis proved by histological analysis between March 2006 and November 2015. All relevant factors including interval from the onset of symptoms to initiation of diagnosis, clinical characteristics, features of CT and MRI, treatment and prognosis were collected. A total of 18 patients (10 males; 8 females) were identified. The median age was 54 years old. Three patients suffered from acute invasive fungal sinusitis, while the other 15 suffered from chronic invasive fungal sinusitis.


RESULTS
The mean duration between onset of symptoms and diagnosis was 5 months. The most common symptom was headache (10/18), followed by visual disturbance (7/18), nasal obstruction (4/18), facial numbness and pain (2/18) and diplopia(2/18). Two patients had diabetes mellitus; one patient had ankylosing spondylitis receiving immunosuppressive drugs treatment for one year. Four patients had the disease confined in the sinus. Complications of this disease included orbital apex involvement in 6 patients, intraorbital and optic nerve involvement in 3 patients, cavernous sinus involvement in 5 patients, pterygopalatine fossa and infratemporal fossa involvement in 5 patients, intracranial extension involvement in 3 patients. Fungal species included aspergillus (15 cases) and mucor (3 cases). Seventeen patients received intravenous antifungal therapy after surgery. The duration of follow-up ranged from 1 to 60 months. Two patients reoccurred and one patient died of the disease.


CONCLUSIONS
Endoscopic debridement combined with intravenous antifungals is efficacious in the management of invasive fungal sinusitis.
Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
W
W
Zhou
Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
Q
Q
Liu
Endoscopic Skull Base Center, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
W D
WD
Zhao
Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
H P
HP
Yu
Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
X C
XC
Sun
Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
J J
JJ
Wang
Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
Z F
ZF
Liu
Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
H Y
HY
Li
Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
C Q
CQ
Zheng
Department of Pathology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
S Y
SY
Wang
Department of Otorhinolaryngology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China; Endoscopic Skull Base Center, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai 200031, China.
D H
DH
Wang
D000208:Acute Disease; D000935:Antifungal Agents / Q000627:therapeutic use; D002426:Cavernous Sinus; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement; D004724:Endoscopy; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D000072742:Invasive Fungal Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology; D010256:Paranasal Sinuses; D011379:Prognosis; D056739:Pterygopalatine Fossa; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality*; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality*; D013997:Time Factors
D000935:Antifungal Agents