Chronic Invasive Fungal Rhinosinusitis: A Systematic Review and Meta-analysis

Objective: Chronic invasive fungal rhinosinusitis (CIFR) can be a challenging disease process to treat. No formal treatment algorithms have been defined for this indolent pathology. We aim to be the first to conduct a systematic review consisting of qualitative and quantitative analysis of English literature CIFR cases.

Data Sources: PubMed, Embase, and Web of Science were searched.

Review Methods: Following PRISMA guidelines, PubMed, Embase, and Web of Science databases were queried. Abstracts were screened independently by two investigators. Case series and case reports that met the inclusion criteria of immunocompetent patients with non-granulomatous CIFR were included. Studies of patients with noninvasive and allergic subtypes of FRS were excluded.

Results: Of the initial 306 abstracts reviewed, 32 full-text articles were included with 91 total patients. Aspergillus was the most commonly implicated fungal genus, as it was found in 69 patients (76%). Six case series were included in the meta-analysis. The pooled prevalence of orbital invasion was 0.42 (95% CI: 0.25–0.59) with an I ² of 36% (p < 0.0001). Similarly, the pooled prevalence of intracranial extension was 0.41 (95% CI: 0.29–0.53) with an I ² of 0% (p < 0.0001). All cases were managed with surgical debridement followed by antifungal therapy of either voriconazole or amphotericin B, resulting in survival of 76 out of 91 patients (84%).

Conclusion: Early diagnosis and timely surgical treatment with adjuvant pharmacological therapy can lead to good outcomes in these patients. Orbital and intracranial extension are key elements to identify during the diagnostic workup of CIFR patients.

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021