Management of Different Fungal Sinusitis with Extension to Skull Base

Background: The subject of fungal sinusitis (FS) has received a great deal of attention during the past decade. FS must be differentiated from other pathophysiologic states in which fungal organisms affect the paranasal sinuses. Included in this group 1 are invasive fungal sinusitis. 1 Mycetoma and 3 AFS (allergic fungal sinusitis). Invasive fungal sinusitis generally affects immunocompromised patients. It is characterized by tissue invasion and necrosis. Mycetoma is large fungal balls that are found in one sinus in immunocompetent patients. AFS is truly allergic because these patients have been shown to have a markedly increased total of IgE and positive results on allergen-specific IgE assay for both fungal and nonfungal antigens.

Method: From 2000 to 2006 in Hazrat e Rasoul Hospital we had 60 cases with different fungal sinusitis complaints. Before management of the different fungal sinusitis types, we documented the diagnosis with different methods. For example, for invasive fungal sinusitis we took a biopsy and for AFS we took a history and imaging. After documentation we decided about the procedure. For AFS we performed endoscopic sinus surgery and steroid therapy. Invasive fungal sinusitis treatment included early diagnosis. For treatment of underlying disease, we offered appropriate débridement and pharmaceutical therapy. In this research, surgical determination protocol was on the basis of range of involvement and divided into three groups: In group A, the patients had nose and sinus involvement and only complete débridement of nose and sinus wass performed. Group B included those patients who also had an involved orbital space; for them, orbital exoneration was also added to the surgery. Group C was assigned whenever cerebral involvement was added to the above-mentioned cases, the prognosis i=was poor, and medical and surgical treatment had no effect on survival of the patient.

Result: We had 30 cases with rhino-orbitocerebral mucormycosis that had a 60% survival rate and 10 cases with mycetoma. Twenty cases of AFS with entension to skull base had a success rate of 90% with endoscopic sinus surgery and intermittent steroid therapy.

Conclusion: The management of different fungal sinusitis with extension to skull base needs a correct diagnosis and appropriate medical and surgical treatment and regular follow-up.