5-Fungal Sinusitis

Fungal sinusitis is not a common disease of the nose but the number of cases is increasing nowadays.  In adults more than children, no discrimination between males and females.

Fungal sinusitis could be invasive or noninvasive:

What is the most important initially is the correct diagnosis of the type of the fungal infection as both types are totally different regarding their diagnosis, treatment, prognosis and complications.

1.       Noninvasive fungal sinusitis is more common and is usually accompanied by allergic rhinitis towards fungus.

Unilateral nasal obstruction with thick mucus of offensive odor and sometimes proptotic eye due to the pressure applied from the nasal polyps.

Diagnosis is achieved by using the nasal endoscopy to detect the affected side, thick mucus , Computed tomography is mandatory to detect any other affected sinuses and the extension of the polyps invading the eye and/or brain.

Treatment is by using the endoscope and the shaver to excise the polyps totally from its roots and suction of the mucus from the affected sinuses and widening of the sinus ostium to guarantee that the disease won’t recur.

Calculated dose from corticosteroids is essential after the surgery to regress the mucosal hypertrophy and for normal aeration of the affected sinus to prevent reaccumilation of fungal debris. Immunotherapy is recommended as this will decrease the incidence of recurrence.

It is worth mentioning that these cases are a one day surgery and is done through the nostrils without any incisions in the face or sublabial.

Follow up is mandatory in these cases every three months to detect any early recurrence

 

2. Invasive fungal sinusitis symptomatize by severe headache from the beginning and it usually affects immunocomprimised patients as in case of diabetes, renal failure ,malignant tumors, corticosteroids and chemotherapy.

The patients with invasive fungal sinusitis usually complaing of severe headache, fever, severe pain around the eye and then thick offensive secretions as the disease progresses together with deterioration of vision, proptosis of the eye and more serious is extension to the brain and disturbance of conscious.

Diagnosis is made by nasal endoscopy to detect the affected and gangrenous part as well as the computed tomography and magnetic resonance imaging to detect affected sinuses and extension of the disease to the eye and/or the brain.

Treatment is done by nasal endoscopy to remove the dead tissues from the nose and the sinuses as well as managing the preexisting condition (diabetes etc.) together with antifungal medication and of course this is done under physician’s supervision to prevent the complication of these drugs on the liver and the kidney.