2012 Volume 105 Issue 6 Pages 549-557
Our hospital surgically treated 788 cases with paranasal inflammatory diseases between 2004 and 2009. Twenty-six of 788 cases (3.3%) were diagnosed as having fungal rhinosinusitis with bacterial and histopathological examinations and were reviewed in the present study. Our cases were classified as fungal ball (22 cases), invasive paranasal aspergillosis (1 case) and allergic fungal rhinosinusitis (3 cases). All of 22 cases with fungal ball treated with endoscopic sinus surgery showed good progress without recurrence. In 21 of the 22 patients, aspergillus was identified. In the past history, from only 6 cases of the 22 cases, steroids were administered in 4 patients, with 1 patient each having diabtes and renel failure. The other cases (16 cases) were not immunocompromised and so, we should keep the possibility of mycosis in mind as infections of sinusitis without immunocompromised body. A patient with invasive paranasal aspergillosis had orbital apex syndrome. Endoscopic sinus surgery combined with an antifungal drug (voriconazol) could improve the orbital pain, but not the loss vision in the left eye. Because orbital apex syndrome due to mycosis is associated with the possibility of brain aneurysm and infarction by thrombophlebitis after treatment, we should follow up with MRI and MRA. We experienced 3 cases with allergic fungal rhinosinusitis. All cases showed eosinophlic mucin and fungus in the parasinus effusion.
