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Similar to Fungal Rhinosinusitis: Varieties, Symptoms, Diagnosis and Treatment
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Fungal Rhinosinusitis: Varieties, Symptoms, Diagnosis and Treatment
- 1. Fungal Rhinosinusitis Bijay shah kanu 4th year PAHS
- 2. Introduction • Many different species of fungi are found in paranasal sinuses • The more common fungi are • Aspergillus • Alternaria • Mucor or rhizopus • May involve single or multiple sinuses.
- 3. Varieties of fungal infections • Fungal ball • Allergic fungal sinusitis • Chronic invasive sinusitis • Fulminant fungal sinusitis
- 4. Fungal ball • It is due to implantation of fungus into an otherwise healthy sinus • CT shows hyperdense area with no evidence of bone erosion or expansion • Maxillary sinus is the most common involved • Followed by sphenoid , ethamoid and frontal sinus • Treatment is surgical removal of fungal ball and • adequate drainage of sinus • No antifungal therapy is required
- 5. Allergic fungal sinusitis • It is an allergic reaction to the causative fungus • Presents with sinunasal polyposis and mucin • contains eosinophils , charcot Leyden crystal and fungal hyphae • There is no invasion of the sinus mucosa with fungus • More than one sinus are involved on one or both side • CT scan shows mucosal thickening with hyperdense areas
- 6. Conti…….. • May be expansion of sinus or bone erosion due to pressure but no invasion of fungal • Treatment is endoscopic surgical clearance of sinuses with provision of drainage and ventilation • Combined with pre and post operative systemic steroids
- 7. Chronic invasive sinusitis • The fungus invades into the sinus mucosa • There is bone erosion by fungus • Presents with chronic rhinosinusitis • CT scan – thickened mucosa with opacifications of sinus and bone erosion • May have intracranial or intra orbital invasion • Histopathology –fungal invasion of submucosa and granulomatous reaction with multinucleated giant cells
- 8. Conti…….. • Treatment consists of surgical removal of involved mucosa , bone and softs tissues • Followed by antifungal therapy with I.V. amphotericin B. • Up to a total of 2-3 gm of drugs is given • Followed by itraconazole therapy for 12 months • Or more monitored by serial CT or MRI scans.
- 9. Fulminant fungal sinusitis • It is acute presentation • is mostly seen in immunocompromised or diabetic patients • Common fungal species are Mucor or aspergillas
- 10. Conti……
- 11. Conti…….. Mucor • Mucor cause rhinocerebral disease . • Due to invasion of the blood vessels , • Mucor fungus ischemic necrosis presenting as a black eschar • involving inferior turbinate , palate or the sinus • spreads to the face , eye , skull base and brain • Treatment is surgical debridement of necrosis tissues • I.V. amphotericin B.
- 12. Conti…… Aspergillus • Can cause acute fulminant sinusitis with tissues invasion • Presents with acute sinusitis and develops sepsis and other sinus complications • Unlike mucor infections , • There is no black escher • Treatment is antifungal therapy and surgery .
- 13. Refference • PL Dhingra, et al. Diseases of ear, nose and throat & head and neck surgery, 6th edition
- 14. THANK YOU