definition of some types of fungal sinusitis and thier management

1. By : Fatimah Bassem Alshiekh
5th year medical student
211504259

2. The sinuses are a connected system of hollow
cavities in the skull.
Most of the sinuses drain into the nose the middle
meatus.

3. It is inflammation of
sinus mucosa duo to
fungal infection

4. Incidence of fungal sinusitis is increasing !
Why?

5. Fungal sinusitis
Non invasive
Aller
gic
Sinus
mycet
oma
Non
allergi
c
Eosinoph
ilic funga
l sinusitis
Invasive
Acute
chroni
c
granul
omat
ous

6. 1-Pathophysiology
The presence of fungus in the sinuses
causes an allergic response, resulting in
production of allergic mucin and nasal
polyps. Usually, the disease affects more
than one sinus on one side.

7. allergic mucin

8. 3-Patient History
-Most common among adolescents and young
adults.
-Environment factors and host genetics have
shown to play a role
-Increase incidence in warm and humid areas
-Atopic patient

9. 3-Clinical presentation
- symptoms of chronic sinusitis (headache,
nasal stuffiness, discharge, and cough)
- progressive nasal obstruction
-crusting
-Rhinorrhoea
-Proptosis
-Nasal polyposis

10. Nasal polyposis

11. 4-Bent's criteria for the diagnosis of allergic
fungal sinusitis:
1. Demonstrable type I hypersensitivity to fungi
2. Nasal polyposis
3. Radiological findings (Heterodense mass
lesion)
4. Presence of eosinophilic mucin mixed with
non invasive fungus
5. Positive fungal stain / fungal culture
(Aspergillus)

12. 5-Investigation
Laboratory study:
Elevated total fungus-specific IgE

13. Imaging Studies
CT
-The majority sinus show near complete
opacification.
Approximately 40% of patients may have each of the
following features:
1-expansion of an involved sinus
2-remodeling and thinning of the bony sinus walls
3-erosion of the sinus wall

14. Coronal CT scan

15. Treatment
Surgically
1-PREOPERATIVE
-systemic steroids seven days prior to surgery, which
helps in reducing polyps and mucosal edema and
helps identify surgical landmarks better.
-Antibiotic
- Nasal decongestants are started a week prior to
surgery.

16. SURGICAL MANAGEMENT
complete removal of all allergic mucin,
polyps and fungal debris.
Recurrence after surgery is not uncommon.

17. Kupferberg (1997) has devised a system of staging
postoperative sinus and decisions regarding further
medical or surgical management may be instated.

18. Stage 0

19. Stage1

20. Stage2

21. Stage3

22. Stages 0 to 2 may respond to
conservative management;Stage 3
usually requires surgery.

23. POSTOPERATIVE MANAGEMENT
-Antibiotics are continued for a period of ten days.
-saline nasal washes, once the sinus packs are removed.
--The patients are followed up at weekly intervals for the
first four weeks following surgery.
--The nasal cavities are cleaned under endoscopic guidance

25. 1- Pathophysiology
-The fungal ball is composed of tightly packed
hyphae often from Aspergillus, Alternaria
-Implantation of fungus into sinus cavity.
-Usually unilateral.
-Maxillary sinus commonly involved.
-Seen in immunocompetent.
-Commonest cause-Aspergillus species.

26. 2-Ppresentation
-The main report is blowing of gravel-
like material from the nose.
- Usually a peanut-butter like
appearance of the fungal ball
-Usually is found accidentally on CT
scanning of the sinuses.

28. CT features
-affected with predilection for the maxillary
- Clue to the diagnosis include soft tissue density
within the sinus with/without foci of calcific
deposit.

30. Treatment
-Treatment is mostly surgical removal of
the fungal mass combined with
widenening of ostium there by
increasing the ventilation of the sinuses.
- Antifungal drugs are not indicated in
these patients.

32. REFERENCES
http://www.jaypeejournals.com/
http://radiopaedia.org/
http://care.american-rhinologic.org/fungal_sinusitis
http://www.drtbalu.co.in/
http://www.medscape.com/