Fungal sinusitis

By : Fatimah Bassem Alshiekh 5th year medical student

211504259

AnatomyThe sinuses are a connected system of hollow cavities in the skull.

 Most of the sinuses drain into the nose the middle meatus.

What is Fungal sinusitis ?

It is inflammation of sinus mucosa duo to fungal infection

Epidemiology Incidence of fungal sinusitis is increasing!

Why?

immunocompromised

Classification Fungal sinusitis

Non invasive

Allergic

Sinus mycet

oma

Non allergi

c

Eosinophilic fungal sinusitis

Invasive

Acute chronic

granulomato

us

Allergic fungal sinusitis

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 .

Allergic fungal sinusitis allergic mucin

Allergic fungal sinusitis 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

Allergic fungal sinusitis

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

Allergic fungal sinusitis

Nasal polyposis

Allergic fungal sinusitis 4-Bent's criteria for the diagnosis of allergic

fungal sinusitis:1. Demonstrable type I hypersensitivity to fungi2. Nasal polyposis3. Radiological findings (Heterodense mass lesion)4. Presence of eosinophilic mucin mixed with non invasive fungus 5. Positive fungal stain / fungal culture (Aspergillus)

Allergic fungal sinusitis 5-Investigation

Laboratory study :Elevated total fungus-specific IgE

Allergic fungal sinusitis Imaging StudiesCT

-The majority sinus show near complete opacification  .

Approximately 40% of patients may have each of the following features: 

1-expansion of an involved sinus2-remodeling and thinning of the bony sinus walls

3-erosion of the sinus wall

Allergic fungal sinusitis Coronal CT scan

Allergic fungal sinusitis

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.

Allergic fungal sinusitis

SURGICAL MANAGEMENTcomplete removal of all allergic mucin, polyps and fungal debris.

 Recurrence after surgery is not uncommon.

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

Allergic fungal sinusitis

Stage 0

Allergic fungal sinusitis

Stage1

Allergic fungal sinusitis

Stage2

Allergic fungal sinusitis

Stage3

Allergic fungal sinusitis

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

Allergic fungal sinusitis 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

Fungal mycetoma (fungal ball )

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.

Fungal mycetoma

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.

Fungal mycetoma

Fungal mycetoma

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 .

Fungal mycetoma

Fungal mycetoma

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.

Thank you

REFERENCES:// . . /http www jaypeejournals com:// . /http radiopaedia org

:// . - . / _http care american rhinologic org fungal sinusitis

:// . . . /http www drtbalu co in:// . . /http www medscape com