APPROACHES TO SURGICAL TREATMENT OF PATIENTS WITH ALLERGIC FUNGAL RHINOSINUSIS
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i4.15572Keywords:
acute rhinosinusitis, fungal body, antrostomyAbstract
Summary. Allergic fungal rhinosinusitis is a chronic respiratory disease characterized by the presence of nasal polyps and mucus which is rich in eosinophils. It is divided into non-invasive and invasive fungal sinusitis.
The aim – to optimize approaches to the treatment of patients with allergic fungal rhinosinusitis based on our clinical observations.
Material and Methods. During the past year, 38 patients with non-invasive fungal rhinosinusitis were under the supervision of the Medical center “LORIMED”. Among these: 71 % were women and 29 % were men. The diagnosis was established according to complaints, anamnesis and CT data of the paranasal sinuses.
Results. All patients underwent surgical interventions such as: endoscopic maxillotomy, ethmoidotomy, sphenoidotomy and others, the complexity of which depended on the degree of sinus damage. Wide functional antrostomies were formed with preservation of the anatomy of the intranasal structures. Six months after the surgeries, the patients' condition was satisfactory, they did not complain, the antrostomies were wide and functional.
Conclusions. Functional endoscopic surgery of the nose and paranasal sinuses is the key to successful surgical treatment of patients with AFGS. Formation of a wide antrostomy for all sinuses, preservation of the mucosa and intranasal structures contributes to better recovery in the postoperative period.
References
Dykewicz MS, Rodrigues JM, Slavin RG. Allergic fungal rhinosinusitis J Allergy Clin Immunol. 2018;142(2):341-351. DOI: 10.1016/j.jaci.2018.06.023. DOI: https://doi.org/10.1016/j.jaci.2018.06.023
Xu T, Guo XT, Zhou YC, Zhou Q, Wang YF. Consideration of the Clinical Diagnosis of Allergic Fungal Sinusitis: A Single-Center Retrospective Study. Ear Nose Throat J. 2023;1455613231167247. DOI: 10.1177/ 01455613231167247. DOI: https://doi.org/10.1177/01455613231167247
Singh V. Fungal Rhinosinusitis: Unravelling the Disease Spectrum. J Maxillofac Oral Surg. 2019;18(2):164-179. DOI: 10.1007/s12663-018-01182-w. DOI: https://doi.org/10.1007/s12663-018-01182-w
Akhondi H, Woldemariam B, Rajasurya V. Fungal Sinusitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023. Retrived from: https://www.ncbi.nlm.nih.gov/books/NBK551496/
Craig JR. Updates in management of acute invasive fungal rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2019;27(1):29-36. DOI: 10.1097/MOO.0000000000000507. DOI: https://doi.org/10.1097/MOO.0000000000000507
Kwon MO, Kim KS. Headache induced by isolated sphenoid fungal sinusitis: sinus headache? J Headache Pain. 2009;10(6):473-476. DOI: 10.1007/s10194-009-0153-z. DOI: https://doi.org/10.1007/s10194-009-0153-z
Galletti B. et al. Rhinocerebral mucormycosis with dissemination to pontine area in a diabetic patient: Treatment and management. Clin Case Rep. 2019;7(7):1382-1387. DOI: 10.1002/ccr3.2255. DOI: https://doi.org/10.1002/ccr3.2255
Weerakkody Y, Sharma R, Tran M. Granulomatous invasive fungal sinusitis. Reference article, Radiopaedia.org. 2015. DOI: 10.53347/rID-37230 DOI: https://doi.org/10.53347/rID-37230
Montone KT. Pathology of Fungal Rhinosinusitis: A Review. Head Neck Pathol. 2016;10(1):40-46. DOI: 10.1007/s12105-016-0690-0. DOI: https://doi.org/10.1007/s12105-016-0690-0
Sharif MS, Ali S, Nisar H. Frequency of Granulomatous Invasive Fungal Sinusitis in Patients with Clinical Suspicion of Chronic Fungal Rhinosinusitis. Cureus. 2019;11(5):e4757. DOI: 10.7759/cureus.4757. DOI: https://doi.org/10.7759/cureus.4757
Huang Y, Gui L. Cavernous sinus-orbital apex aspergillus infection in a diabetic patient: A case report. Medicine (Baltimore). 2019;98(13):e15041. DOI: 10.1097/MD.0000000000015041. DOI: https://doi.org/10.1097/MD.0000000000015041
Huang F, Liu F, Zhen X, Gong S, Chen W, Song Z. Pathogenesis, Diagnosis, and Treatment of Infectious Rhinosinusitis/Microorganisms. 2024;12(8):1690. DOI: 10.3390/microorganisms12081690. DOI: https://doi.org/10.3390/microorganisms12081690
Luong AU, Chua A, Alim BM, Olsson P, Javer A. Allergic Fungal Rhinosinusitis: The Role and Expectations of Biologics. J Allergy Clin Immunol Pract. 2022;10(12):3156-3162. DOI: 10.1016/j.jaip.2022.08.021. DOI: https://doi.org/10.1016/j.jaip.2022.08.021
Fan YH et al. Predicting the Probability of the Incidence of Maxillary Sinus Fungus Ball in Patients Using Nomogram Models. Diagnostics (Basel). 2023; 13(19):3156. DOI: 10.3390/diagnostics13193156. DOI: https://doi.org/10.3390/diagnostics13193156
Deutsch PG, Whittaker J, Prasad S. Invasive and Non-Invasive Fungal Rhinosinusitis-A Review and Update of the Evidence. Medicina (Kaunas). 2019; 55(7):319. DOI: 10.3390/medicina55070319. DOI: https://doi.org/10.3390/medicina55070319
Ryan MW, Clark CM. Allergic Fungal Rhinosinusitis and the Unified Airway: the Role of Antifungal Therapy in AFRS.Curr Allergy Asthma Rep. 2015;15(12):75. DOI: 10.1007/s11882-015-0573-6. DOI: https://doi.org/10.1007/s11882-015-0573-6
Patro SK, Verma RK, Panda NK, Chakrabarti A, Singh P. Efficacy of preoperative itraconazole in allergic fungal rhinosinusitis. Am J Rhinol Allergy. 2015;29(4):299-304. DOI: 10.2500/ajra.2015.29.4187. DOI: https://doi.org/10.2500/ajra.2015.29.4187
Medikeri G, Javer A. Optimal Management of Allergic Fungal Rhinosinusitis. J Asthma Allergy. 2020; 13:323-332. DOI: 10.2147/JAA.S217658. DOI: https://doi.org/10.2147/JAA.S217658
