Gupta Ashok K, Bansal Sandeep, Gupta Anish, Mathur Nitin
Department of Otolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
Int J Pediatr Otorhinolaryngol. 2006 Apr;70(4):603-8. doi: 10.1016/j.ijporl.2005.08.014. Epub 2005 Oct 10.
Comparison of characteristic features, radiology, management and recurrence pattern of fungal sinusitis between children and adults.
A prospective study conducted in the department of Otorhinolaryngology, Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh in which all the cases presenting with the features of allergic fungal sinusitis (AFS) between January 2000 and January 2005 were enrolled. These cases were divided into two groups, group 1 comprised of cases with age less than 15 years and group 2 with age more than 15 years. Detailed history, physical examination and nasal endoscopic examination and computed tomography (CT) scan of the paranasal sinuses was done in all the cases. The cases with prior history of sinonasal surgery were excluded from the study. All patients refractory to medical management were subjected to endoscopic sinus surgery. All the cases were followed up for a period ranging from 6 to 39 months to see for the recurrence. The data of both the groups was analysed statistically using chi square test.
The study population comprised of 200 cases, with 68 cases in group 1 and 132 cases in group 2. The most common symptom in both the groups was presence of nasal obstruction. The children had higher incidence of having unilateral disease (46 out of 68) compared with adults, where it was 38 out of 132. The bony erosion was seen more often in group 1. Surgery was done endoscopically in all the cases. The intra orbital or intra cranial extension was seen in 58 cases of group 1 and 47 cases of group 2 (p<0.001). Recurrence was seen in 18 (15 with intraorbital and 3 with intracranial extension) cases in group 1 and 13 cases (11 with intraorbital and 2 with intracranial extension) in group 2 (p<0.005).
In our study, we found a higher incidence of facial deformities, proptosis, intraorbital/intracranial extension and a higher rate of recurrence in group 1, therefore, suggesting a more aggressive nature of AFS in children than adults mandating an early diagnosis, proper management and regular follow up in these cases.
比较儿童与成人真菌性鼻窦炎的特征、放射学表现、治疗方法及复发模式。
在昌迪加尔医学教育与研究研究生院头颈外科耳鼻喉科进行的一项前瞻性研究，纳入了2000年1月至2005年1月期间所有具有变应性真菌性鼻窦炎（AFS）特征的病例。这些病例分为两组，第1组为年龄小于15岁的病例，第2组为年龄大于15岁的病例。所有病例均进行了详细的病史采集、体格检查、鼻内镜检查及鼻窦计算机断层扫描（CT）。有鼻窦手术史的病例被排除在研究之外。所有药物治疗无效的患者均接受了鼻内镜鼻窦手术。所有病例均随访6至39个月以观察复发情况。两组数据采用卡方检验进行统计学分析。
研究人群包括200例病例，第1组68例，第2组132例。两组最常见的症状均为鼻塞。与成人相比，儿童单侧病变的发生率更高（68例中有46例），成人单侧病变的发生率为132例中有38例。第1组骨质侵蚀更为常见。所有病例均通过鼻内镜进行了手术。第1组58例和第2组47例出现眶内或颅内扩展（p<0.001）。第1组18例（15例眶内扩展和3例颅内扩展）和第2组13例（11例眶内扩展和2例颅内扩展）出现复发（p<0.005）。
在我们的研究中，我们发现第1组面部畸形、眼球突出、眶内/颅内扩展的发生率更高，复发率也更高，因此提示儿童AFS比成人更具侵袭性，这些病例需要早期诊断、适当治疗及定期随访。
