Han Doo Hee, An Soo-Youn, Kim Si Whan, Kim Dong-Young, Rhee Chae-Seo, Lee Chul Hee, Min Yang-Gi
Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea.
Acta Otolaryngol Suppl. 2007 Oct(558):78-82. doi: 10.1080/03655230701624913.
In a retrospective study of 239 cases of fungal sinusitis, noninvasive paranasal sinus aspergillosis was most common and successfully treated by endoscopic sinus surgery (ESS) with postoperative sinus irrigation. For the treatment of fungal sinusitis, ESS with or without antifungal agents and control of predisposing factors for secondary cases are recommended.
The aim of this study was to investigate the clinical characteristics of fungal sinusitis and evaluate the treatment outcomes of primary and secondary fungal infections of the paranasal sinuses.
Two hundred thirty-nine cases of fungal infection of the paranasal sinuses seen between January 1997 and December 2006 were retrospectively analyzed by reviewing their medical records. There were 200 cases of primary fungal infection and 39 cases of secondary fungal infection.
The symptoms of chronic rhinosinusitis such as nasal obstruction, purulent rhinorrhea, and postnasal drip were commonly present in both primary and secondary infections, and the sphenoid sinus was commonly involved in secondary infection. The radiological findings in fungal sinusitis included haziness, calcification, and bone destruction of the involved sinuses. CT scans in 80% of the primary and 69% of the secondary cases revealed calcific densities in a paranasal soft tissue mass. Twenty-eight of 38 cases which had MR showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities surrounded by bright signal on T2-weighted images. In secondary cases, the most common concomitant disease was diabetes mellitus. All patients received surgery including biopsy, ESS, and Caldwell-Luc's operation. Mucosal hypertrophy with fungus ball, which was the most common finding in both types, was found in 124 cases (62%) with primary and in 26 cases (67%) with secondary cases, and aspergillosis was most common, followed by unidentifiable colony, and mucormycosis. Eleven cases received amphotericin-B postoperatively. Two hundred thirty-eight cases showed no recurrence during the mean follow-up period of 11 months.
在一项对239例真菌性鼻窦炎的回顾性研究中，非侵袭性鼻旁窦曲霉菌病最为常见，通过鼻内镜鼻窦手术（ESS）及术后鼻窦冲洗可成功治疗。对于真菌性鼻窦炎的治疗，建议采用ESS联合或不联合抗真菌药物，并控制继发性病例的诱发因素。
本研究旨在调查真菌性鼻窦炎的临床特征，并评估原发性和继发性鼻旁窦真菌感染的治疗效果。
回顾性分析1997年1月至2006年12月期间所见的239例鼻旁窦真菌感染病例的病历。其中原发性真菌感染200例，继发性真菌感染39例。
慢性鼻窦炎的症状如鼻塞、脓性鼻漏和鼻后滴漏在原发性和继发性感染中均普遍存在，蝶窦在继发性感染中常受累。真菌性鼻窦炎的影像学表现包括受累鼻窦的模糊、钙化和骨质破坏。80%的原发性病例和69%的继发性病例的CT扫描显示鼻旁软组织肿块中有钙化密度。38例进行磁共振成像（MR）检查的病例中，28例在T1加权图像上信号强度降低，在T2加权图像上被明亮信号包围的区域信号强度明显降低。在继发性病例中，最常见的伴发疾病是糖尿病。所有患者均接受了包括活检、ESS和柯-陆氏手术在内的手术。黏膜肥大伴真菌球是两种类型中最常见的表现，原发性病例中有124例（62%），继发性病例中有26例（67%），曲霉菌病最为常见，其次是无法鉴定的菌落，毛霉菌病。11例患者术后接受了两性霉素B治疗。238例患者在平均11个月的随访期内未复发。
