Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy.
ISGOS, The Italian Study Group on Odontogenic Sinusitis.
Ann Otol Rhinol Laryngol. 2021 Nov;130(11):1302-1310. doi: 10.1177/00034894211002431. Epub 2021 Mar 18.
Paranasal sinus fungus ball is a common non-invasive mycosis with excellent long-term surgical treatment results. The present systematic review and meta-analysis were undertaken to define current treatment concepts and success rates in paranasal sinus fungus ball treatment.
Systematic searches were performed in multiple databases with criteria designed to include all studies published until May 2020 focusing on paranasal sinuses fungus ball treatment in humans. We selected studies including at least 10 patients, specifying treatment modalities, providing a minimum 6-month follow-up, and objectivating treatment success. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for treatment modalities and success rates. Success rates were pooled in a random effect meta-analysis and compared according to the use of intraoperative sinus lavages and postoperative antibiotics.
Among 740 unique citations, 14 studies were deemed eligible. Most (n = 11) were retrospective case series. All studies relied on endoscopic sinus surgery. Intraoperative lavages were proposed in 10 studies and postoperative antibiotics in 7 (for all patients in 5 studies and for selected patients in 2). No significant heterogeneity was observed between results (Cochran's Q = .639, test = 0). Treatment success rate was 98.4% (95% confidence interval 97.4%-99.3%). Intraoperative sinus toilette and postoperative antibiotics didn't significantly improve the success rate.
Endoscopic sinus surgery shows excellent results in fungus ball treatment. Further prospective studies might help further reducing antibiotics prescriptions in these patients and improve their management.
鼻窦真菌球是一种常见的非侵袭性真菌病，具有良好的长期手术治疗效果。本系统评价和荟萃分析旨在确定鼻窦真菌球治疗的当前治疗概念和成功率。
在多个数据库中进行了系统搜索，制定的标准旨在纳入截至 2020 年 5 月所有专注于人类鼻窦真菌球治疗的研究。我们选择了至少包括 10 名患者的研究，明确了治疗方式，提供了至少 6 个月的随访，并确定了治疗成功。经过重复去除、摘要和全文选择以及质量评估后，我们回顾了合格文章的治疗方式和成功率。采用随机效应荟萃分析汇总成功率，并根据术中鼻窦灌洗和术后使用抗生素进行比较。
在 740 条独特的引用中，有 14 项研究被认为符合条件。大多数（n = 11）为回顾性病例系列研究。所有研究均依赖于内镜鼻窦手术。术中灌洗在 10 项研究中提出，术后抗生素在 7 项研究中提出（在 5 项研究中适用于所有患者，在 2 项研究中适用于选择性患者）。结果之间未观察到显著的异质性（Cochran's Q = .639， 检验 = 0）。治疗成功率为 98.4%（95%置信区间 97.4%-99.3%）。术中鼻窦冲洗和术后使用抗生素并没有显著提高成功率。
内镜鼻窦手术在真菌球治疗中显示出良好的效果。进一步的前瞻性研究可能有助于进一步减少这些患者的抗生素处方，并改善其管理。
