Wang Dong, Li Yichen, Hua Hongting, Zhao Yi, Gao Chao-Bing, Fang Ping
Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, Anhui, China.
Eur Arch Otorhinolaryngol. 2022 Apr;279(4):1885-1890. doi: 10.1007/s00405-021-06933-z. Epub 2021 Jun 15.
This study was conducted to evaluate outcomes in patients presenting with fungus ball of the maxillary sinus (MSFB) and frontal sinusitis who were treated via middle meatal antrostomy alone.
This was a randomized, controlled study with a parallel group design. Patients with MSFB and frontal sinusitis were randomly assigned to the maxillary middle meatal antrostomy (MMMA) or control (MMMA + frontal sinusotomy) groups. Patient demographics, complaints, imaging findings were analyzed, and surgical outcomes were evaluated using the Lund-Kennedy endoscopic score (LKES) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire.
In total, 40 patients were separated into two groups, with similar symptoms including nasal obstruction, mucopurulent rhinorrhea, maxillary or frontal pain, blood stained nasal discharge, nasal cacosmia and orbital pain being observed in both groups. Total LKES and SNOT-22 scores were significantly improved in both groups at 6 months post-treatment, with no significant differences in these scores between groups within a mean 6.8-month follow-up.
These results suggest that frontal sinusotomy is not required to resolve frontal sinusitis associated with MSFB. As such frontal sinusitis appears to be a reactive process caused by fungal ball obstruction, it regresses spontaneously following fungus ball removal, drainage of the maxillary sinus, and middle meatal antrostomy.
本研究旨在评估仅通过中鼻道上颌窦造口术治疗的上颌窦真菌球（MSFB）合并额窦炎患者的治疗效果。
这是一项采用平行组设计的随机对照研究。患有MSFB和额窦炎的患者被随机分配到上颌中鼻道造口术（MMMA）组或对照组（MMMA + 额窦切开术）。分析患者的人口统计学资料、症状、影像学检查结果，并使用Lund-Kennedy内镜评分（LKES）和22项鼻鼻窦结局测试（SNOT-22）问卷评估手术效果。
总共40例患者被分为两组，两组症状相似，均有鼻塞、黏液脓性鼻漏、上颌或额部疼痛、血性鼻分泌物、鼻臭和眼眶疼痛。治疗后6个月时，两组的LKES总分和SNOT-22总分均显著改善，在平均6.8个月的随访期内，两组之间这些评分无显著差异。
这些结果表明，对于与MSFB相关的额窦炎，无需进行额窦切开术。由于这种额窦炎似乎是由真菌球阻塞引起的反应性过程，在真菌球清除、上颌窦引流和中鼻道上颌窦造口术后会自行消退。
