Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine of Monastir, Tahar Sfar Hospital, Mahdia, 5100, Tunisia.
Department of Endocrinology and Internal Medicine, Faculty of Medicine of Monastir, Tahar Sfar Hospital, Mahdia, 5100, Tunisia.
F1000Res. 2021 Aug 31;10:869. doi: 10.12688/f1000research.67204.2. eCollection 2021.
Fungal rhinosinusitis (FRS) remains a rare disease. The noninvasive forms are hard to diagnose. The management protocols remain controversial. We aim to describe the clinical, radiological and pathological features of noninvasive FRS and present our management protocol and follow-up results. This descriptive study was conducted in the ear-nose-throat department of the university hospital, Taher Sfar in Mahdia, Tunisia. All patients who responded to the definition of noninvasive FRS (fungal balls and allergic fungal sinusitis) were included. The study was conducted over a three year period (May 2017 - April 2021). Eleven patients were included in this study: four cases of fungal balls and seven cases of allergic fungal sinusitis. Patients presented with symptoms of chronic recurrent rhinosinusitis with no response to conventional treatments. Computed tomodensitometry scan showed opacification of the paranasal sinuses in all patients. Other signs were heterogeneous opacities, local calcifications and thinning of the bony walls of the sinuses. Histopathological findings were inflammatory polyps in all cases of allergic FRS with the presence of fungal hyphae in 42.8% of the cases. All patients underwent surgery after a median delay of 12 [6-24] months of the symptom's onset. The used procedures were endoscopic middle meatal antrostomy for all patients, ethmoidectomy (81.8%) and sphenoidotomy (36.4%). None received systemic antifungals or corticosteroids with a favorable outcome in all cases. Symptoms of noninvasive FRS are nonspecific. The scan images contribute to the diagnosis, but the perioperative findings and the histopathological results remain crucial. The management is mainly surgical.
真菌性鼻窦炎（FRS）仍然是一种罕见的疾病。非侵袭性形式难以诊断。管理方案仍存在争议。我们旨在描述非侵袭性 FRS 的临床、放射学和病理学特征，并介绍我们的管理方案和随访结果。这项描述性研究在突尼斯马赫迪耶的 Taher Sfar 大学医院耳鼻喉科进行。所有符合非侵袭性 FRS（真菌球和变应性真菌性鼻窦炎）定义的患者均被纳入研究。研究时间为三年（2017 年 5 月至 2021 年 4 月）。本研究共纳入 11 例患者：真菌球 4 例，变应性真菌性鼻窦炎 7 例。患者表现为慢性复发性鼻窦炎症状，对常规治疗无反应。计算机断层扫描显示所有患者的副鼻窦均有混浊。其他征象为不均匀混浊、局部钙化和鼻窦骨壁变薄。所有变应性 FRS 病例的组织病理学检查均为炎性息肉，42.8%的病例存在真菌菌丝。所有患者均在症状出现后中位数 12 [6-24] 个月后接受手术。所有患者均采用内镜中鼻甲切开术、筛窦切除术（81.8%）和蝶窦切开术（36.4%）。所有患者均未接受全身抗真菌药或皮质激素治疗，所有患者均获得良好效果。非侵袭性 FRS 的症状无特异性。扫描图像有助于诊断，但围手术期发现和组织病理学结果仍然至关重要。治疗主要是手术。
