Fan Y H, Wu P W, Huang Y L, Lee C C, Lee T J, Huang C C, Chang P H, Huang C C
Department of Medical Education, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Rhinology. 2023 Apr 1;61(2):153-160. doi: 10.4193/Rhin22.329.
Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-specific symptoms. SSFB could potentially lead to serious orbital and intracranial complications. Computed tomography (CT) scan is usually the first imaging test of the diagnostic workup in patients with specific clinical symptoms. This study aimed to compare the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball) chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most common inflammatory diseases of the sphenoid sinus.
By retrospective database review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and histopathological diagnoses of USRS were enrolled as the control group. Clinical characteristics and CT features were evaluated.
Headache, rhinorrhoea, nasal obstruction, postnasal dripping, and hyposmia were the most common symptoms in both groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface, bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the multivariate analysis. Based on the results of the regression analysis, a nomogram for predicting the probability of SSFB was plotted.
We developed a nomogram model as a novel preoperative diagnostic tool for identifying SSFB according to the predictors both in clinical characteristics and on CT features. This could help the clinicians in predicting the probability of SSFB, to reduce ineffective or delayed treatment and occurrence of complications.
蝶窦真菌球（SSFB）是一种罕见疾病，通常表现为非特异性症状。SSFB可能会导致严重的眼眶和颅内并发症。计算机断层扫描（CT）通常是对有特定临床症状患者进行诊断性检查的首选影像学检查。本研究旨在比较SSFB与单侧（非真菌球）慢性蝶窦鼻窦炎（USRS）的临床特征和CT特征，以帮助区分蝶窦这两种最常见的炎症性疾病。
通过回顾性数据库检索，纳入66例经组织病理学诊断为孤立性SSFB的患者进行分析。将54例接受了内镜鼻窦手术且临床和组织病理学诊断为USRS的患者作为对照组。评估临床特征和CT特征。
头痛、流涕、鼻塞、鼻后滴漏和嗅觉减退是两组最常见的症状。在单因素分析中，年龄较大、白细胞计数较低、表面不规则、骨质缺损、外侧壁硬化和病灶内高密度（IH）是SSFB的显著预测因素。在多因素分析中，年龄较大、表面不规则和IH仍具有统计学意义。根据回归分析结果，绘制了预测SSFB概率的列线图。
我们开发了一种列线图模型，作为一种新型的术前诊断工具，根据临床特征和CT特征中的预测因素来识别SSFB。这有助于临床医生预测SSFB的概率，减少无效或延迟治疗以及并发症的发生。
