Date post: | 18-Aug-2015 |
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Fungal sinusitis
By : Fatimah Bassem Alshiekh 5th year medical student
211504259
AnatomyThe sinuses are a connected system of hollow cavities in the skull.
Most of the sinuses drain into the nose the middle meatus.
What is Fungal sinusitis ?
It is inflammation of sinus mucosa duo to fungal infection
Epidemiology Incidence of fungal sinusitis is increasing!
Why?
immunocompromised
Classification Fungal sinusitis
Non invasive
Allergic
Sinus mycet
oma
Non allergi
c
Eosinophilic fungal sinusitis
Invasive
Acute chronic
granulomato
us
Allergic fungal sinusitis
1-Pathophysiology The presence of fungus in the sinuses causes an allergic response, resulting in production of allergic mucin and nasal polyps. Usually, the disease affects more
than one sinus on one side .
Allergic fungal sinusitis allergic mucin
Allergic fungal sinusitis 3-Patient History
-Most common among adolescents and young adults.
-Environment factors and host genetics have shown to play a role
-Increase incidence in warm and humid areas-Atopic patient
Allergic fungal sinusitis
3-Clinical presentation - symptoms of chronic sinusitis (headache, nasal stuffiness, discharge, and cough)- progressive nasal obstruction-crusting-Rhinorrhoea-Proptosis-Nasal polyposis
Allergic fungal sinusitis
Nasal polyposis
Allergic fungal sinusitis 4-Bent's criteria for the diagnosis of allergic
fungal sinusitis:1. Demonstrable type I hypersensitivity to fungi2. Nasal polyposis3. Radiological findings (Heterodense mass lesion)4. Presence of eosinophilic mucin mixed with non invasive fungus 5. Positive fungal stain / fungal culture (Aspergillus)
Allergic fungal sinusitis 5-Investigation
Laboratory study :Elevated total fungus-specific IgE
Allergic fungal sinusitis Imaging StudiesCT
-The majority sinus show near complete opacification .
Approximately 40% of patients may have each of the following features:
1-expansion of an involved sinus2-remodeling and thinning of the bony sinus walls
3-erosion of the sinus wall
Allergic fungal sinusitis Coronal CT scan
Allergic fungal sinusitis
Treatment Surgically
1-PREOPERATIVE-systemic steroids seven days prior to surgery, which
helps in reducing polyps and mucosal edema and helps identify surgical landmarks better.
-Antibiotic -Nasal decongestants are started a week prior to
surgery.
Allergic fungal sinusitis
SURGICAL MANAGEMENTcomplete removal of all allergic mucin, polyps and fungal debris.
Recurrence after surgery is not uncommon.
Allergic fungal sinusitis Kupferberg (1997) has devised a system of staging postoperative sinus and decisions regarding further medical or surgical management may be instated.
Allergic fungal sinusitis
Stage 0
Allergic fungal sinusitis
Stage1
Allergic fungal sinusitis
Stage2
Allergic fungal sinusitis
Stage3
Allergic fungal sinusitis
Stages 0 to 2 may respond to conservative management;Stage 3 usually requires surgery.
Allergic fungal sinusitis POSTOPERATIVE MANAGEMENT
-Antibiotics are continued for a period of ten days. -saline nasal washes, once the sinus packs are removed. --The patients are followed up at weekly intervals for the first four weeks following surgery.--The nasal cavities are cleaned under endoscopic guidance
Fungal mycetoma (fungal ball )
1 -Pathophysiology-The fungal ball is composed of tightly packed
hyphae often from Aspergillus, Alternaria -Implantation of fungus into sinus cavity.
-Usually unilateral.-Maxillary sinus commonly involved.
-Seen in immunocompetent.-Commonest cause-Aspergillus species.
Fungal mycetoma
2-Ppresentation -The main report is blowing of gravel-
like material from the nose. -Usually a peanut-butter like
appearance of the fungal ball-Usually is found accidentally on CT
scanning of the sinuses.
Fungal mycetoma
Fungal mycetoma
CT features -affected with predilection for the maxillary
-Clue to the diagnosis include soft tissue density within the sinus with/without foci of calcific
deposit .
Fungal mycetoma
Fungal mycetoma
Treatment -Treatment is mostly surgical removal of
the fungal mass combined with widenening of ostium there by
increasing the ventilation of the sinuses . -Antifungal drugs are not indicated in
these patients.
Thank you
REFERENCES:// . . /http www jaypeejournals com:// . /http radiopaedia org
:// . - . / _http care american rhinologic org fungal sinusitis
:// . . . /http www drtbalu co in:// . . /http www medscape com