Clinical Experience on Treatment of Chronic Invasive Fungal Sinusitis

Objective: To investigate the clinical manifestations and diagnosis and treatment of chronic invasive fungal sinusitis (CIFS).

Methods: We collected and followed up 16 cases of CIFS cases of the Beijing Tongren Hospital from March 2006 to June 2014. We analyzed the clinical characteristics, CT and MRI characteristics, nasal secretions and used pathological method to determine type of pathogenic fungi. Treatment includes surgical removal of diseased tissue, systemic use of antifungal agents and local irrigation.

Results: Of the 16 patients, 7 were males and 9 were females; mean age was 55.4 ± 13.4 years. Headache appeared in 8 cases, ocular symptoms showed in 15 cases, 6 cases developed orbital apex syndrome, 6 cases had systemic disease; unilateral sinus disease (15 cases). The highest incidence of nasal sinus was ethmoid sinus, sphenoid sinus, maxillary sinus. Pathological findings were found in 6 cases of fungal tissue, 6 cases developed surrounding tissue invasion, and 4 cases of granuloma. Aspergillus in 6 cases, 3 cases of hairy fungus, and 7 cases of secretions smear or tablet showed visible hyphae and (or) spores; 10 cases underwent G experiments, 3 cases were positive; 4 cases underwent GM experiments, 1 cases of weak positive. 16 cases of patients admitted to hospital after the removal of the nasal cavity and sinus surgery, after surgery to give anti-fungal drugs, nasal washing. During 1–8 years of follow-up, 4 patients died, the mortality rate was 25%, and the visual acuity was restored in 70% patients after operation.

Conclusion: Invasive fungal sinusitis is a disease with poor prognosis, diagnosis needs clinical manifestations, imaging features, pathogenic fungi, and pathological examination, treatment principle includes surgical resection of lesions and with sufficient and adequate antifungal drugs.