Clin Exp Otorhinolaryngol.  2014 Sep;7(3):181-187. 10.3342/ceo.2014.7.3.181.

Invasive Fungal Sinusitis of the Sphenoid Sinus

• Lee DH
• Yoon TM
• Lee JK
• Joo YE
• Park KH
• Lim SC

• KMID: 1973467
• DOI: http://doi.org/10.3342/ceo.2014.7.3.181

Abstract

OBJECTIVE
This study was conducted to present the clinical outcome of invasive fungal sinusitis of the sphenoid sinus and to analyze clinical factors influencing patient survival.
METHODS
A retrospective review of 12 cases of invasive fungal sphenoiditis was conducted.
RESULTS
Cases were divided into acute fulminant invasive fungal spheonoidits (n=4) and chronic invasive fungal sphenoiditis (n=8). The most common underlying disease was diabetes mellitus (n=9). The most common presenting symptoms and signs included visual disturbance (100%). Intracranial extension was observed in 8 patients. Endoscopic debridement and intravenous antifungals were given to all patients. Fatal aneurysmal rupture of the internal carotid artery occurred suddenly in two patients. The mortality rate was 100% for patients with acute fulminant invasive fungal sphenoiditis and 25% for patients with chronic invasive fungal sphenoiditis. In survival analysis, intracranial extension was evaluated as a statistically significant factor (P=0.027).
CONCLUSION
The survival rate of chronic invasive fungal sphenoiditis was 75%. However, the prognosis of acute fulminant invasive fungal sphenoiditis was extremely poor despite the application of aggressive treatment, thus, a high index of suspicion should be required and new diagnostic markers need to be developed for early diagnosis of invasive fungal sinusitis of the sphenoid sinus.

Keyword

Invasive; Fungus; Sinusitis; Sphenoid sinus

MeSH Terms

Aneurysm
Carotid Artery, Internal
Debridement
Diabetes Mellitus
Early Diagnosis
Fungi
Humans
Mortality
Prognosis
Retrospective Studies
Rupture
Sinusitis*
Sphenoid Sinus*
Survival Rate

Figure

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  Fig. 1 Endoscopic finding shows a necrotic lesion of the orbital apex and sphenoid sinus (A) and relatively healthy neurovascular structures following debridement of the orbital apex (B). ON, optic nerve; ICA, internal carotid artery; SF, sellar floor.

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  Fig. 2 Acute fulminant fungal sphenoiditis in a 70-year-old female. Coronal computed tomography (A) and magnetic resonance imaging (B) scan show fungal sphenoid sinusitis with lesion extension into the orbital apex and both frontal lobes.

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  Fig. 3 Chronic invasive fungal sphenoiditis in a 69-year-old male. Coronal computed tomography (A) and magnetic resonance imaging (B) scan show fungal sphenoid sinusitis with lesion extension into the orbital apex, pterygopalatine fossa, cavernous sinus, nasopharynx, and parapharyngeal space.

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