Fungal Sinusitis: Clinical Features and Treatment Outcomes with Emphasis on Endoscopic Sinus Surgery

Lee, Bong Jae; Kim, Hyuk; Kim, Jae Ho; Kim, Yong Jae

Abstract

BACKGROUND: Endoscopic sinus surgery has emerged as a successful surgical modality in the treatment of fungal sinusitis. In this study, we aimed to investigate the clinical characteristics of fungal sinusitis and evaluate the efficacy of endoscopic sinus surgery in comparison with Caldwell-Luc's operation for treating fungal sinusitis.
MATERIALS AND METHODS
Sixty seven patients (69 cases) who underwent surgery between 1989 and 1996 were retrospectively analyzed by reviewing their medical records and X-ray films. The Caldwell-Luc's operation was applied for 37 cases, and the endoscopic sinus surgery was carried out for 32 cases.
RESULTS
All patients were adults consisting of 27 males and 40 females. Of the 69 cases, aspergillosis was most common, followed by unidentifiable fungal colonies, mucormycosis, and candidiasis. Nasal obstruction was the most common symptom and those symptoms associated with fungal sinusitis were nonsepcific. Preoperative computerized tomograms (CT) revealed mottled calcific densities within the involved sinuses in 64.3% of cases and pathological examinations showed that all of these had fungal sinusitis. Of the 37 patients who underwent Caldwell-Luc's operation, two were of the invasive types, with one of them showing postoperative recurrence. The 32 patients who underwent endoscopic sinus surgery showed no recurrence during the mean follow-up period of 11.8 months.
CONCLUSION
Our results suggest that the mottled calcific densities in the sinus CT could be used as a telltale sign of the fungal sinusitis and that the endoscopic surgical technique could replace Caldwell-Luc's operation for the treatment of noninvasive fungal sinusitis.