Background. Invasive fungal rhinosinusitis with orbital complications (IFSwOC) is a life-threatening condition. The incidence of mortality has been reported to be up to 80 percent. This study was conducted to determine the risk factors, presentations, clinical, and imaging findings that could help to manage this condition promptly. Methods. We conducted a case-control study of 100 patients suffering from rhinosinusitis with orbital complications. The risk factors, clinical presentations, radiological findings, medical and surgical managements, durations of hospital stay, and mortality rate data were collected. Results. Sixty-five patients were diagnosed with IFSwOC, while the other thirty-five patients composed the control group. The most important risk factor for IFSwOC was diabetes mellitus. Visual loss and diplopia were the significant symptom predictors. The significant clinical predictors were nasal crust, oculomotor nerve, and optic nerve involvement. The CT findings of IFSwOC were sinus wall erosion and hyperdensity lesions. The mortality rate was 25.71 percent in the IFSwOC group and 3.17 percent in the control group. Conclusions. Invasive fungal rhinosinusitis with orbital complications is symptomatic of a high mortality rate. The awareness of a patient’s risk factors, the presenting symptoms, signs of fungal invasion, and aggressive management will determine the success of any treatment procedures.
Category Archives: Rhinology
Chronic rhinosinusitis and emerging treatment options
This review describes the epidemiology and various treatments in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Evidence for short-term use of systemic corticosteroids has been shown to be favorable in CRSwNP, but still limited in CRSsNP. Topical corticosteroids improve symptom scores in both CRS subgroups. The role of microbes in CRS is still controversial. Culture-directed antibiotics are recommended for CRSsNP with exacerbation. Long-term use of low dosage antibiotics is recommended for CRSsNP for their anti-inflammatory effects. Other emerging treatment options are also discussed.
Acute Versus Chronic Invasive Fungal Rhinosinusitis: A Case-Control Study
Authors: Patorn Piromchai and Sanguansak Thanaviratananich
Introduction: Invasive fungal rhinosinusitis is a challenging condition that can be found mostly in immunocompromised patients. Failure to diagnose and treat this entity promptly usually results in rapid progression and death. The purpose of this study was to determine clinical presentation, complication and morbidity in patients with acute versus chronic invasive fungal rhinosinusitis.
Setting and design: Case-control study at Srinagarind Hospital, Khon Kaen University between January 1998 and May 2008.
Methods: The patient’s data with the diagnosis of invasive fungal rhinosinusitis was included. Demographic data, underlying diseases, presenting symptoms, histologic sinonasal tissue evaluations, sinonasal tissue cultures, CT scan findings, surgical interventions, morbidity, and mortality were collected.
Results: Sixty-five patients were diagnosed as invasive fungal rhinosinusitis between January 1998 and May 2008. The data of six patients were unable to obtain. Fifty-nine patients were included in this study. Patients with immunocompromised status have significant greater risk for acute than chronic IFS, OR = 6.5 (P = 0.004). Patients with mucosal necrosis have the significant higher risk for acute IFS, OR = 5.5 (P = 0.01). There was no significant difference in orbital complications proportion between acute and chronic invasive fungal rhinosinusitis, OR = 2.42 (P = 0.15). Sinus wall erosion have found significantly in chronic IFS group, OR = 0.24 (P = 0.02). The average hospital stayed was 30.58 ± 26.43 days with no difference between groups (P = 0.50). Fourteen patients in acute IFS group were dead (31.11%) while all patients in chronic IFS group were survived.
Conclusions: Invasive fungal rhinosinusitis continues to present a challenge to the otolaryngologist. Acute IFS was found most commonly in immunocompromised patients. The most consistent finding of acute IFS was mucosal necrosis and black crust/debris. The CT finding of sinus wall erosion may help in diagnosis of chronic IFS.
Systemic antibiotics for chronic rhinosinusitis without nasal polyps in adults.
Piromchai P, Thanaviratananich S, Laopaiboon M.
Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 40002.
Chronic rhinosinusitis (CRS) is a common health problem which significantly affects quality of life. A wide range of medical and surgical therapies have been used to treat CRS. Both systemic and topical antibiotics are used with the aim of eliminating infection and inflammation, altering bacterial biofilm formation, reversing ostial occlusion and improving symptoms. Various groups of systemic antibiotics have been studied; clinical cure rates reported are inconsistent and range from 50% to 95%.
To determine the effectiveness and adverse reactions associated with systemic antibiotic therapy for CRS in adults.
We searched the Cochrane ENT Group Trials Register; CENTRAL (2010, Issue 2); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 10 June 2010.
Randomised controlled trials (RCTs) comparing systemic antibiotics with placebo for chronic rhinosinusitis in adults.
DATA COLLECTION AND ANALYSIS:
Two authors extracted data independently, compared results and resolved disagreements by discussion. We assessed treatment effect by calculating the risk ratio (RR) and 95% confidence intervals (CI) of cure at a specific time point for each trial. We used mean difference (MD) and 95% CI for continuous variables (severity scores, duration of symptoms, etc.).
We included one study involving 64 patients. We assessed the overall risk of bias in this study as high. The study reported that roxithromycin could reduce the mean response score of patients by 0.73 points on a 1 to 6-point scale (95% CI 0.32 to 1.14, P = 0.0005) compared to those on placebo at three months after the start of treatment. This study also used sinonasal outcome test-20 (SNOT-20) comparing between pre and post-treatment at six, 12 and 24 weeks. The mean change in SNOT-20 from baseline at 24 weeks in the roxithromycin group was not significantly more than in the placebo group, at 0.27 points (95% CI -0.24 to 0.78, P = 0.30) on a 0 to 5-point scale.
There is limited evidence from one small study to support the use of systemic antibiotics for the curative treatment of chronic rhinosinusitis in adults. Further good quality trials, with large sample sizes, are needed to evaluate the use of antibiotics in chronic rhinosinusitis.
Alternative Agents to Prevent Fogging in Head and Neck Endoscopy
Background: The essential factor for diagnosis and treatment of diseases in head and neck endoscopy is the visibility of the image. An anti-fogging agent can reduce this problem by minimizing surface tension to prevent the condensation of water in the form of small droplets on a surface. There is no report on the use of hibiscrub? or baby shampoo to reduce fogging in the literature. The objective of this study was to compare the efficacy between commercial anti-fogging agent, hibiscrub? and baby shampoo to reduce fogging for the use in head and neck endoscopy. Methods: The study was conducted at the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University in August 2010. Commercial anti-fogging agent, baby shampoo and hibiscrub? were applied on rigid endoscope lens before putting them into a mist generator. The images were taken at baseline, 15 seconds, 30 seconds and 1 minute. The images? identifiers were removed before they were sent to two evaluators. A visual analogue scale (VAS) was used to rate the image quality from 0 to 10. Results: The difference in mean VAS score between anti-fogging agent, baby shampoo and hibiscrub? versus no agent were 5.46, 4.45 and 2.1 respectively. The commercial anti-fogging agent and baby shampoo had most protective benefit and performed significantly better than no agent (P < 0.05). Conclusions: Baby shampoo is an effective agent to prevent fogging during head and neck endoscopy and compares favourably with commercial anti-fogging agent.