Diagnosis and Endoscopic Surgery of Chronic Invasive Fungal Rhinosinusitis

Abstract

Background Chronic invasive fungal rhinosinusitis (CIFRS) was thought to be a rare fungal disease of the sinus but is becoming increasingly common. Methods for the early diagnosis of CIFRS and treatment efficacy have not been thoroughly explored. This study was designed to summarize the diagnosis and endoscopic surgical treatment of a group of patients with CIFRS. Methods Twenty-eight cases of CIFRS treated by nasal endoscopic sinus surgery between January 2000 and December 2006 were retrospectively analyzed. Results Each case underwent nasal endoscopic debridement surgery; six cases with progressive symptomatology were given systemic broad-spectrum antifungal drugs for at least 12 weeks after the operation. Long-term outcome was positive in most cases. Twenty-three cases were cured while five recurred, of which two recurred within 6 months. Four cases underwent further endoscopic surgery, two were subsequently cured, one died of severe intracranial Mucor infection, and one was lost to follow-up. The overall cure rate was 89.3%. Conclusion Endoscopic surgery is an effective and microinvasive therapy for patients with CIFRS. The procedure includes elimination of the diseased sinus mucosa with or without simultaneous administration of broad-spectrum antifungal medicines. Early diagnosis of CIFRS and surgical nasal sinus debridement can improve prognosis.