Objective To determine risk factors affecting mortality in acute invasive fungal sinusitis. Method This observational cohort study was conducted over a five-year period. Results Of 109 recruited patients, 90 (82.6 per cent) had diabetes mellitus. Predominant fungi were zygomycetes (72.6 per cent) with Rhizopus arrhizus being most common. Of the patients, 12.8 per cent showed a positive biopsy report from radiologically normal sinuses. Factors affecting mortality on multivariate analysis were: female sex (p = 0.022), less than two weeks between symptoms and first intervention (p = 0.01), and intracranial involvement (p = 0.034). Other factors significant on univariate analysis were: peri-orbital swelling (p = 0.016), restricted ocular movements (p = 0.053), intracranial symptoms (p = 0.008), posterior disease (p = 0.058), imaging showing ocular involvement (p = 0.041), fungus being zygomycetes (p = 0.050) and post-operative cavity infection (p = 0.032). Bilateral, palatal and retromaxillary involvement were not associated with poor prognosis. Conclusion Diagnosis of acute invasive fungal sinusitis requires a high index of clinical suspicion. Recognition of factors associated with poor prognosis can help when counselling patients, and can help initiate urgent intervention by debridement and antifungal therapy. Post-operative nasal and sinus cavity care is important to reduce mortality.
<p class="abstract"><strong>Background:</strong> Objectives of the study were to evaluate the degree of obstruction of upper aerodigestive tract in patients with snoring and obstructive sleep apnea syndrome (OSAS) by nasopharyngolaryngoscopy assisted Muller’s maneuver; to evaluate the degree of obstruction of upper aerodigestive tract in patients with snoring and OSAS with imaging technique magnetic resonance imaging (MRI); and to find the association between fibroptic nasopharyngolaryngoscopy assisted Muller’s maneuver (NMM) and sleep MRI.</p><p class="abstract"><strong>Methods:</strong> Study design was<strong> </strong>open prospective observational study<strong>. </strong>30 patients diagnosed with snoring and OSA were included in the study at department of ear, nose and throat (ENT), Command Hospital, Air Force, Bangalore. They underwent detailed clinical evaluation and polysomnography followed by assessment of levels and degree of obstruction of upper aerodigestive tract by flexible fiber optic laryngoscopy (FOL) assisted Mullers maneuver and functional (f) sleep MRI. </p><p class="abstract"><strong>Results:</strong> 20 patients (66.7%) were diagnosed as obstructive sleep apnea syndrome, 10 patients (33.3%) were snorers by Polysomnography. 27 (90%) patients show moderate to severe collapse at level of the base of tongue, 25 (83.3) patients show moderate to severe collapse at the level of soft palate by flexible FOL assisted Mullers maneuver. 22 (73.4%) patients show a collapse the level of the soft palate, 20 (66.6%) patients show a collapse at the level of the base of tongue by f sleep MRI. In this study, on applying Chi square test there was significant association between soft palate Flexible nasopharyngoscopy with muller’s method and soft palate MRI with Chi square value 35.690, p value <0.001. There was significant association between base of tongue flexible nasopharyngoscopy with Muller’s method and base of tongue sleep MRI with Chi-square value 14.511, and p value <0.005.</p><p class="abstract"><strong>Conclusions:</strong> Polysomnography is gold standard test to diagnose OSA. Flexible nasopharyngoscopy with Muller’s method and sleep MRI shows the most common site of upper airway collapse is at the level of the soft palate and the base of tongue.</p>
Inflammatory myofibroblastic tumour is a rare entity causing sinonasal involvement with variable behaviour. Mimicking various benign and malignant lesions, accurate diagnosis is often clinched on histopathology complemented with appropriate immunohistochemistry markers. Surgical resection is the main treatment modality with other forms of therapy reserved for unresectable lesions. We highlight a case of dual involvement of the sinonasal region and nasal bones along with the diagnostic and treatment challenges encountered. As the nasal bones were involved, surgical resection with negative margins required cosmetic reconstruction in the same sitting. A costochondral graft helped in achieving cosmetic pleasing results with no recurrence on follow-up.
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