Frequency of non-invasive fungal sinusitis in patients undergoing surgery for chronic rhinosinusitis

Abstract

Background: In this study, we investigated the presence of non-invasive fungal sinusitis in patients who underwent endoscopic sinus surgery with the diagnosis of chronic rhinosinusitis in our clinic. Methods: A total of 283 patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis in our clinic between 2008-2018, who were at the ages of 18 or above, and who did not have invasive fungal sinusitis and tumor were included in the study. Sinus pathology was examined by routine examination using nasal endoscopy and computed tomography. Eosinophil count, total, and specific IgE levels were measured in the peripheral blood samples of the patients. Sinus surgery was performed under general and local anesthesia with the Messerklinger technique. Aspirated secretions from the sinuses and removed surgical tissues were examined microbiologically and histopathologically. Results: 68 females, 215 males, totally 283 patients with a mean age of 41 had sinus surgery; 11 (40.74%) females and 16 (59.26%) males, totally 27 (9.54%) patients had non-invasive fungal sinusitis. 18 (6.36%) of the cases were microbiologically reported as allergic fungal sinusitis while 9 (3.18%) of them reported as mycetoma. Nasal obstruction (19, 70.37%) and headache (13, 48.14%) were the most common clinical findings. Eosinophilic mucus was detected in the sinus material of the patients with allergic fungal sinusitis. According to their prevalence, Aspergillus, Penicillium, and Candida were the most prevalent in the patients with allergic fungal sinusitis, respectively; Aspergillus fumigatus and Aspergillus flavus were the most prevalent in the patients with allergic fungal sinusitis, respectively. Radiologically, fungal balls localized at the maxillary sinuses in six patients, the sphenoid sinuses in two patients, and the ethmoid sinus in one patient. As a treatment, sinus surgery was performed as a complete evacuation of the mucus and removal of pathological and polypoid tissues. The follow-up periods of the patients ranged between 7-31 months; the mean duration of follow-ups was 17 months. Non-invasive fungal infections were not treated with antifungal therapy, no recurrence was observed. Conclusions: In this study, non-invasive fungal sinus infection was detected 9.54% of patients. Nasal examination, radiological, and immunological examination should be applied to patients as additional examinations on the suspicion of pre-operative fungal rhinosinusitis; samples should be taken from the sinuses during surgery and should be examined for fungus microbiologically and histopathologically. Antifungal therapy was not administered to patients with non-invasive fungal infection. Endoscopic sinus surgery is a successful method in the treatment of non-invasive fungal rhinosinusitis.