A Clinical study of Fungal Rhinosinusitis

Karthiga, A (2013) A Clinical study of Fungal Rhinosinusitis. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: The Kingdom of fungi is ubiquitous and omnipresent having prevailed over the tides of time, over numerous decades by adapting to various methods of survival in the susceptible host including humans. Estimates vary, but the number of fungal species probably exceeds 50,000 and most benefits mankind. Fungi of saprophytic form derive nutrition from decaying organic matter. These forms increase in virulence when the host is immunocompromised. Fungal Rhino sinusitis is a known medical entity seen in the ENT Out Patient department. Acute or Chronic Rhino sinusitis is a common condition affecting upto 20% of population of which 6%-12% is caused by fungi. Fungal Rhino sinusitis presents as Acute/Chronic and Invasive/Non-Invasive based on duration and Histopathological evidence of Invasion into Sinonasal sub-mucosal tissue. The presenting signs & symptoms of Acute or Chronic Fungal Rhinosinusitis are not distinctly different from those seen in Bacterial Rhinosinusitis. Patients usually compliant of purulent rhinorrhea, persistent headache, facial pain, diplopia, nasal polyp, nasal obstruction. A high index of suspicion clinically should be supported by histopathology in the diagnosis of fungal infections. Invasive Fungal Rhino sinusitis unless diagnosed early and treated aggressively can lead to Intracranial or Intraorbital complication & has a high mortality rate. In the current study, we evaluate the epidemiology, wide spectrum of clinical manifestation, Histopathological characteristics & the best methods for accurate diagnosis of Fungal Rhino sinusitis. AIM OF THE STUDY: 1. To Study the Epidemiology of Fungal Infections of Nose & Para Nasal Sinuses in our region. 2. To Study the Clinical Manifestation of Fungal Rhino Sinusitis. 3. To Study the Radiological & Pathological characteristics of Fungal Rhino Sinusitis. METHODOLOGY: Study Design – Prospective Study. Study Place – Department of ENT, Stanley Medical College Hospital, Chennai. Study Period – February 2011 to September 2012. Sample – 30 Patients. INCLUSION CRITERIA: 1. Both male & female sex, 2. Age groups 11-60 years, 3. All cases of Chronic Rhinosinusitis, 4. All cases of Nasal polyps with nasal discharge, 5. All cases of Rhinosinusitis with proptosis, headache & epistaxis, 6. Immunocompromised patients (Uncontrolled Diabetes Mellitus, Post transplant, HIV patients) who presented with features suspicious of fungal sinusitis. 7. Patients with Fungal Rhinosinusitis were diagnosed by screening the patients with chronic Rhinosinusitis with or without nasal polyps. EXCLUSION CRITERIA: 1. Patients with proven bacterial sinusitis, 2. Patients with associated neoplastic lesion were excluded, 3. Medically & surgically unfit patients., 4. Not willing for study, 5. Bleeding diathesis. CONCLUSION: In a Prospective study of 30 patients with Fungal Rhinosinusitis; 1. The most common age group with Fungal Rhinosinusitis was between 21-40 years of age. 2. Non-Invasive Fungal Rhinosinusitis (Fungal Ball & Allergic Fungal Rhinosinusitis) was more commonly encountered in our region. 3. Fungal Ball was most commonly caused by Aspergillus species involving especially the maxillary sinuses with reportedly equal incidence in both the sexes. 4. Allergic Fungal Rhinosinusitis was common among the male sex & all the patients presented with Nasal polyps & Allergic Mucins. Most of them showed Histopathological positivity in our study population. 5. Invasive type of Fungal Rhinosinusitis was less commonly reported, it was more commonly Acute in presentation. 6. Mucoracea family - Rhizopus appears to be the common isolate in Acute Invasive form of Fungal Rhinosinusitis. 7. The Acute Fulminant Invasive form presented with wide spectrum of manifestation from simple sinusitis form to extensive Facial Necrosis. In this study, it was common in the elderly population who were Immunologically compromised due to Diabetes Mellitus. 8. Chronic Invasive form of Fungal Rhinosinusitis was least/not reported in this study.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Fungal Rhinosinusitis, Clinical study.
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 27 Mar 2020 07:08
Last Modified: 27 Mar 2020 07:08
URI: http://repository-tnmgrmu.ac.in/id/eprint/12485

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