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Alsalem S, Almontashri A, Alsalem M, Altamimi F, Alyami N, Hajjaf S, Ahmed F. Value of MRI signal intensity in evaluation of allergic fungal rhinosinusitis compared with CT Hounsfield units: Retrospective study. Medicine (Baltimore) 2024; 103:e38951. [PMID: 38996133 PMCID: PMC11245196 DOI: 10.1097/md.0000000000038951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
"Allergic fungal sinusitis (AFS)" is typically diagnosed using radiologic images like computed tomography (CT) scans and magnetic resonance imaging (MRI), with the "Hounsfield unit (HU)" in CT scans and T2-weighted images (T2WI) in MRI serving as reliable objective parameters. However, diagnosing AFS might be difficult because of possible signal changes and densities caused by variations in the secretion concentration in the sinus. Few studies have compared the diagnostic performance of MRI and CT scans. This study aimed to investigate the value of MRI signal intensity in evaluating AFS compared with CT HUs. This retrospective study included 111 patients with pathologically confirmed AFS who underwent CT imaging followed by MRI evaluation at King Saud Medical City, Riyadh, Saudi Arabia, from January 2012 to December 2022. Radiographic densities of sinus opacities on CT scan, including the mean HU values, and MRI findings, including signal voids on T1-weighted images and T2WI, were gathered and analyzed. To determine the efficacy of these radiographic characteristics in predicting the disease and the best cutoff value, we employed receiver operator characteristic curves. The mean age was 31.9 ± 15.6 years, and most patients were 74 females (66.7%). The main symptom was nasal obstruction in 73 patients (65.8%). In comparison, between HU and signal void on T2WI, there was moderate predictive performance [area under the curve: 0.856, P = .001]. An ideal HU cutoff value of 69.50 HU was obtained with a sensitivity of 100% and a specificity of 44.7%. However, the receiver operator characteristic for T1-weighted images could not be plotted, as no signal was avoided to predict AFS and it was not statistically significant (area under the curve: 0.566; P = .287). The study found a CT HU of 69.5 can predict MRI T2WI signal values with a void signal, aiding in diagnostic workup and evaluation for AFS.
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Affiliation(s)
- Seham Alsalem
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Department of Radiology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ali Almontashri
- Department of Hematology, Maternity and Children Hospital, Najran, Saudi Arabia
| | - Mohammed Alsalem
- Department of Radiology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fahad Altamimi
- Department of Otolaryngology, King Saud Medical City, Alfaisal University, Riyadh, Saudi Arabia
| | - Nasher Alyami
- Department of Laboratory Medicine, Hematology Section, King Khaled University Hospital, Ministry of Health, Najran, Saudi Arabia
| | - Shaker Hajjaf
- Department of Radiology, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University, Ibb, Yemen
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Hafrén L, Saarinen R, Kurimo R, Viljanen M, Lundberg M. Aspergillus Sinusitis: Risk Factors and Phenotyping. J Clin Med 2024; 13:2579. [PMID: 38731108 PMCID: PMC11084900 DOI: 10.3390/jcm13092579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Aspergillus can cause fungal rhinosinusitis (FRS). We aimed to identify risk factors for sinonasal Aspergillus disease. Methods: Patients with a positive sinonasal mycological culture for Aspergillus species diagnosed in our hospital located in a continental climate were included in the 9-year retrospective study. Results: Of the 86 patients, 3 had invasive FRS (IFRS), 51 had fungal ball (FB) disease, and 32 had chronic rhinosinusitis with fungus (CFRS). In the IFRS group, all patients had a malignancy and were immunocompromised. Allergies, allergic rhinitis, asthma, nasal polyps, and the use of inhaled and nasal steroids were more common in the CFRS group, and IgE levels were greater than those in the FB and IRFS groups (p < 0.05). Conclusion: FB disease is a relatively symptom-free single-sinus disease among elderly individuals, and IFRS is dominant among immunocompromised patients. We discovered a third patient group, predominantly with nasal polyps, atopy, asthma, and elevated blood IgE and eosinophils, that did not fulfill the allergic FRS (AFRS) criteria. It is possible that a less fulminant category of underdiagnosed AFRS exists in cold climates. Treatment with local debridement is usually sufficient for FRS, apart from IFRS, and relapses are not common in cold climates.
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Affiliation(s)
- Lena Hafrén
- Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland
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Roh D, Shin JH, Kim SW, Kim SW, Kim BG, Cho JH, Park YJ, Kim DH. Sinonasal microbiome and inflammatory profiles in fungal ball and chronic rhinosinusitis. Auris Nasus Larynx 2024; 51:242-250. [PMID: 38061935 DOI: 10.1016/j.anl.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/12/2023] [Accepted: 11/08/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Fungal balls (FB) are the main form of non-invasive fungal rhinosinusitis found in immunocompetent hosts. Bacterial coinfection affects clinical symptoms. We investigated the sinonasal microbiome and inflammatory profiles in FB and chronic rhinosinusitis (CRS) patients. METHODS Thirty-three participants were prospectively recruited. Nasal swab samples and sinonasal tissues were collected from controls, and FB and CRS patients. DNA extraction and microbiome analysis using V3-V4 region 16S rRNA sequencing were performed. Inflammatory cytokine levels in the sinonasal tissues, blood eosinophil counts, and serum total IgE were measured. RESULTS No significant differences were observed in species richness or evenness measures. The phylogenetic tree demonstrated that the FB samples were different from the controls. The sinus bacteria composition differed among the groups. At the phylum level, Firmicutes in FB were significantly depleted compared with those in CRS, while Proteobacteria were more enriched in FB than that in controls and CRS. At the genus level, in FB, Staphylococcus and Corynebacterium were significantly decreased compared to those in the controls. The prevalence of Haemophilus was the highest in FB. Blood eosinophil counts and IL-5 and periostin levels in the sinonasal tissue of the FB group were significantly lower than those in the CRS group. CONCLUSIONS FB patients had different microbiome compositions and fewer type 2 inflammatory profiles than CRS patients did. However, whether these findings cause FB or result from bacterial and/or fungal infection remains unclear. Further studies are needed to reveal how these differences occur and affect the development of FB and clinical symptoms.
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Affiliation(s)
- Daeyoung Roh
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea; Mind-neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Ji-Hyeon Shin
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Guk Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Van Ngo C, Nguyen H, Aklinski J, Nguyen DMT, Le HH, Le TTB, Nguyen HQ, Huynh HH, Hanh Nhi LH, Minh LHN. The Combined Middle and Inferior Antrostomy for Fungal Maxillary Sinusitis Treatment. Indian J Otolaryngol Head Neck Surg 2023; 75:2850-2855. [PMID: 37974720 PMCID: PMC10645746 DOI: 10.1007/s12070-023-03863-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/04/2023] [Indexed: 11/19/2023] Open
Abstract
Aims: The objective of this study is to assess the effectiveness of the combined middle and inferior meatal antrostomy (MIMA) in management of patients with maxillary fungal sinusitis. Material and Methods: Design: retrospective cross sectional study. Setting and subjects: From September 2018 to March 2021, fifty-five patients with non-invasive maxillary fungal sinusitis, who underwent transnasal endoscopic combined MIMA. Methods: The study compared patients' pre- and post-operative subjective symptoms, including nasal obstruction, discharge, facial pain or pressure, halitosis, anosmia, and other non-specific symptoms. Endoscopic characteristics of recurrent fungal maxillary sinusitis and postoperative complications were also observed. Closure of the IMA site was evaluated at three and six months post-surgery and patients were categorized into three groups based on closure degree. Results: All clinical symptoms, including nasal discharge, nasal obstruction, nasal pruritus, anosmia, halitosis, sneezing, facial pain, ophthalmic and otologic symptoms, were resolved over six months after combined MIMA in majority of cases (94 - 100%). After three and six months, the postoperative endoscopic evaluation revealed recurrent fungal maxillary sinusitis in 1.8% and 5.4% of cases, respectively. Partial stenosis of the inferior antrostomy was observed in 7.2% and 16% of cases, while complete stenosis was noted in 3.6% and 7.2% of cases after three months and six months. Conclusions: The combined MIMA is effective and has better outcomes than the medial meatal antrostomy approach alone without additional operative time. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03863-6.
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Affiliation(s)
- Cong Van Ngo
- Department of Otolaryngology-Head and Neck Surgery, Cho Ray Hospital, Ho Chi Minh City, 700000 Vietnam
| | - Hoang Nguyen
- Department of Foundation Science, Nova Southeastern University, The Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM), Clearwater, FL 33025 USA
- Department of Preventative Medicine, School of Medicine, University of California at Los Angeles/Charles R. Drew (UCLA), Los Angeles, CA USA
| | - Joseph Aklinski
- Department of Foundation Science, Nova Southeastern University, The Kiran C. Patel College of Osteopathic Medicine (NSU-KPCOM), Clearwater, FL 33025 USA
| | - Dung My Thi Nguyen
- Faculty of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000 Vietnam
| | - Hoang Huy Le
- Faculty of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000 Vietnam
| | - Trang Thi Bich Le
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410 USA
| | - Hien Quang Nguyen
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410 USA
| | - Hong-Han Huynh
- School of Biotechnology, Tan Tao University, Long An, Vietnam
- Interdisciplinary and Translational Medicine Internship Training Program, College of Medical Science and Technology, Taipei Medical University, Taipei, 110 Taiwan
- International Master Program for Translational Science, College of Medical Science and Technology, Taipei Medical University, Taipei, 110 Taiwan
| | - Le Huu Hanh Nhi
- Cardiovascular Research Department, Methodist Hospital, Merrillville, IN 46410 USA
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000 Vietnam
| | - Le Huu Nhat Minh
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110 Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, 106 Taiwan
- Emergency Department, University Medical Center, Ho Chi Minh City, Vietnam
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Cha CH, Chen WC, Wang YM, Wu SC, Chiu TJ, Wu CN, Wee Y, Wang CS, Yang YH, Luo SD. Comparison of Fungal and Non-Fungal Rhinosinusitis by Culture-Based Analysis. J Pers Med 2023; 13:1368. [PMID: 37763136 PMCID: PMC10532977 DOI: 10.3390/jpm13091368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Incidence of fungal rhinosinusitis has increased in recent few years. We investigated the differences in microbiological findings between patients with fungal and non-fungal rhinosinusitis by growing microbiological cultures from samples obtained from sinus surgery. METHODS Using the Chang Gung Research Database, we enrolled all chronic rhinosinusitis (CRS) patients who had ever undergone sinus surgery from 2001 to 2019 and had microbiological culture during sinus surgery. Enrolled patients were divided into fungal and non-fungal groups, based on fungal culture and surgical pathology. RESULTS A total of 898 patients were diagnosed with fungal rhinosinusitis and 2884 with non-fungal rhinosinusitis. The fungal group had a higher age distribution (56.9 ± 13.1 vs. 47.0 ± 14.9), a larger proportion of females (62.4% vs. 37.0%), more unilateral lesions (80.4% vs. 41.6%), a lower incidence of the need for revision surgery (3.6% vs. 6.0%, p = 0.004), and a higher proportion of Pseudomonas aeruginosa in the culture (14.3% vs. 4.6%, p < 0.001). CONCLUSIONS This large-scale study showed that Pseudomonas aeruginosa are more commonly found in patients with fungal rhinosinusitis and in patients who needed revision surgery, suggesting that efforts aimed at eliminating Pseudomonas are needed in order to improve the disease outcomes of patients with fungal rhinosinusitis.
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Affiliation(s)
- Chih-Hung Cha
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
| | - Yu-Ming Wang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tai-Jan Chiu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
| | - Yinshen Wee
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Ching-Shuen Wang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-H.C.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Xu T, Wang YF, Wang YL, Guo XT, Luo J. Correlational Analysis of Nasal Resistance and Acoustic Rhinometry Measurements With the Localization of Fungus Balls in the Paranasal Sinuses. EAR, NOSE & THROAT JOURNAL 2023:1455613231189953. [PMID: 37534693 DOI: 10.1177/01455613231189953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Objective: To investigate the reason for fungal balls (FBs) being localized in paranasal sinuses, we analyzed the clinical presentations of patients with FB rhinosinusitis (FBS). Methods: Clinical data, anatomical variation (ie, nasal septal deviation, concha bullosa, and Haller cell), as well as measurements of nasal resistance (NR), nasal cavity volume (NCV), and nasal cross-sectional area (NCA) using active anterior rhinomanometry and acoustic rhinometry were collected from FBS patients hospitalized in our hospital between January 2021 and December 2022. A retrospective analysis was conducted using IBM SPSS 19.0 to perform the Shapiro-Wilk test, t-test and logistic regression analysis. Results: A total of 95 FBS patients, including 33 male and 62 female patients, were included in this study. FBs in maxillary sinus were the most common (83, 87.4%), followed by sphenoid sinus (9, 9.5%). Logistic multivariate regression analysis revealed that a higher left-to-right NR ratio was associated with an increased likelihood of FBs being present in the left sinus [Odds ratios (OR) = 0.185; 95% CI, 0.061-0.558; P < .01]. When the ratio of the left-to-right second-minimum NCA was higher and the FB was more in the right sinus (OR = 3.194; 95% CI, 1.593-6.405; P = .001). Additionally, when the difference between left and right NCV was greater and FB occurred more commonly in the right sinus (OR = 1.435; 95% CI, 1.196-1.721; P < .001). Nonetheless, the presence of nasal septum deviation and concha bullosa did not significantly contribute to FB formation. Conclusions and significance: The differences in NR, NCA, and NCV between the affected and unaffected sides of nasal cavity are risk factors for the FB formation. To reduce FBS recurrence, it is important to focus on improving nasal ventilation during the surgical treatment.
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Affiliation(s)
- Tao Xu
- Department of Otorhinolaryngology Head and Neck Survey, The First Affiliated Hospital of USTC, Division of life sciences and medicine, University of Science and technology of China, Hefei, Anhui, 230001, China
| | - Yin-Feng Wang
- Department of Otorhinolaryngology Head and Neck Survey, The First Affiliated Hospital of USTC, Division of life sciences and medicine, University of Science and technology of China, Hefei, Anhui, 230001, China
| | - Ya-Lin Wang
- Department of Otorhinolaryngology Head and Neck Survey, The First Affiliated Hospital of USTC, Division of life sciences and medicine, University of Science and technology of China, Hefei, Anhui, 230001, China
| | - Xiao-Tao Guo
- Department of Otorhinolaryngology Head and Neck Survey, The First Affiliated Hospital of USTC, Division of life sciences and medicine, University of Science and technology of China, Hefei, Anhui, 230001, China
| | - Jing Luo
- Department of Otorhinolaryngology Head and Neck Survey, The First Affiliated Hospital of USTC, Division of life sciences and medicine, University of Science and technology of China, Hefei, Anhui, 230001, China
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Luong AU, Chua A, Alim BM, Olsson P, Javer A. Allergic Fungal Rhinosinusitis: The Role and Expectations of Biologics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3156-3162. [PMID: 36028212 DOI: 10.1016/j.jaip.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
Allergic fungal rhinosinusitis (AFRS) is a noninvasive subtype of chronic rhinosinusitis with nasal polyps (CRSwNP) that usually develops in immunocompetent atopic individuals and is more common in geographic regions characterized by warm temperatures and high humidity, conducive to higher environmental fungal presence. Allergic fungal rhinosinusitis usually presents with unique computed tomography findings and significant polyp burden, yet patients often report minimal sinus symptoms. Patients with AFRS often have extremely elevated serum total and fungal-specific IgE levels. Treatment almost always requires surgery, in which adjuvant medical therapy is critical to success. However, until recently the choice of adjuvant therapy has consisted primarily of either oral and/or topical steroids. Although oral corticosteroids decrease recurrence after surgery, data for the effectiveness of other adjunctive pharmacologic agents, including topical and oral antifungal agents and immunotherapy, have remained unclear and hence are not recommended in recent guidelines including the International Consensus of Allergy and Rhinology. Three biologics, omalizumab, dupilumab, and mepolizumab, have recently been approved for treating CRSwNP in general, but clinical trials to date with these biologics did not involve AFRS patients. Recently published case reports and smaller prospective studies have shown good efficacy of these biologics on the AFRS subgroup of patients. This article provides an overview of the understanding of the pathophysiology of AFRS, implications of this understanding on the possible role of biologics, and clinical reports on the use of biologics in treating AFRS. Because biologics are indicated for treating CRSwNP, follow up real-world evidence studies are needed for AFRS.
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Affiliation(s)
- Amber U Luong
- McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas.
| | - Andy Chua
- McGovern Medical School of the University of Texas Health Science Center at Houston, Houston, Texas
| | - Bader M Alim
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Petter Olsson
- Novartis AB, Kista, Sweden; Division of Ear, Nose, and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Amin Javer
- St Paul's Sinus Centre, University of British Columbia, Vancouver, Canada
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Zhang X, Zhang N, Huang Q, Cui S, Liu L, Zhou B. Analysis of metabolites of fungal balls in the paranasal sinuses. BMC Infect Dis 2022; 22:733. [PMID: 36100882 PMCID: PMC9472387 DOI: 10.1186/s12879-022-07710-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractFungal ball sinusitis is characterized by complex fungus infections with non-invasive inflammation. But no research reported fungal ball composition and metabolic-related product types currently. 12 patients with chronic rhinosinusitis who underwent surgery and 9 healthy control were enrolled in this study. Samples from both groups were analyzed for high-throughput metabolites by UPLC-MS. OsiriX software was applied to perform imaging measurements on sinus CT. 2138 and 394 metabolites were screened from cationic and anionic modes. There was a significant difference in the abundance of glycerophospholipid metabolism and sphingolipid metabolism between the two groups, with the experimental group showing an increased trend related to the sphingolipid metabolic pathway, including sphingosine 1-phosphate (S1P) and related products, diacylglycerol, sphingomyelin (SM), suggesting that its metabolites are associated with mucosal and bony inflammation. Imaging measurements showed a median sinus CT value (median (P25, P75) of 351(261.4, 385.8) HU and a median sinus wall thickness (median (P25, P75) of 2.31(1.695, 3.718) mm, which correlated with the levels of glycerophospholipid metabolites and sphingolipid metabolites (P < 0.03). Dysfunctional glycerophospholipid and sphingolipid metabolism is present in the lesion of fungal ball sinusitis. Glycerophospholipid and sphingolipid metabolism plays a significant role in the progression of mucosal and osteitis produced by fungal ball sinusitis.
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Alharbi A, Reville N, Molinier S, Bastier PL, de Gabory L. Characterization of fungus ball CT-hyperdensities within maxillary and sphenoid sinuses. Dentomaxillofac Radiol 2022; 51:20180384. [PMID: 35762348 PMCID: PMC10043618 DOI: 10.1259/dmfr.20180384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/10/2022] [Accepted: 06/03/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES CT-scan hyperdensities (HD) are described in more than 60% of all paranasal sinus fungus ball (FB) cases. Two types can be distinguished according to their density: calcium and metal types. We aimed to establish the prevalence and density of the HD observed in sphenoid and maxillary sinus FB and their relation to dental factors. METHODS This retrospective study included 64 patients operated in a tertiary referral center for unilateral maxillary or sphenoid FB diagnosed by histology or mycology. Pre-operative CT scans were analyzed by three independent observers (two ENT and one radiologist). RESULTS There were 45 maxillary FB and 19 sphenoid FB. 63 FB showed HD. Metal-type HD were observed in 28 maxillary FB but not in sphenoid sinuses. Among maxillary FB, the prevalence of endodontic treatment was significantly more significant on the FB side than on the healthy side (p = 0.02). The prevalence of endodontic treatment on the pathological side was more significant in the metal-type group than in the group without metal-type HD (p = 0.01). Isolated calcium-type HD were evidenced in 17 maxillary FB and 18 sphenoid FB (p = 0.019). CONCLUSION This study highlights the existence of two different types of HD in FBs of the paranasal sinuses with an association between metal-type HD and endodontic treatments.
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Affiliation(s)
| | - Nicolas Reville
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Sandrine Molinier
- Radiology and Medical Imaging Department, University Hospital of Bordeaux, Bordeaux, France
| | - Pierre-Louis Bastier
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
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Kikuta S, Han B, Yoshihara S, Nishijima H, Kondo K, Yamasoba T. High CT Attenuation Values Relative to the Brainstem Predict Fungal Hyphae Within the Sinus. Front Surg 2022; 9:876340. [PMID: 35784936 PMCID: PMC9243468 DOI: 10.3389/fsurg.2022.876340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives There is currently no established objective diagnostic indicator for the differentiation of sinus fungal ball (SFB) from unilateral nonfungal chronic sinusitis (UCRS). This study evaluated whether computed tomography (CT) attenuation values relative to those of the brainstem (relative CT number) are useful for differentiating SFB from UCRS. Materials and Methods Consecutive patients who were pathologically diagnosed with SFB or UCRS between 2013 and 2021 were retrospectively identified. The relative CT numbers of region of interest (ROIs) within the sinuses were compared between the two patient groups. Factors with predictive power for differentiating SFBs from UCRSs were identified by uni/multivariable logistic regression analyses. Results One hundred and eighty-three patients with unilateral chronic sinusitis were finally analyzed (SFB, 86 cases; UCRS, 97 cases). Regardless of the presence or absence of calcified lesions, the relative CT numbers in SFB were significantly higher than those in UCRS. ROIs showing high relative CT numbers were those where fungal hyphae were present. In the uni/multivariable logistic regression analysis, age (p < 0.001), relative CT number (p < 0.001), and calcification (p = 0.002) had predictive value for distinguishing SFB from UCRS. Within those cases not showing calcification, age (p = 0.004) and relative CT number (p < 0.001) were predictive factors for differentiating SFB from UCRS. A relative CT number >1.5 was significantly associated with SFB (sensitivity, 70%; specificity, 91%), with a significantly larger area under the receiver operating characteristics curve than age. Conclusions High relative CT numbers within the sinus are strongly associated with the presence of fungal hyphae, and measurement of relative CT number is a powerful adjunctive diagnostic method for distinguishing between SFB and UCRS.
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Makihara S, Kariya S, Omichi R, Miyamoto S, Naito T, Uraguchi K, Oka A, Tsumura M, Okano M, Ando M. Subclinical obstructive lung function changes in patients with sinus fungus ball. Allergol Int 2022; 71:539-541. [PMID: 35410808 DOI: 10.1016/j.alit.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/01/2022] Open
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12
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The Endonasal Endoscopic Approach to Different Sinonasal Fungal Balls. Int J Otolaryngol 2022; 2022:6721896. [PMID: 35360416 PMCID: PMC8964197 DOI: 10.1155/2022/6721896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Fungal ball sinusitis is a sinonasal fungus ball that usually affects immunocompetent adults with female predominance. The most affected sinus is the maxillary sinus. Aspergillus species is the most typically found fungus. Computed tomography (CT) scan is the gold standard tool in order to diagnose fungal ball sinusitis. The ultimate method for a fungal ball is functional endoscopic sinus surgery (FESS), which has a high success rate and a low morbidity rate. Objective. This study aims to demonstrate the various clinical presentations of fungal ball sinusitis including isolated maxillary sinus, sphenoid sinus, simultaneous occurrence of maxillary and sphenoid fungal ball, and post endonasal endoscopic pituitary surgery fungal ball with various age groups. Also, this study aims to emphasize the importance of early diagnosis and treatment in such cases. Patients and Methods. A retrospective study that was carried in the otorhinolaryngology department of two hospitals: King Fahad Specialist Hospital and Qatif Central Hospital, Eastern Region, Saudi Arabia. The study was conducted on a total of 16 patients who were diagnosed with paranasal sinuses fungal ball in an 11-year period from January 2008 and November 2019. Results. Out of 16 patients with paranasal sinuses fungal ball, 11 cases were female and 5 males, with age ranging between 16 and 46 years. Results showed eight isolated sphenoid (50%), six isolated maxillary fungal ball (38%), one simultaneous occurrence of the sphenoid and maxillary fungal ball (6%), and one post endonasal endoscopic pituitary surgery for pituitary adenoma (6%). CT scan was performed for all 16 cases which is the standard tool for the diagnosis of the fungal ball. Conclusion. Fungal ball may present with variety of symptoms but most commonly with postnasal discharge (PND), headache, and facial pain. CT sinuses is the diagnostic radiological modality to confirm the diagnosis. The FESS functional endoscopic sinus surgery is the gold safe approach for patients with fungal ball to manage their symptoms, confirm the diagnosis, and removal of disease with no morbidities.
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Fungal ball of the maxillary sinus and the risk of persistent sinus dysfunction after simple antrostomy. Am J Otolaryngol 2020; 41:102541. [PMID: 32466983 DOI: 10.1016/j.amjoto.2020.102541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Maxillary sinus fungal ball is a common cause of unilateral maxillary sinusitis. Fungal balls or mycetomas are primarily treated with surgery to remove the fungus. However, this assumes the pre-fungal ball sinus cavity was normal and post-surgery patients may suffer from mucostasis in the sinus cavity with persistent symptoms. It is proposed that fungal balls are potentially a feature of impaired mucus clearance as they are a pathology in their own right. METHODS A case series of consecutive patients undergoing antrostomy for maxillary sinus fungal ball was performed. Patient factors including age, gender, smoking status, comorbidities (allergy, asthma, and reflux), disease specific factors including duration of symptoms, microbiology (bacterial co-infection, Gram-positive and/or Gram-negative) and preoperative radiologic findings (extent of sinus development, and neo-osteogenesis/bone thickness) were collected. The primary outcome was sinus function defined by evidence of a normal functioning maxillary sinus, with the absence of mucostasis or pooling, on endoscopic exam at three months, six months and last follow-up. Endoscopic evaluation of inflammation was also collected. RESULTS 28 patients (age 58.5 ± 15.5 years, 64.3% female) were assessed. Mucostasis was present at three months in 39.3%, at six months in 32.1%, and 17.9% at last follow-up. There was no comorbidity or radiologic finding that was associated with failure to normalize. Those patients with mucostasis had a higher modified Lund-Mackay endoscopic score at last follow-up (5.0 ± 0.7 v 0.2 ± 0.6, p < 0.01). CONCLUSIONS Long term post-operative mucostasis occurred in 17.9% of patients following an adequate maxillary antrostomy for treatment of a fungal ball. Patients with mucostasis had persistent mucosal inflammation and a greater need for further surgery (modified medial maxillectomy).
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Wang LL, Chen FJ, Yang LS, Li JE. Analysis of pathogenetic process of fungal rhinosinusitis: Report of two cases. World J Clin Cases 2020; 8:451-463. [PMID: 32047798 PMCID: PMC7000939 DOI: 10.12998/wjcc.v8.i2.451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/21/2019] [Accepted: 01/02/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Fungal rhinosinusitis is an infectious and/or allergic disease caused by fungi in the sinus and nasal cavity. Due to the warm and humid climate in Guangxi Zhuang Autonomous Region, the incidence of fungal rhinosinusitis is higher than that in other provinces. However, its physiological mechanism is not yet clear. Not every patient colonized by fungi develops a fungal infection. To a large extent, the immune status of the patient determines the nature of fungal disease in the nasal passages. The pathologic process of progression from harmless fungal colonization to fungal rhinosinusitis is unclear and has not been reported. CASE SUMMURY We report two patients, one who developed fungal rhinosinusitis 1.5 years after surgery performed to treat an inverted papilloma, and the other with a history of hypertension and cerebral infarction. Both patients recovered from their surgeries. An average time of 2.5 years elapsed from the development of maxillary sinus cysts to the development of fungal rhinosinusitis. CONCLUSION According to these case reports, we speculate that the progression of fungal rhinosinusitis from harmless colonization to disease onset requires approximately one to three years and that the length of the process may be related to underlying diseases, surgical treatment, deficient autoimmune status, and abuse of hormone antibiotics and hormones. Additional data are needed to conduct relevant studies to appropriately prevent and treat fungal rhinosinusitis.
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Affiliation(s)
- Lin-Lin Wang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning 530022, Guangxi Zhuang Autonomous Region, China
| | - Feng-Ji Chen
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning 530022, Guangxi Zhuang Autonomous Region, China
| | - Long-Su Yang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning 530022, Guangxi Zhuang Autonomous Region, China
| | - Jie-En Li
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6, Shuangyong Road, Nanning 530022, Guangxi Zhuang Autonomous Region, China
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15
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Kim SC, Ryoo I, Shin JM, Suh S, Jung HN, Shin SU. MR Findings of Fungus Ball: Significance of High Signal Intensity on T1-Weighted Images. J Korean Med Sci 2020; 35:e22. [PMID: 31950777 PMCID: PMC6970076 DOI: 10.3346/jkms.2020.35.e22] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Central dark-signal intensity with high-signal, hypertrophic mucosal wall of paranasal sinuses on T2-weighted images (T2WI) is a characteristic magnetic resonance imaging (MRI) feature of sinonasal fungus ball. However, this finding is usually interpreted as non-fungal chronic sinusitis with central normal sinus air. In addition, T1-weighted images (T1WI) and T2WI are basic sequences of all magnetic resonance (MR) examinations. Therefore, we evaluated the usefulness of T1WI for detecting fungus balls comparing with computed tomography (CT) findings and T2-weighted MRI findings. METHODS This retrospective study was approved by the Institutional Review Board of Korea University Guro Hospital. Two reviewers assessed preoperative CT and MR images of 55 patients with pathologically confirmed fungus balls. Reviewers evaluated the presence and patterns of calcifications on CT. Overall signals and the presence and extent of certain signals of fungus balls on MRI were also assessed. The relationship between calcifications and MRI signals was also evaluated. RESULTS Of the patients, 89.1% had calcifications on CT. All had dark signal portions with high signal, hypertrophic mucosal walls on T2WI. Most (92.7%) patients showed iso- to hyper-intense overall signals on T1WI and 89.1% had T1-weighted high signal portions on MRI. The presence, patterns, and location of calcifications had no significant correlation with T1-weighted high-signal intensity portion. CONCLUSION Fungus ball can be suggested by the presence of the hyper-signal intensity portions in the fungal mass on T1WI in conjunction with dark-signal lesions surrounded by high-signal, hypertrophic mucosal walls in paranasal sinuses on T2WI.
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Affiliation(s)
- Soo Chin Kim
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Jae Min Shin
- Department of Otorhinolaryngology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sangil Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Na Jung
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ui Shin
- Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
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Cha H, Song Y, Bae YJ, Won TB, Kim JW, Cho SW, Rhee CS. Clinical Characteristics Other Than Intralesional Hyperdensity May Increase the Preoperative Diagnostic Accuracy of Maxillary Sinus Fungal Ball. Clin Exp Otorhinolaryngol 2019; 13:157-163. [PMID: 31674170 PMCID: PMC7248610 DOI: 10.21053/ceo.2019.00836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/04/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives This study aimed to evaluate the clinical characteristics of maxillary sinus fungus ball (MFB) to increase the preoperative diagnostic accuracy. Methods A retrospective review of 247 patients who underwent endoscopic sinus surgery for unilateral maxillary sinusitis from January 2015 to December 2017 at a single institution was performed. Patients with pathologically proven MFB were compared to those with unilateral chronic maxillary sinusitis (CMS). Patient demographics and computed tomography (CT) findings were evaluated. The CT features were categorized as intralesional hyperdensity (calcification), the irregular lobulated protruding lesion (fuzzy appearance), maxillary sinus full haziness without mass effect, maxillary sinus full haziness with mass effect, and others. A regression tree analysis was performed. Results In total, 247 patients were analyzed; among them, 179 (72.5%) had MFB and 68 (27.5%) had CMS. MFB showed predominance in older individuals. Among the radiological features, intralesional hyperdensity was most commonly associated with MFB. The presence of a fuzzy appearance or full opacity with mass effect was also associated with MFB. The highest area under the curve was noted with the regression tree analysis based on the model, which included the presence of intralesional hyperdensity, demographic data (age), and presence of fuzzy appearance or maxillary sinus full haziness with mass effect in case of absence of intralesional hyperdensity (0.904). Conclusion A simple algorithm to optimize the preoperative diagnosis of MFB was developed. Physicians should be aware of such findings in the management of patients presenting with unilateral CMS.
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Affiliation(s)
- Hyunkyung Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjae Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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17
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Lee DH, Yoon TM, Lee JK, Lim SC. Computed tomography-based differential diagnosis of fungus balls in the maxillary sinus. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:277-281. [PMID: 31471220 DOI: 10.1016/j.oooo.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/22/2019] [Accepted: 08/04/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We investigated the computed tomography (CT) features of the maxillary sinus fungus ball and compared them with those of other maxillary sinus diseases. STUDY DESIGN The CT findings of 98 fungus ball lesions in 96 patients, with 35 cases of sinusitis confined to the maxillary sinus and 35 other sinus lesions confined to the maxillary sinus, were analyzed. RESULTS The most common CT feature of maxillary sinus fungus balls was calcification within the maxillary sinus (n = 77 [78.6%]), followed by complete opacification (n = 57 [58.2%]), partial opacification with an irregular surface (n = 36 [36.7%]), bony sclerosis (n = 16 [16.3%]), and partial opacification (n = 5 [5.1%]). A high probability of maxillary sinus fungus ball was found when the CT scans showed calcification within the maxillary sinus and partial opacification with an irregular surface (P < .05). CONCLUSIONS Maxillary sinus fungus balls show a higher frequency of calcification and partial opacification with an irregular surface on CT scans compared with maxillary sinusitis and other maxillary sinus lesions. Therefore, calcification and partial opacification with an irregular surface on preoperative CT scans suggest the maxillary sinus fungus ball as the first diagnostic consideration.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Jeonnam, Korea
| | - Tae Mi Yoon
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Jeonnam, Korea
| | - Joon Kyoo Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Jeonnam, Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Chonnam National University Hwasun Hospital, Jeonnam, Korea.
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18
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Ahn SH, Lee EJ, Hong MP, Shin GC, Kim KS. Comparison of the clinical characteristics of bilateral and unilateral fungal balls in Korea. Eur Arch Otorhinolaryngol 2019; 276:1975-1980. [DOI: 10.1007/s00405-019-05408-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/25/2019] [Indexed: 01/09/2023]
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19
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Fadda GL, Succo G, Moretto P, Veltri A, Castelnuovo P, Bignami M, Cavallo G. Endoscopic Endonasal Surgery for Sinus Fungus Balls: Clinical, Radiological, Histopathological, and Microbiological Analysis of 40 Cases and Review of the Literature. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2019; 31:35-44. [PMID: 30783597 PMCID: PMC6368987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Paranasal sinus fungus ball (PSFB) is a non-invasive mycosis, which appears in immunocompetent patients, along with unilateral lesion. The purpose of this study was to analyse various symptoms of PSFB and its radiological, pathological, and microbiological findings. In addition, this study involved the investigation of the incidence of bacterial coinfection and surgical techniques applied for this infection and to report the modern developments in this domain. MATERIALS AND METHODS This retrospective study was carried out on 40 consecutive patients referring for PSFB treatment to the Ear, Nose, and Throat Department in San Luigi Gonzaga University Hospital, Turin, Italy, from April 2014 to 2017. Pertinent literature was reviewed and compared within the specified period. All patients were examined by preoperative computed tomography (CT) scan, and 26 (65%) patients were subjected to magnetic resonance imaging (MRI). RESULTS Totally, 33 patients (82.5%) were affected with single sinus infection, whereas most of the cases suffered from maxillary sinusitis. With regard to CT scan findings, microcalcifications were found in 32.5% of the cases; however, mucosal membrane thickening around the fungus ball (FB) was visible in contrast-enhanced CT scans. According to MRI examination, FB showed a characteristic "signal void" on T 2(42.3%). Only 7(17.5%) patients had a positive mycological culture, whereas bacterial coinfections were identified in 47.5% of the cases. Out of 40 patients, 3(7.5%) subjects had only radiological evidence of fungal colonization while having no histopathological evidence. No patient received postoperative antifungal drugs, and there were no serious complications with only one recurrence. CONCLUSION Endoscopic endonasal surgery is the treatment of choice for patients with PSFB receiving no associated local or systemic antifungal therapy. A histopathological study facilitates the confirmation of the diagnosis and exclusion of the invasive form of fungal rhinosinusitis.
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Affiliation(s)
- Gian-Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.,Corresponding Author: Department of Otorhinolaryngology, University of Turin, Orbassano, Italy. San Luigi Gonzaga Hospital. Regione Gonzole 10, Orbassano, 10043 Turin, Italy. Tel: +39-011-9026463, E-mail:
| | - Giovanni Succo
- FPO IRCCS, Head & Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy.
| | - Paolo Moretto
- Department of Diagnostic Imaging, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
| | - Andrea Veltri
- Department of Diagnostic Imaging, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
| | - Maurizio Bignami
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
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20
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Ho CF, Lee TJ, Wu PW, Huang CC, Chang PH, Huang YL, Lee YL, Huang CC. Diagnosis of a maxillary sinus fungus ball without intralesional hyperdensity on computed tomography. Laryngoscope 2018; 129:1041-1045. [PMID: 30582161 DOI: 10.1002/lary.27670] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/30/2018] [Accepted: 10/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Maxillary sinus fungus ball (MSFB) is the most common type of noninvasive fungal rhinosinusitis. Surgical removal of the ball achieves good outcomes. Making a rapid and accurate diagnosis is important to avoid unnecessary medical therapy. Intralesional hyperdensity (IH) on computed tomography (CT) is reportedly a good indicator. The aim of this study was to evaluate the diagnostic features of MSFB without IH on preoperative CT images. STUDY DESIGN Retrospective database review. METHODS Two hundred fifty-eight patients with histopathological evidence of a sinus fungal ball were retrospectively investigated. Forty-seven of 222 patients with MSFB did not show IH on preoperative CT images and were enrolled in the MSFB group. Forty-one patients with unilateral nonfungal chronic rhinosinusitis were enrolled in a control group. CT features previously reported to have diagnostic significance were evaluated. RESULTS Sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and irregular surface of the material were significantly more common in the MSFB group than in the control group. In the subgroup of patients with total opacification in the maxillary sinus, the sensitivity, specificity, and positive and negative predictive values for erosion of the inner sinus wall were more than 90%. In the subgroup with partial opacification, the sensitivity, specificity, and positive predictive value of an irregular surface of the material were more than 80%. CONCLUSIONS We have devised an algorithm to help diagnose MSFB without IH on preoperative CT images. Use of this algorithm would improve the diagnostic accuracy and ensure appropriate treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1041-1045, 2019.
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Affiliation(s)
- Che-Fang Ho
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,the Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,the Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Lin Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Lin Lee
- Department of Radiology, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,the Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Jiang RS, Huang WC, Liang KL. Characteristics of Sinus Fungus Ball: A Unique Form of Rhinosinusitis. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2018; 11:1179550618792254. [PMID: 30090023 PMCID: PMC6077877 DOI: 10.1177/1179550618792254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/10/2018] [Indexed: 11/26/2022]
Abstract
Objective: The purpose of this study was to investigate the characteristics of this unique form of rhinosinusitis. Methods: Ninety-one patients with sinus fungus balls were evaluated for clinical characteristics. Nasal tissues obtained from 38 patients with sinus fungus ball, along with 26 controls were used for histopathological, cytokines/chemokines, western blotting, and genetic analyses. Results: Patients with fungus balls had significantly more females and their age was older. The presentation of fungus ball was predominantly unilateral (97.8%). Thirty-three patients (36.3%) had risk factors for fungal infection. Macrophage and neutrophil dominated cellular infiltration was found in nasal tissues of fungus ball patients. A tendency of reduced tight junction staining (e-cadherin) and protein expression was found. Interleukin 8 (IL8) and granulocyte colony stimulating factor (G-CSF) significantly increased in sinus fungus ball tissue homogenates when compared with those from controls. Higher prevalence of a single single nucleotide polymorphism (SNP) with E-cadherin was found in the patients with fungus ball. Conclusions: We found that patients with sinus fungus ball had robust immune responses, allowing recruitment and activation of macrophages and neutrophils. However, patients with sinus fungus ball could have genetic or acquired weakness in immunity. The fungal hyphae were localized and accumulated within single sinus instead of being eradicated by host.
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Affiliation(s)
- Rong-San Jiang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Wan-Chun Huang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kai-Li Liang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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22
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Endoscopic Modified Medial Maxillectomy for Fungal Ball of the Hypoplastic Maxillary Sinus With Bony Hypertrophy. J Craniofac Surg 2018; 29:e304-e307. [DOI: 10.1097/scs.0000000000004379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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23
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Kimura M. [Histopathological Diagnosis of Fungal Sinusitis and Variety of its Etiologic Fungus]. Med Mycol J 2018; 58:J127-J132. [PMID: 29187720 DOI: 10.3314/mmj.17.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fungal sinusitis is divided into two categories depending on mucosal invasion by fungus, i.e., invasive and noninvasive. Invasive fungal sinusitis is further divided into acute and chronic disease based on time course. Noninvasive fungal sinusitis includes chronic noninvasive sinusitis (fungal ball type) and allergic fungal sinusitis. Chronic noninvasive sinusitis is the most predominant fungal sinusitis in Japan, followed by allergic fungal sinusitis. Invasive fungal sinusitis is rare. Hyphal tissue invasion is seen in invasive fungal sinusitis. Acute invasive fungal sinusitis demonstrates hyphal vascular invasion while chronic invasive fungal sinusitis usually does not. Fungal tissue invasion is never found in noninvasive sinusitis. A fungal ball may exist adjacent to sinus mucosa, but its hyphae never invade the mucosa. Fungal balls sometimes contain conidial heads and calcium oxalate, which aid in identifying the fungus in the tissue. Allergic fungal sinusitis is characterized by allergic mucin that is admixed with numerous eosinophils and sparsely scattered fungal elements. Histopathology is important in classifying fungal sinusitis, especially in confirming tissue invasion by the fungus.
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Affiliation(s)
- Masatomo Kimura
- Department of Pathology, Kindai University Faculty of Medicine
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Vergara-de la Rosa E, Galvez-Olortegui J, Vargas-Armas C, Galvez-Olortegui T. Do Women With a History of Pregnancy and Endodontics, Have Higher Risk of Maxillary Fungal Ball? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Yoon YH, Xu J, Park SK, Heo JH, Kim YM, Rha KS. A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015). Int Forum Allergy Rhinol 2017; 7:1070-1075. [DOI: 10.1002/alr.22007] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/19/2017] [Accepted: 08/02/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Young Hoon Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
| | - Jun Xu
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
- Department of Otorhinolaryngology-Head and Neck Surgery; Yanbian University Hospital; Yanbian China
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
| | - Jae Hyung Heo
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
| | - Ki-Sang Rha
- Department of Otorhinolaryngology-Head and Neck Surgery; Chungnam National University, School of Medicine; Daejeon Korea
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Yamauchi T, Tani A, Yokoyama S, Ogawa H. Assessment of non-invasive chronic fungal rhinosinusitis by cone beam CT: comparison with multidetector CT findings. Fukushima J Med Sci 2017; 63:100-105. [PMID: 28747616 DOI: 10.5387/fms.2016-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate the accuracy of cone beam CT (CBCT) to diagnose non-invasive chronic fungal rhinosinusitis. METHODS Preoperative CT evaluation of non-invasive chronic fungal rhinosinusitis was performed by CBCT (3D Accuitomo 170®) and traditional multidetector CT (MDCT) (Aquilion 32®) in 13 and 38 patients with non-invasive chronic fungal maxillary sinusitis, respectively, in different facilities. Detection of intrasinus calcification was compared between these two groups. RESULTS Detection of intrasinus calcification in patients with non-invasive chronic fungal maxillary sinusitis was higher in the MDCT group (84.2%) than the CBCT group (46.2%). CONCLUSION CBCT is inferior to MDCT in detection of intrasinus calcification in patients with non-invasive chronic fungal maxillary sinusitis. CBCT is frequently used in the screening of the paranasal lesion, but it is not enough to evaluate non-invasive chronic fungal maxillary sinusitis alone. STUDY DESIGN Retrospective study.
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Affiliation(s)
- Tomohiko Yamauchi
- Department of Otolaryngology, Aizu Medical Center, Fukushima Medical University
| | - Akiko Tani
- Department of Otolaryngology, Fukushima Medical University
| | - Shuji Yokoyama
- Department of Otolaryngology, Aizu Medical Center, Fukushima Medical University
| | - Hiroshi Ogawa
- Department of Otolaryngology, Aizu Medical Center, Fukushima Medical University
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Mohammadi A, Hashemi SM, Abtahi SH, Lajevardi SM, Kianipour S, Mohammadi R. An investigation on non-invasive fungal sinusitis; Molecular identification of etiologic agents. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:67. [PMID: 28616054 PMCID: PMC5461590 DOI: 10.4103/jrms.jrms_166_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 02/22/2017] [Accepted: 02/25/2017] [Indexed: 12/14/2022]
Abstract
Background: Fungal sinusitis is increasing worldwide in the past two decades. It is divided into two types including invasive and noninvasive. Noninvasive types contain allergic fungal sinusitis (AFS) and fungus ball. AFS is a hypersensitivity reaction to fungal allergens in the mucosa of the sinonasal tract in atopic individuals. The fungus ball is a different type of noninvasive fungal rhinosinusitis which is delineated as an accumulation of debris and fungal elements inside a paranasal sinus. Fungal sinusitis caused by various fungi such as Aspergillus species, Penicillium, Mucor, Rhizopus, and phaeohyphomycetes. The aim of the present study is to identify fungal species isolated from noninvasive fungal sinusitis by molecular methods. Materials and Methods: During 2015–2016, a total of 100 suspected patients were examined for fungal sinusitis. Functional endoscopic sinus surgery was performed using the Messerklinger technique. Clinical samples were identified by phenotypic and molecular methods. Polymerase chain reaction (PCR) sequencing of ITS1-5.8S-ITS2 region and PCR-restriction fragment length polymorphism with MspI restriction enzyme was performed for molecular identification of molds and yeasts, respectively. Results: Twenty-seven out of 100 suspected cases (27%) had fungal sinusitis. Nasal congestion (59%) and headache (19%) were the most common clinical signs among patients. Fifteen patients (55.5%) were male and 12 patients (44.5%) were female. Aspergillus flavus was the most prevalent fungal species (26%), followed by Penicillium chrysogenum (18.5%) and Candida glabrata species complex (15%). Conclusion: Since clinical manifestations, computed tomography scan, endoscopy, and histopathological findings are very nonspecific in AFS and fungus ball; therefore, molecular investigations are compulsory for precise identification of etiologic agents and appropriate management of these fungal infections.
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Affiliation(s)
- Abdolrasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mostafa Hashemi
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Hamidreza Abtahi
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mohammad Lajevardi
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Kianipour
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Vergara-de la Rosa E, Galvez-Olortegui J, Vargas-Armas C, Galvez-Olortegui T. Do women with a history of pregnancy and endodontics, have higher risk of maxillary fungal ball? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 68:307-308. [PMID: 28069110 DOI: 10.1016/j.otorri.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Esteban Vergara-de la Rosa
- Unidad de Investigación Clínica, Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Servicio de Otorrinolaringología, Hospital Regional Docente de Trujillo, Trujillo, Perú; Escuela de Posgrado, Universidad Privada Antenor Orrego, Trujillo, Perú.
| | - José Galvez-Olortegui
- Unidad Generadora de Evidencias y Vigilancia Epidemiológica, Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Facultad de Medicina, Universidad Nacional de Trujillo, Perú
| | - Carlos Vargas-Armas
- Unidad de Investigación Clínica, Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Servicio de Periodoncia e Implante, Unidad de Segunda Especialización en Estomatología, Universidad Nacional de Trujillo, Perú
| | - Tomas Galvez-Olortegui
- Escuela de Posgrado, Universidad Privada Antenor Orrego, Trujillo, Perú; Unidad Generadora de Evidencias y Vigilancia Epidemiológica, Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú
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Jiang Z, Zhang K, Huang W, Yuan Q. A Preliminary Study on Sinus Fungus Ball with MicroCT and X-Ray Fluorescence Technique. PLoS One 2016; 11:e0148515. [PMID: 26978273 PMCID: PMC4792473 DOI: 10.1371/journal.pone.0148515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/19/2016] [Indexed: 11/18/2022] Open
Abstract
Background Sinus fungus ball, an accumulation of fungal dense concretions, is a common disease in practice, and might cause fatal complications or lead to death once converted into invasive type. Early preoperative diagnosis of this disease can lead to appropriate treatment for patients and prevent multiple surgical procedures. Up to now, the diagnostic criteria of sinus fungus ball have been defined and computed tomography (CT) scan was considered as a valuable preoperative diagnostic tool. However, the sensitivity of clinical CT is only about 62%. Thus, investigating the factors which influence sensitivity is necessary for clinical CT to be a more valuable preoperative diagnosis tool. Furthermore, CT scan usually presents micro-calcifications or spots with metallic density in sinus fungus ball. Previous literatures show that there are some metallic elements such as calcium and zinc in fungus ball, and they concluded that endodontic treatment has a strong correlation with the development of maxillary sinus fungus ball and zinc ion was an exogenous risk factor. But the pathogenesis of sinus fungus ball still remains unclear because fungus ball can also develop in other non-maxillary sinuses or the maxillary sinus without root canal treatment. Is zinc ion the endogenous factor? Study on this point might be also helpful for investigating the pathogenesis of sinus fungus ball. In this paper, we tried to investigate the factors which influence the sensitivity of clinical CT by imaging sinus fungus ball with microCT. The origin of zinc ion was also studied through elements test for different fungal ball samples using x-ray fluorescence technique. Methods Specimens including fungal ball material and sinus mucosa from patients confirmed by pathological findings were extracted after surgery. All fungal ball specimens came from sphenoid sinus, ethmoidal sinus and maxillary sinus with or without previous endodontic treatment respectively. All of them were imaged by microCT with spatial resolution up to 5μm to acquire three-dimensional structure, and then the heavy metal elements were detected with x-ray fluorescence spectrometer analysis. Result High concentration of zinc and calcium were detected in all fungal ball specimens compared to sinus mucosa membrane. Particles with different size varied from disperse to density, which have similar shape to the result of clinical CT but with different size, were found in three-dimensional reconstruction results of microCT. Conclusions Spatial resolution is an influent factor of clinical CT sensitivity for sinus fungus ball. Improving the resolution of clinical CT will help to improve its sensitivity. Besides iatrogenic endodontic materials, endogenous metal elements of zinc and calcium might associate with the growth of fungal ball and the micro-calcifications or spots with metallic density of CT imaging.
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Affiliation(s)
- Zidong Jiang
- Department of Otolaryngology, Peking Union Medical College Hospital, Beijing, China
- * E-mail: (ZJ); (QY)
| | - Kai Zhang
- Institute of High Energy Physics, Chinese Academy of Science, Beijing, China
| | - Wanxia Huang
- Institute of High Energy Physics, Chinese Academy of Science, Beijing, China
| | - Qingxi Yuan
- Institute of High Energy Physics, Chinese Academy of Science, Beijing, China
- * E-mail: (ZJ); (QY)
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A Case of Fungus Ball-Type Pansinusitis Due to Fusarium proliferatum. Mycopathologia 2015; 180:251-5. [PMID: 26025662 DOI: 10.1007/s11046-015-9906-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
Incidence of fungal sinusitis due to the genus Fusarium has increased during the last two decades. We report a case of fungus ball sinusitis with multiple sinuses involvement in an Iranian 21-year-old woman. The patient was diagnosed as having a fungus ball-type sinusitis in computed tomography scan. The sinus biopsy revealed fungal structures on histopathological and direct microscopic examinations and a Fusarium species arose in culture. Partial sequencing of the translation elongation factor 1-alpha identified the isolate as F. proliferatum. Removal of all lesions by endoscopic surgery resulted in a favorable outcome. To the best of our knowledge, this is the first case of F. proliferatum-associated fungus ball which involved multi-sinus and highlights the efficiency of molecular methods for discrimination of fungal agents involved.
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