Vol.98No.11contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 98 No. 11 November 2005
Clinical Study of Nasal and Paranasal Sinus Mycosis
Toshifumi Hasegawa and Kazuo Kumoi
(National Hospital Organization Himeji Medical Center)
Fifty-four cases (18 males and 36 females) with nasal and paranasal sinus mycosis treated at Himeji Medical Center between 1992 and 2002 were reviewed. Patient ages ranged from 22 to 94 years with an average of 61.6 years. Hepatic disease was present in 12 cases and diabetes in 5 cases. The sinuses involved with mycosis were the maxillary sinus (32 cases), the maxillary and ethmoid sinuses (13 cases), the sphenoid sinus (5 cases), the ethmoid sinus (2 cases), the frontal sinus (1 case), and the nasal cavity (1 case). All cases demonstrated unilateral diseases. Twenty-three cases had symptoms associated with pain and 14 cases with bleeding.
CT scans of 53 cases showed high density areas in 52 cases (98.1％) and bony destructions in 4 cases (7.5％). CT scans of 45 cases of maxillary mycosis showed expansions of the lateral nasal wall in 33 cases (73.3％), widenings of the natural ostium in 24 cases (53.3％) and sinus wall thickenings in 39 cases (86.7％). MRI showed that 14 (70.0％) of 20 cases had changes in the intensity of the maxillary bone. Concerning anatomical variants, 24 cases (53.3％) had septal deviations and 16 cases (35.6％) had concha bullosas. The affected side was the wide side of the sinonasal tracts in 15 cases (33.3％) and the narrow side in 20 cases (44.4％).
All cases were diagnosed by pathological examinations, while fungus was detected in 4 (10.8％) of 37 cultures. Species of mycosis were aspergillus (49 cases), candida (2 cases) and mucor (1 case).
Radical antrotomy of sinuses was performed in 31 cases and endonasal sinus surgery in 16 cases. Forty-six of the cases treated surgically were cured, while there was one recurrence of the invasive type. After surgical treatment, patients were administered antifungal medications over 3 months and irrigations of saline over 6 months to prevent recurrences.
Key words : clinical study, nasal and paranasal sinus mycosis, aspergillus