Allergic fungal sinusitis is very common in the tropical countries.20-30% of patients I see in my clinic come under this category.
Fungal sinusitis may occur in patients with chronic sinusitis, who usually have a predisposing cause such as uncontrolled diabetes or are immunosuppressed. It is of utmost importance that surgeon suspect the possibility of fungal sinusitis in theses patients if they do not respond to medical treatment or have any complication of sinusitis.
A variety of different causative organisms could be responsible for fungal sinusitis. Aspergillus and mucor mycosis are the commonest. Non-invasive fungal sinusitis is usually due to aspergillosis. It mimics sinusitis but there is no response to antibiotics.
Surgical clearance is of fungus is required with medical treatment. In invasive fungal sinusitis, patients will complain of fever, local pain, swelling, discharge and foul smell. Fungal sinusitis is often detected after the onset of an orbital complication or cranial nerve palsy and the sinus involvement seen on CT scan. While imaging will undoubtedly help in the diagnosis and assessment of the extent of fungal involvement, nasal swabs or tissue must be sent for fungal culture in all patients with the slightest doubt of fungal infection to confirm the diagnosis. Early diagnosis, correction of any underlying cause and aggressive treatment is the key to a successful outcome.
Surgical treatment by Caldwe Luc and Fess is required .This is followed by corticosteroid, Itraconazole , antihistamines treatment.