Chronic granulomatous invasive fungal sinusitis (CGIFS) is a peculiar disease of the paranasal sinuses due to its rarity, patient subset, and disease course. We describe 7 cases of histopathologically confirmed CGIFS with different treatment plans and varying outcomes. Of particular note was that one of these patients developed allergic fungal rhinosinusitis after complete resolution of his primary invasive disease, a finding that has never been reported in the literature. Another patient had an atypical fungal species ( Aspergillus nidulans) on fungal stain and culture, while one immunodeficient patient had a large intracerebral disease component and died after 2 months of treatment. We also present a review of the pertinent literature investigating this rare disease.

Cholesterol Granulomas of the Maxillary Sinus, considered an unusual presentation at this anatomical site. Over last 2 decades, only few cases are reported in the literature (English) and no available comprehensive reviews or studies on this entity. Herein in this article we present a comprehensive literature review of the available reports of 16 cases along with reporting a new case which we managed, aided with its histopathological pictures. This review article can be a reference for practitioners in the field of otorhinolaryngology who may encounter these cases. Also, it attracts the attention to consider this pathology among the differential diagnoses of nasal masses. Moreover, including a described pathological imaging may help young pathologist to identify this pathology.

Background Bone erosions are common in allergic fungal rhinosinusitis (AFRS). This study aimed at developing an image-based grading and scoring system for paranasal sinus (PNS) wall erosion in AFRS. Methods A retrospective review of all confirmed AFRS cases based on the Bent and Kuhn criteria was conducted. Preoperative computed tomography (CT) images were studied to detect PNS wall erosion with expansion. Based on our observation, we described a grading system based on the proportion of PNS wall erosion, with 1 if less than one-third, 2 if between one-third and two-thirds, and 3 if more than two-thirds of the wall is eroded. This method provides a new scoring system ranging from 0 to 72. The inter-observer reliability of this scoring system was tested and the percent of agreement was found to be 90%. Results Among 142 AFRS cases, 82 patients (57.7%) had bone erosion. Orbital extension via lamina papyracea erosion occurred in 28.2% and 17.6% of the anterior and posterior ethmoid sinuses respectively, via floor erosion in 8.3% of the frontal sinuses, and via roof erosion in 2.1% of the maxillary sinuses. Intracranial extension caused by the anterior skull base erosion occurred in 19.4%, 10.9%, and 6% of the posterior ethmoid, anterior ethmoid, and frontal sinuses, respectively. The middle and posterior cranial fossa skull base was eroded in 14.4% and 9.2% of the sphenoid sinuses, respectively. Infratemporal extension occurred via erosion of the sphenoid sinus lateral wall in 17.3% of the sphenoid sinuses and via erosion of the maxillary sinus posterior wall in 6.7% of the maxillary sinuses. The mean of bone erosion score was 9.52, and the highest score was 34/72. Conclusion The orbit is the most common extra-sinus extension site via the lamina papyracea erosion. We propose a new grading and scoring system to assess disease severity and progress.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Deviated nasal septum is a very common finding in ENT clinic, most of the times, as incidental findings without any related symptom. Sometimes it present in association with suspiciously related sinusitis. Our study is to identify the possible association between deviated nasal septum and sinusitis, so that we can consider septoplasty alone a first surgical management for these cases without any sinus procedure or not. </span></p><p class="abstract"><strong>Methods:</strong> A <span lang="EN-IN">cross sectional case-control study<strong>. </strong>SPSS.v22 used for data analysis<strong>.</strong> We used Kuhn-Kinnedy staging system for sinus pathology and applied it on the osteomeatal complex (OMC) and all paranasal sinuses. Those patients with deviated septum were studied for sinus disease especially maxillary and anterior ethmoid sinuses, and those with sinus disease were studied for deviated septum.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">We studied 238 patients, 120 males and 118 females, of them 164 (control) found to have central septum (68.9%) and 74 (cases) found to have deviated nasal septum (31.1%), 42 to the right and 32 to the left. 104 candidates (43.7%) found to have sinus disease. All findings were almost equal in both genders. Of the total sample, 40% of those with central septum found to have patent OMC and normal sinus mucosa equally. Of those who have DNS (74 candidates), OMC found to be opacified in 13.5% in the ipsilateral side, and 27% bilaterally. In those with DNS maxillary sinus was diseased in 20.3% ipsilaterally, 21.2% contralaterally, and 18.5% bilaterally. Anterior ethmoid sinuses were similarly affected in 40.5% ipsilateral and contralateral to DNS. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">According to our finding, no significant association between deviated nasal and paranasal sinusitis. Attributing sinuses disease to deviated nasal septum may lead to over treatment of the patient and unnecessary surgery.</span></p><p> </p>