A Multi-Institutional Database Review of Orbital Complications and Survival Outcomes in Adult Patients with Invasive or Non-Invasive Fungal Rhinosinusitis

Abstract

Background: Invasive fungal rhinosinusitis (IFS) with orbital complications has remained a challenging disease over the past few decades. Only a few studies have been conducted to investigate the factors associated with orbital complications in fungal rhinosinusitis (FRS). We aimed to review the characteristics between IFS and non-invasive fungal rhinosinusitis (NIFS) and determine clinical factors associated with orbital complications and overall survival. Methods: A multi-institutional database review study was conducted using the Chang Gung Research Database (CGRD) from January 2001 to January 2019. We identified FRS patients using International Classification of Diseases diagnosis codes and SNOMED CT. We categorized patients into IFS and NIFS groups and analyzed the demographic data, underlying diseases, clinical symptoms, laboratory data, image findings, fungal infection status, and survival outcomes. Results: We included 1624 patients in our study, with 59 IFS patients and 1565 NIFS patients. The history of an organ or hematopoietic cell transplantation had a significant prognostic effect on the survival outcomes, with surgical intervention and high hemoglobin (Hb) and albumin levels recognized as positive predictors. Posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were risk factors of orbital complications. Conclusions: In NIFS patients, orbital complications were found to be associated with old age, a high WBC count, high blood glucose, and a high CRP level. For the risk factors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were recognized as predictors. Among IFS patients, a history of organ or hematopoietic cell transplantation was a risk factor for poor survival, while, conversely, surgical intervention and high Hb and albumin levels were related to improved survival. As predictors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling upon the first visit should raise attention, with close monitoring.

Identifying the Risk Factors for Orbital Complications in Isolated Sphenoid Rhinosinusitis

“…In this study, patients with isolated sphenoid rhinosinusitis and diabetes mellitus or malignant neoplasms were prone to orbital complications. A previous study reported that high blood glucose and C-reactive protein levels were risk factors for orbital complications in patients with non-invasive fungal rhinosinusitis [30]. Those laboratory data suggested an immunosuppressive status and systemic inflammation [30].…”

“…A previous study reported that high blood glucose and C-reactive protein levels were risk factors for orbital complications in patients with non-invasive fungal rhinosinusitis [30]. Those laboratory data suggested an immunosuppressive status and systemic inflammation [30]. Patients with diabetes mellitus or malignant neoplasms are usually considered relatively immunocompromised and could be susceptible to complications of rhinosinusitis [31,32].…”

Percutaneous Transluminal Angioplasty and Stenting for Progressive Intracranial Carotid Artery Stenosis Secondary to Invasive Sphenoid Sinus Aspergillosis: A Case Report

“…Invasive fungal sinusitis is rare, which accounts for 3.6% of all fugal sinusitis. 4 ) The middle turbinate is the commonly affected site, and the various presenting symptoms include fever, headache, rhinorrhea, facial pain, and diplopia. 5 ) Invasive fungal sinusitis is associated with rapid infiltration and destruction of adjacent tissues, such as the facial bone, and is therefore occasionally misdiagnosed as a tumor.…”