Invasive and Non-Invasive Fungal Rhinosinusitis—A Review and Update of the Evidence

Abstract

Fungal infections are a subset of infectious processes that an otolaryngologist is required to be familiar with. They can be encountered in otology, rhinology and head and neck surgery. The presence of fungal rhinosinusitis is well recognised by otolaryngologists, but the classifications and appropriate management are not so well understood. The prevalence of fungal sinus disease is thought to be have been increasing in recent decades There is speculation that this may be due to increased awareness, antibiotic overuse and increased use of immunosuppressant medications. Added to this, there has been a large amount published on the role of fungi as a causative organism in chronic rhinosinusitis. Given the importance of fungal rhinosinusitis in clinical practice, we aim to review the classification and current management strategies based on up-to-date literature.

Rhinosinusitis and the role of imaging

“…Fungal rhinosinusitis refers to a wide variety of conditions that can present acutely in severely immunocompromised patients, or chronically in patients with mild immunosuppressive states such as diabetes mellitus or chronic corticosteroid use. 9 It is categorized as acute (less than 4 weeks) or chronic (greater than 4 weeks), and as noninvasive or invasive.…”

“…fungal colonization, encountered in patients with anatomic abnormalities such as nasal polyps. 9 Fungal infections are also thought to have a role in the development of chronic rhinosinusitis. 10…”

“…When invasive acute or chronic fungal infection is suspected, contrast-enhanced CT or contrast-enhanced MRI can be used to visualize the sinuses, brain, and orbits. 9 CT fi ndings of invasive infection can include hypoattenuating mucosal thickening over the affected sinus and nasal cavity, bony erosion, and fi ndings extending beyond the sinus and nasal cavities. MRI is time-consuming to obtain yet favorable for evaluating intracranial and intraorbital spread.…”

Validation of a Bioanalytical Reverse-Phase High-Performance Liquid Chromatographic Method for the Quantitation of Nystatin in an Animal Model After Intranasal in Situ Gel Administration

“…It has been reported that nystatin can be loaded into liposomes and administered intravenously to reduce toxicity while retaining its antifungal activity [3][4][5][6]. At present, there are no drug therapies of nystatin that can be used to treat non-invasive nasal aspergillosis, except for nasal irrigation [7,8]. Moreover, using permeation enhancers, the intranasal delivery of nystatin can perhaps be used to achieve drug concentration in systemic circulation, thus can be applied in treatment of systemic fungal infections [9].…”

Mycotic Infection (Fungal Ball) of the Paranasal Sinuses: A Clinicopathological Observation

“…Fungal (mycotic) infections represent one of the four major microbiological subgroups (bacteria, viruses, parasites, fungi) of human diseases [1]. Although there are thousands of different types of fungi, there are only a small number of fungi being clinically relevant.…”