Fungal Sinusitis

4.5.1 Describe the classification of fungal sinusitis. Discuss the Bent and Kuhn criteria for allergic fungal sinusitis (AFS). Is AFS distinct from Eosinophilic Mucin Rhinosinusitis (EMRS)?

Chakrabarti A, Denning DW, Ferguson BJ, et al. Fungal Rhinosinusitis: A Categorization and Definitional Schema Addressing Current Controversies. Laryngoscope. 2009 Sep;119(9):1809-18. PMID:19544383

deShazo RD, Chapin K, Swain RE. Fungal Sinusitis.N Engl J Med. 1997 Jul 24;337(4):254-9. PMID:9227932

Bent JP, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg. 1994 Nov;111(5):580-8. PMID:7970796

Sok JC, Ferguson BJ. Differential diagnosis of eosinophilic chronic rhinosinusitis. Curr Allergy Asthma Rep. 2006 May;6(3):203-14. PMID:16579870

4.5.2 What organisms are responsible for non-invasive and invasive fungal sinusitis?

4.5.3 Describe radiographic findings of invasive and non-invasive fungal sinusitis.

Reddy CE, Gupta AK, Singh P, Mann SB. Imaging of granulomatous and chronic invasive fungal sinusitis: Comparison with allergic fungal sinusitis. Otolaryngol Head Neck Surg. 2010 Aug;143(2):294-300. PMID:20647138

Groppo ER, El-Sayed IH, Aiken AH, Glastonbury CM. Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 2011 Oct;137(10):1005-10. PMID:22006778

4.5.4 Review the CT and intra-operative endoscopic picture provided. What is the most likely diagnosis?

http://portal.entnet.org/images/COCLIA/2011-2012%20updates/COCLIA%20Media/Fungal%20Sinusitis/Fungal%20Sinusitis-Q4.jpg

4.5.5 How is allergic fungal sinusitis treated? Is medical management effective? What is the role of antifungal therapy in chronic rhinosinusitis? 

Marple B, Newcomer M, Schwade N, Mabry R. Natural history of allergic fungal rhinosinusitis: a 4- to 10-year follow-up. Otolaryngol Head Neck Surg. 2002 Nov;127(5):361-6. PMID:12447228

Sacks PL, Harvey RJ, Rimmer J, et al. Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis. Cochrane Database Syst Rev. 2011 Aug 10;(8):CD008263. PMID:21833965

4.5.6 Is there a role for immunotherapy in treating allergic fungal sinusitis?

Greenhaw B, deShazo RD, Arnold J and Wright L. Fungal immunotherapy in patients with allergic fungal sinusitis. Ann Allergy Asthma Immunol. 2011 Nov;107(5):432-do~/images 10.1016/j.anai.2011.05.02Epub 2011 Jun 15. PMID:22018615

4.5.7 Review the low and high power histopathology images of sinonasal tissue provided here. What is the most likely diagnosis?

http://portal.entnet.org/images/COCLIA/2011-2012%20updates/COCLIA%20Media/Fungal%20Sinusitis/Fungal%20Sinusitis-Q7.jpg

4.5.8 Discuss risk factors, clinical presentation and management of invasive fungal sinusitis?

4.5.9 You are called to the ICU to evaluate a neutropenic patient for invasive fungal sinusitis. Review a systematic approach to the diagnosis and management of this problem.

DelGaudio JM, Clemson LA. An early detection protocol for invasive fungal sinusitis in neutropenic patients successfully reduces extent of disease at presentation and long term morbidity. Laryngoscope. 2009 Jan;119(1):180-3. PMID:19117301

4.5.10 Should frozen sections be routinely employed for early diagnosis of invasive fungal sinusitis?

Ghadiali MT, Deckard NA, et al. Frozen-section biopsy analysis for acute invasive fungal rhinosinusitis. Otolaryngol Head Neck Surg. 2007 May;136(5):714-9. PMID:17478203